Contact tracing protocols & forms

A checklist for optimizing contact tracing protocols and forms for teams standing up a contact tracing program

Checklist

1. Governance

• Establish governance structure and relevant government agencies' and organizations' roles in contact tracing.

  • Consider federal, state, county, and local agencies.

  • Consider potential roles for the private sector. To address the large number of COVID-19 cases in some areas, authorities are assembling many partners in contact tracing efforts, including from the private sector.

    • Private companies can provide specialized capabilities around the use of technology to support contact tracing.

    • Private healthcare organizations and employers can play an important role in contact tracing (and testing). For example, private health systems can commit to track patients and report positive tests.

    • Heath networks, academics, and affiliates can provide technical guidance and training.

    • The private sector could also have a role in supporting people in isolation and quarantine.

  • Contact tracing efforts must always comply with local regulations and guidelines of health authorities, given privacy and transmission risk concerns.

2. Legal authority over isolation and quarantine

• Determine whether and how isolation/quarantine orders can be mandated by law or remain voluntary:

  • Work with lawyers to understand which officials have the legal authority to impose mandatory quarantine or isolation and under what conditions. States and cities may have different approaches. Confirm which authority has jurisdiction to issue an order depending on where the case or contact is found, resides, or need to be isolated/quarantined.

  • If contact tracers lack authority to issue mandatory quarantine or isolation orders, there should be provisions to refer appropriate civil authorities to issue formal orders to cases and contacts who refuse voluntary requests.

  • Where isolation or quarantine guidelines can be mandated by law, establish protocols with processes and consequences if someone refuses to comply.

    • Jurisdictions should use supportive techniques that encourage people to stay at home and comply with isolation and quarantine. (See Self-Isolation and Self-Quarantine Enforcement and Compliance: Principles and Considerations for U.S. Contact Tracing Programs for more information)

      • If a person is found violating voluntary requests or mandatory orders, a stepwise procedure can be used that escalates social support to the person (for example: escalating from an SMS message to a phone call from health department staff to understand and troubleshoot issues that may be preventing that person from complying).

    • Forceful and punitive enforcement measures are not advised. If jurisdictions do use more coercive enforcement measures:

      • Measures should be applied equally across all sub-groups in the population and ensure that they are not biased or overused.

      • There should be clear communications about how measures are monitored and enforced.

      • Measures should be proportionate to the offense and the least restrictive necessary to ensure compliance.

    • Include processes for people to appeal mandatory quarantine and isolation orders.

3. Cases for interview and contact elicitation

• 3.a Interview and elicit contacts on all confirmed and probable cases. If public health resources are limited, prioritize confirmed cases. (See CDC's Prioritizing Case Investigations and Contact Tracing for COVID-19 in High Burden Jurisdictions)

  • See Measures to Improve COVID-19 Response: End-to-End Quality Improvement of COVID-19 Testing, Case Investigation and Contact Tracing
  • See CDC guidance on Case Investigation Hierarchy
  • See CDC's Key Information to Collect During a Case Interview
  • See CDC's Talking with the Patient – A Case Investigator’s Guide to COVID-19
  • See Tips to Improve COVID-19 Control Through Better Case and Contact Follow-up
  • See Draft case interview and contact elicitation worksheet

• 3.b Define how cases will be reported to the health department for contact tracing in a manner that minimizes time from diagnosis to identification; set targets for timeliness, e.g. percent reported within 24 hours: (See Case Reporting for more information)

  • Positive laboratory test result (hospital clinical laboratory, commercial laboratory, public health laboratory)

  • Medical care provider referral of probable case pending laboratory confirmation

  • Home testing (pending confirmation by public or commercial laboratory)

4. Staffing and workforce strategy

• Identify staffing/workforce strategy, within public health department or outsourced and managed by public health department. (See CDC COVID-19 Sample Training Plans, Guidance, and Resources; See Public Health Workforce for more information.)

5. Technology-enabled processes

• 5.a Determine if contact tracing processes will be supported by a digital app; integrate the app into the disease surveillance system workflow. (See Technology checklist for more information.)

  • Data security and data privacy protections need to be built into all technologies and processes.

