Contract Tracing : Part of a Multi-pronged Approach to Fight the COVID-19 Pandemic. This document highlights basic principles of contact tracing to stop COVID-19 transmission; detailed guidance for health departments and potential contact tracers is forthcoming.

1. 316704A April 29, 2020 8:30 AM
cdc.gov/coronavirus
Thisdocumenthighlightsbasicprinciplesofcontact
tracingtostopCOVID-19transmission;detailedguidancefor
healthdepartmentsandpotentialcontacttracersisforthcoming.
Contacttracing,acorediseasecontrolmeasureemployedbylocal
andstatehealthdepartmentpersonnelfordecades,isakeystrategy
forpreventingfurtherspreadofCOVID-19.Immediateactionisneeded.
Communitiesmustscaleupandtrainalargecontacttracerworkforce
andworkcollaborativelyacrosspublicandprivateagenciestostopthe
transmissionofCOVID-19.
Certaincoreprinciplesofcontacttracingmustalwaysbeadheredto:
• Contacttracingispartoftheprocessofsupportingpatientswithsuspectedor
confirmedinfection.
• Incontacttracing,publichealthstaffworkwithapatienttohelpthemrecall
everyonewithwhomtheyhavehadclosecontactduringthetimeframewhile
theymayhavebeeninfectious.
• Publichealthstaffthenwarntheseexposedindividuals(contacts)oftheir
potentialexposureasrapidlyandsensitivelyaspossible.
• Toprotectpatientprivacy,contactsareonlyinformedthattheymayhavebeen
exposedtoapatientwiththeinfection.Theyarenottoldtheidentityofthepatient
whomayhaveexposedthem.
• Contactsareprovidedwitheducation,information,andsupporttounderstand
theirrisk,whattheyshoulddotoseparatethemselvesfromotherswhoarenot
exposed,monitorthemselvesforillness,andthepossibilitythattheycouldspread
theinfectiontootherseveniftheythemselvesdonotfeelill.
• Contactsareencouragedtostayhomeandmaintainsocialdistancefromothers
(atleast6feet)until14daysaftertheirlastexposure,incasetheyalsobecomeill.
Theyshouldmonitorthemselvesbycheckingtheirtemperaturetwicedailyand
watchingforcoughorshortnessofbreath.Totheextentpossible,publichealth
staffshouldcheckinwithcontactstomakesuretheyareself-monitoringand
havenotdevelopedsymptoms.Contactswhodevelopsymptomsshouldpromptly
isolatethemselvesandnotifypublichealthstaff.Theyshouldbepromptly
evaluatedforinfectionandfortheneedformedicalcare.
Contacttracingisaspecializedskill.
Tobedoneeffectively,itrequirespeoplewiththetraining,supervision,andaccesstosocial
andmedicalsupportforpatientsandcontacts.Requisiteknowledgeandskillsforcontact
tracersinclude,butarenotlimitedto:
• Anunderstandingofpatientconfidentiality,includingtheabilitytoconduct
interviewswithoutviolatingconfidentiality(e.g.,tothosewhomightoverhear
theirconversations)
• Understandingofthemedicaltermsandprinciplesofexposure,infection,
infectiousperiod,potentiallyinfectiousinteractions,symptomsofdisease,
pre-symptomaticandasymptomaticinfection
• Excellentandsensitiveinterpersonal,culturalsensitivity,andinterviewingskills
suchthattheycanbuildandmaintaintrustwithpatientsandcontacts
• Basicskillsofcrisiscounseling,andtheabilitytoconfidentlyreferpatientsand
contactsforfurthercareifneeded
• Resourcefulnessinlocatingpatientsandcontactswhomaybedifficulttoreachor
reluctanttoengageinconversation
• Understandingofwhentoreferindividualsorsituationstomedical,social,or
supervisoryresources
• Culturalcompetencyappropriatetothelocalcommunity
COVID-19
CONTACTTRACING
Part of a Multipronged Approach to Fight the COVID-19 Pandemic
COVID-19 ContactTracing for Health Departments

2. Contacttracingispartoftheprocessofsupportingpatientsand
warningcontactsofexposureinordertostopchainsoftransmission.
