State/territory health agency survey results provide insight into how COVID-19 case investigation and contact tracing programs have developed and evolved in response to changing conditions pandemic.
In our article from Journal of Public Health Management and Practice, “COVID-19 Case Investigation and Contact Tracing Programs and Practice: Snapshots from the Field”, we sought to characterize how case investigation and contact tracing (CI/CT) programs developed and adapted over the course of of the first year of the pandemic. In the early stages of the COVID-19 response, our understanding of how state and territory health agencies were rising up and implementing CI/CT programs was often based on anecdotal evidence, reports in the media and online news analysis. Our goals were to systematically capture the state of COVID-19 IC/CT programs and practices in the United States, and to inform the national discourse on COVID-19 contact tracing with the “ground truth” of state and territory health agencies.
To that end, the Association of State and Territorial Health Officials (ASTHO) administered two quick queries to state and territory health agencies in November 2020 and April 2021. We received responses from 27 and 24 jurisdictions, respectively, with 16 jurisdictions participating in both surveys. . While the results of these short surveys should not be overgeneralized, these snapshots from the field have provided valuable insights into how CI/CT programs have responded to the evolving nature of the COVID-19 pandemic.
Workforce Development in a Response to an Evolving Public Health Pandemic
Our quick queries captured CI/CT workforce changes over time, such as agency-reported staff capacity. In November 2020, the majority (70%) of responding health agencies indicated that they did not have enough case investigators and contact tracers to meet their needs. Notably, jurisdictions during this period were experiencing a significant increase in COVID-19 cases, which increased the workload of IC/CT programs and likely impacted their reporting of staff capacity. Five months later, however, a majority (63%) of respondents indicated that they did have enough case investigators and contact tracers to meet their demands. What drove these changes in staff capacity? A variety of factors may have played a role, including changing rates of disease transmission and process adaptations that streamlined programmatic efforts, such as prioritization of IC/CTs and case-based reporting.
Our results highlight that the size of the CI/CT workforce itself was also changing. In April 2021, 42% of respondents said they were planning or in the process of downsizing. The decline in the number of cases and the increase in immunity (through vaccination or infection) may have influenced this change. Respondents noted, however, that staffing needs change over time due to outbreaks of disease transmission, viral variants and other events, such as the reopening of schools. As the pandemic continues to evolve – and IC/CT COVID-19 staff are integrated with other communicable disease programs – flexible staffing plans that respond to changes in transmission of the COVID-19 disease and the local context will be essential.
The dynamic and flexible nature of the CI/CT workforce coupled with its experience in engaging community members makes this workforce uniquely qualified to continue building and strengthening relationships between public health government, community organizations and individual community members. We believe these relationships will be the foundation upon which the remaining COVID-19 response and all future infectious disease outbreak response efforts will be built.
Challenges impacting COVID-19 contact tracing programs
Our quick queries showed that CI/CT program challenges have changed over time. However, three of the main challenges – public acceptance and trust, technology and data systems, and long-term/sustainable funding – were consistent across the November 2020 and April 2021 surveys. Qualitative responses presented in our article describe the impact of these challenges on the implementation of the COVID-19 CI/CT program:
- Public Acceptance and Trust: Respondents highlighted how concerns about sharing personal health information, frustrations with isolation and quarantine guidelines, and pandemic fatigue have impacted the public’s willingness to engage with CI/ CT.
- Technology and data systems: Respondents noted that interoperability issues have impacted efforts to integrate CI/CT datasets with existing public health surveillance systems. Modifying or adopting new data systems to support COVID-19 CI/CT programs has also presented challenges.
- Long-term/sustainable funding: Respondents highlighted the need for sustained funding to support workforce development efforts and maintain COVID-19 CI/CT program activities over the long term.
While we have seen progress in each of these areas, the persistence of these challenges in our November 2020 and April 2021 surveys suggests that they warrant continued exploration and action by public health officials. As the public health system transitions to sustained management of COVID-19, strong relationships between public health organizations and the communities they serve will be critical to advancing public health measures to reduce the transmission of COVID-19. COVID-19 and to increase vaccination. The CI/CT workforce is well positioned to support these efforts, but to do so effectively we must explore new ways to engage and build trust with the community, modernize the digital tools and technologies available to support this workforce and ensure that CI/CT programs are sustainably funded.
For more information on ASTHO’s Quick Requests and our findings, read our report on the practice in the July 2022 issue of Journal of Public Health Management and Practice.
Elizabeth Ruebush is the Senior Director of Public Health Data Modernization at ASTHO and previously served as the organization’s Technical Lead for Infectious Disease Outbreak Response and Recovery. She earned a Masters in Public Health from Johns Hopkins University and a Bachelor of Arts from Williams College.
Paris Harper Hardy is director of assessment and evaluation at ASTHO. Her work focuses on supporting ASTHO’s programmatic teams to coordinate and improve data collection activities with health agencies. A native of Philadelphia, Paris has lived throughout the East Coast, earning degrees from Cornell University, the University of Georgia, and Emory University.
Meredith Allen is the vice president of health security at ASTHO, focusing for the past two years on the response of state health agencies to COVID-19. Also a Philadelphia native, Meredith previously worked in local public health as an epidemiologist and is a graduate of the University of Delaware, Harvard University and Drexel University.