• 5.b Identify which points in the contact tracing workflow can be efficiently automated and which workflows will be conducted by staff:

  • Identification of case and notification to public health department

  • Searching online databases for address, phone number, and other information for a case when not available with a case report

  • Notifying case of diagnosis

  • Eliciting contacts from a case (including importing contact information via app)

  • Notifying contacts of potential exposure

  • Daily symptom monitoring of cases and contacts

  • Preferred method of daily monitoring (SMS, phone, e-mail)

  • Method contacts and cases can use to alert health departments of social service needs

6. Contact tracing protocols

• 6.a Develop contact tracing protocols.

  • Determine if contacts will be prioritized for follow-up, including when outreach will be automated vs. done in-person.

    • Ideally, health departments should collect information on all close contacts. Those that do not have the capacity to monitor and test all contacts promptly can use a risk prioritization guide. (See CDC guidance on Close Contact Evaluation and Monitoring Hierarchy)
    • For suggestions on identifying and mitigating bottlenecks, see Measures to Improve COVID-19 Response: End-to-End Quality Improvement of COVID-19 Testing, Case Investigation and Contact Tracing.
  • Determine if contacts will be notified by contact tracers or if cases will be asked to notify their own contacts directly.

  • Determine structure for reaching household contacts; for example, in some jurisdictions, it may be allowable to have one point of contact per household vs treating each household member as a separate contact.

  • Identify whether and how contacts will be monitored for quarantine compliance.

  • Determine how and when to test contacts for COVID-19 infection.

    • As testing availability permits, test all contacts immediately after notification, and again two to three days before release from quarantine (or if/when symptoms begin).

    • Determine how and when testing will be supported, including transportation or escort if needed.

    • Determine how to guarantee contact received test.

  • Testing is recommended for all close contacts. Determine when to trigger clinical consultation if contacts develop symptoms.

    • Monitor contacts for symptoms for up to 14 days after exposure. See CDC guidance on options to reduce quarantine time for contacts.
    • Determine if contacts will be actively monitored or will be asked to self-monitor.

    • If contact develops symptoms, instruct them to immediately seek clinical consultation (from regular provider or telemedicine services, as relevant)

    • See CDC guidance on when to seek medical attention.

• 6.b Define contact tracing procedure by setting.

  • Include information on translation, language lines, and contacts with communication impairments

  • 6.b.1 For mass gatherings, e.g. public transportation, concerts, worship services, weddings, funerals:

    • Develop health department protocols that trigger epidemiology field investigation.

    • Trigger broadcasting/public messaging to reach all potentially exposed contacts.

  • 6.b.2 For congregate settings, e.g. schools, homeless shelters, jails, prisons, group homes, workplaces, crowded multi-generational housing:

    • Develop health department protocols that trigger epidemiology field investigation.

      • Work with field epidemiology team and specialty staff to assess facilities’ infection control policies and procedures in collaboration with occupational health.

      • Elevate to enhanced in-person contact tracing procedures.

      • Collaborate with setting leadership to identify and notify all potentially exposed contacts.

  • 6.b.3 For facilities that deliver health care, e.g. hospitals, nursing homes, long-term care facilities, rehabilitation facilities, assisted living facilities, personal care homes, memory care, inpatient hospice facilities, methadone clinics, inpatient drug treatment facilities:

    • Develop public health department protocols that trigger epidemiology field investigation.

      • Work with field epidemiology team and specialty staff to assess facilities’ infection control policies and procedures in collaboration with occupational health.

    • Assume all facility residents and staff are contacts.

    • Sort and separate populations by: probable and confirmed cases; infected and contagious but asymptomatic or pre-symptomatic; not infected but at-risk.

    • Identify outside visitors and refer to routine contact tracing.

• 6.c Determine criteria for other triggers to refer to public health department protocols, e.g. disease clusters, cases and contacts with complex or extraordinary needs.

7. Confidentiality protocols

• Identify and document protocols for maintaining confidentiality during contact tracing, e.g., any requirements for storage of notes and data, and special considerations when conducting contact tracing from home. Follow HIPAA regulations.

8. Notification and communication protocols

• Identify which communication with contacts can be passive only (e.g. by web, email, text, or app interface), or, if resources allow, if all contacts will receive a phone call.