GiventhemagnitudeofCOVID-19casesandplanstoeventuallyrelaxmitigationefforts
suchasstayathomeordersandsocialdistancing,communitiesneedalargenumber
oftrainedcontacttracers.Thesecontacttracersneedtoquicklylocateandtalkwiththe
patients,assistinarrangingforpatientstoisolatethemselves,andworkwithpatientsto
identifypeoplewithwhomthepatientshavebeeninclosecontactsothecontacttracer
canlocatethem.Theactualnumberofstaffneededislargeandvariesdependingona
numberoffactorsincludingbutnotlimitedto:
• Thedailynumberofcases
• Thenumberofcontactsidentified
• Howquicklypatientsareisolated,andcontactsarenotifiedandadvisedtostay
home,self-monitor,andmaintainsocialdistancefromothers
The time to start
building the trained
workforce is now.
Timeisoftheessence.
Identifyingcontactsandensuringtheydonotinteractwithothersiscriticaltoprotect
communitiesfromfurtherspread.Ifcommunitiesareunabletoeffectivelyisolatepatients
andensurecontactscanseparatethemselvesfromothers,rapidcommunityspreadof
COVID-19islikelytoincreasetothepointthatstrictmitigationstrategieswillagainbe
neededtocontainthevirus.
Contacttracersneedto:
• ImmediatelyidentifyandinterviewpeoplewithSARSCoV-2infectionsand
COVID-19(i.e.,disease)
• Supportisolationofthosewhoareinfected
• Warncontactsoftheirexposure,assesstheirsymptomsandrisk,andprovide
instructionsfornextsteps
• Linkthosewithsymptomstotestingandcare
Basedonourcurrentknowledge,aclosecontactissomeonewhowaswithin6feet
ofaninfectedpersonforatleast15minutesstartingfrom48hoursbeforeillness
onsetuntilthetimethepatientisisolated.Theyshouldstayhome,maintainsocial
distancing,andself-monitoruntil14daysfromthelastdateofexposure.
Contactinvestigationincarefacilities,othercongregateliving
settingsandhouseholdswithmanypeoplelivinginonehouse
isapriority.
ContactinvestigationofpatientswithCOVID-19potentiallyexposedatworkand
patientsinhealthcarefacilities, congregatelivingsettingsorhousingwithmanypeople
iscomplex.Appropriateengagementwithinfectioncontrolandoccupationalhealth
programsisrecommended.Prioritysettingsinclude:
• Healthcarefacilitiesincludinglong-termcarefacilities
• Grouphome/board
• Homelessshelters
• Federal,stateandlocalcorrectionalfacilities
• Crowded,multigenerationalhousing
Inadditiontohealthcareworkers,itisimportanttoassessinteractionsbetweenresidents
andallstaff,includingbutnotlimitedtoactivitycoordinators,foodservicestaff,and
sanitationmanagement. Transitionalcasemanagementplansshouldbeputinplacefor
patientsinisolationandcontactswhoareseparatedformonitoring.Managementplans
shouldalsobecreatedfortransitioningfromonesettingtoanother,suchastransitions
fromhospitalstoacuteorlong-termcarefacilitiesorhomeisolation,orfromprisonand
jailtoparoleandprobation.
CONTACTTRACING Part of a Multipronged Approach to Fight the COVID-19 Pandemic
COVID-19 ContactTracing for Health Departments

3. Socialservicesandhousingwillbeneededforcontactsunableto
separatethemselvesfromothersintheircurrentlivingsituation.
Separatingcontactsfrompeoplewhoarenotexposediscriticaltothesuccessofany
contacttracingeffortandrequiressocialsupportsforindividualcomplianceandmedical
monitoring.Firstandforemostistheassessmentofanindividual’sabilitytostayinhome
andmaintainsocialdistancefromothers,asafeenvironmentthatprovidesthenecessary
supports(privateroomandbathroom,adequatefoodandwater,andaccesstomedication)
andtheabilitytopracticeadequateinfectioncontrol.ForaportionoftheU.S.population
thiswillbeachallenge,particularlyforsomeofthemostvulnerablepopulations.
Supportservicesforconsiderationincludebutmaynotbelimitedtohousing,food,
medicine,andeconomicsupports.Forcontactswithoutaprimarycareprovider,linkage
toclinicalcaremaybeneeded.Supportformedicalmonitoringincludespatientcare
packages(e.g.,thermometers,sanitizers,mask,gloves)andtechnologicalsupportsfor
medicalmonitoring(e.g.,mobilephoneapps). Ifpossible,contactsshouldbeaskedto
voluntarilystayhome,monitorthemselves,andmaintainsocialdistancingfromothers.
However,healthdepartmentshavetheauthoritytoissuelegalordersofquarantine,should
thesituationwarrantthatmeasure.
Communicationwiththepubliciscrucial.
Engagementofthepublicwithcontacttracersmustbe
widelyacceptedinordertoprotectfriends,family,and
communitymembersfromfuturepotentialinfections.
Keypublicofficialsandcommunityleaderswillneedtobe
engagedandsupportiveofcontacttracingefforts.Consider
reachingouttocommunityleadersaspartoftheneighborhood-levelcontacttracing
team.Tobesuccessful,acommunitywillneedpublicawareness,andunderstandingand
acceptanceofcontacttracingandtheneedforcontactstoseparatethemselvesfromothers
whoarenotexposed.Communitymembersneedtotakeresponsibilitytofollowthe
guidancefrompublichealthagencies.
Datamanagementandtechnologywillbeneeded.
Caseinvestigation,contacttracing,andcontactfollow-upandmonitoringwillneedtobe
linkedwithtimelytesting,clinicalservices,andagiledatamanagementsystemstofacilitate
real-timeelectronictransmissionoflaboratoryandcasedataforpublichealthaction.
Technologypartnersarekeyinthemodificationofexistingsystemsandthedevelopment
ofnewuser-friendlydatainterfacestomanagemultipledatastreamswithseamless
interoperability.Casemanagementtoolscanhelpautomatekeypiecesofthecontact
tracingprocess,makingtheoverallprocessmoreefficient.Ideally,datasystemswouldalso
includeautomatedreportstoaidinmonitoringprogressandoutcomesofcontacttracing.
Datasharingagreementsbetweenlocal,tribalandstate,andfederaljurisdictionsneedto
beestablishedoraugmentedtoensuretimelyandaccuratedatacollectionandsharing.
Theadoptionofemergingtechnologiesthatcanassistprivateandpublichealth
practitionerswithclientcommunication,medicalmonitoring,andstrategiestoamplify
contacttracingmaygreatlyhelpwithscalingupcontacttracingasneeded.
Ongoing monitoring and assessment of contact tracing efforts
will be needed.
Publichealthagenciesandtheirpartnerswillneedtomonitorsomekeycomponentsof
theirprogramstoimproveperformanceasneeded.Potentialmetricsroutinelyreviewed
couldincludethefollowingprocessandoutcomemeasures:
• Caseinterviewing:Timetointerviewfromsymptomonsetandfromdiagnosis;
proportioninterviewed;mediannumberofcontactselicited;proportionwithno
contactselicited.
• Contactnotification:Proportionofcontactsnotified;timefromfirstpotential
exposuretonotification.
• Contactfollow-up:Dailyproportionofcontactswhosestatusisevaluated;
proportionofcontactswithsymptomsevaluatedwithin24hoursofonsetof
symptoms;proportionofcontactswhocompletetheirfullself-monitoringperiod
• Contacttracingefficacy:PercentofnewCOVID-19casesarisingamongcontacts
duringself-monitoringperiod.
CONTACTTRACING Part of a Multipronged Approach to Fight the COVID-19 Pandemic
COVID-19 ContactTracing for Health Departments