  • Determine protocols for cases and contacts who do not respond to texts or phone calls (by risk level). Try alternative methods of locating and communicating with cases and contacts, such as Facebook Messenger (Using Facebook to Help Locate People With or At Risk for COVID-19).
  • Consider campaigns to ask people to answer their phones and to engage honestly with contact tracers.

  • Establish expected number of contact attempts and if/when in-person outreach to cases and contacts will be attempted, with safety protocols in place (CDC guidance).
  • Identify any other situations in which an in-person home visit may be required.

  • Determine protocol for in-person visits and incorporate PPE considerations for in-person communications (CDC guidance).

9. Cross-jurisdictional protocol

• Determine protocol for locating and notifying contacts outside of the jurisdiction in cooperation with the jurisdiction where the contact resides.

10. Ports of entry protocol

• Determine protocol for testing and tracing cases at ports of entry.

  • If border agents identify a case, identify which jurisdiction will be responsible for care and tracing.

11. Social support protocol

• Define wrap-around services to support individuals in isolation and quarantine and determine eligibility criteria for the provision of wrap-around services. (See Social Supports for more information)

  • What criteria are used to determine eligibility?

  • Who assesses for eligibility, e.g. link to Department of Human Services to conduct?

  • What is the process for applying, approving, and connecting a person to services?

  • Warmline for post-quarantine issues

12. Out-of-home isolation

• 12.a Determine which cases will be offered isolation out of home, and if any will be mandated.

• 12.b Determine which contacts will be offered quarantine out of home, and if any will be mandated.

13. Telemedicine protocols

• Arrange clinical linkage including telemedicine support. (See Clinical Consult for more information)

Implementation Tools

• CDC: Resources for Case Investigations and Contact Tracing
• CDC: Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing
• CDC: Health Departments: Interim Guidance on Developing a COVID-19 Case Investigation & Contact Tracing Plan
• CDC: Contact Tracing Explanation and Resources
• COVID-19 contact tracing steps
• National Academy for State Health Policy: State Approaches to Contact Tracing during the COVID-19 Pandemic
• Measures to Improve COVID-19 Response: End-to-End Quality Improvement of COVID-19 Testing, Case Investigation and Contact Tracing
• Tips to Improve COVID-19 Control Through Better Case and Contact Follow-up
• Using Facebook to Help Locate People With or At Risk for COVID-19
• Draft contact tracing protocols for mass gatherings

  • Restaurants
  • Bars, pubs, and clubs
  • Club and organization meetings
  • Funerals
  • Weddings
  • Performance group meetings and rehearsals
  • Public meetings
  • Private events
  • Worship services
• Self-Isolation and Self-Quarantine Enforcement and Compliance: Principles and Considerations for U.S. Contact Tracing Programs
• Samples forms and protocols

  • CDC: Human Infection with 2019 Novel Coronavirus - Case Report Form
  • CDC: Key Information to Collect During a Case Interview
  • CDC: Talking with the Patient – A Case Investigator’s Guide to COVID-19
  • Draft case interview and contact elicitation worksheet
  • CDC: Notification of Exposure: A Contact Tracer's Guide for COVID-19
  • CDC: Self-Isolation and Self-Quarantine Home Assessment Checklist
  • CDC: Sample Daily Temperature/Symptom Log for Close Contacts
  • Draft contact monitoring form
  • Using Facebook to Help Locate People With or At Risk for COVID-19
• Sample scripts

  • Massachusetts Community Tracing Collaborative:

    • Contact tracing scripts
    • Case Investigator script
    • Monitoring contacts in quarantine script
    • Monitoring cases in isolation script
    • Voicemail Script
    • Contact Tracing Script, Navajo Nation
  • New York State Department of Health: Case interview script
  • New York State Department of Health: Contact interview script
  • New York State Department of Health: Contact monitoring script
• Call protocols

  • Unanswered Calls Protocol
  • Declining to Speak with Tracers Protocol
  • Invalid or Missing Phone Number
  • Declining to Provide Contacts Protocol
  • Employee Letter for Cases & Contacts
  • Best Practices towards Maximizing Connect Rate
  • Settings with Multiple Close Contacts
  • Isolation and Quarantine "What If" Protocol

LIVING DOCUMENT This playbook is a dynamic, "living" document. Global knowledge pertaining to COVID-19 is rapidly evolving. Feedback and suggestions can be sent to [e-mail].