# Contact Tracing Playbook Resources to help you scale contact tracing in your community We learn more about contact tracing for COVID-19 every day. This playbook distills contact tracing guidance and resources from the Center for Disease Control (CDC) and World Health Organization (WHO), as well as from governments like Massachusetts, New York, and North Dakota, who have already begun their contact tracing efforts. We link to resources, frameworks, and templates to help you consider how to implement basic contact tracing in your community. While we include guidance for high-risk communities (e.g., correctional, healthcare, or long-term care) when we're aware of it, not all guidance shared here may be appropriate for those populations, and it is likely support for those groups will beyond additional investment beyond what we recommend here. {% hint style="info" %} This is a **live document** and will be changing as we learn more. Feel free to submit pull requests or [edit on github](https://github.com/harperreed/contact-tracing-playbook). {% endhint %} This playbook was written in collaboration with: * [Geometer](https://geometer.io) * [U.S. Digital Response](http://usdigitalresponse.org) * [Lots of volunteers](/about/authors) Contact tracing is a core public health function, and the techniques and strategies for contact tracing are not new. The US government’s [Center for Disease Control (CDC)](https://www.cdc.gov/) and the broader public health community [have long depended on contact tracing to](https://www.cdc.gov/eis/field-epi-manual/index.html) [help control highly communicable diseases](https://www.cdc.gov/eis/field-epi-manual/index.html) like HIV/AIDS, ebola, tuberculosis, and syphilis. In the battle against COVID-19, contact tracing is [one of five essential and interdependent public health strategies](https://www.newyorker.com/science/medical-dispatch/its-not-too-late-to-go-on-offense-against-the-coronavirus) (along with social distancing, testing, isolation & quarantine, and treatment) that will enable us to safely reopen society while continuing to flatten the curve. While the techniques and strategies for contact tracing are not new, COVID-19's unprecedented scale and speed require we implement time-tested contact tracing strategies in new ways, using new tools and technologies. This will require substantial investments in time, resources, and budget, as well as continued collaboration across federal, state, local, tribal, and territorial health departments. {% content-ref url="/pages/-M6Y8DlVYIHWgc7lEIhP" %} [What is contact tracing](/what) {% endcontent-ref %} {% hint style="success" %} Have questions? [Get in touch with USDR](/about/have-questions-get-in-touch-with-usdr) {% endhint %} # What is contact tracing The basic steps of contact tracing for COVID-19 Contact tracing involves identifying people who may have come into contact ("contacts") with an infected person (“case”) and then subsequent monitoring of said contacts’ health. We outline below how the three core steps of contact tracing can be used to contain COVID-19 outbreaks. Most federal, state, and local public health departments already do contact tracing for other communicable diseases, meaning your jurisdiction likely has dedicated contact tracing infrastructure and budget. Elsewhere in this playbook we’ll address how to think about workforce expansion and building on existing infrastructure. {% content-ref url="/pages/-M6YIjPtsU7NAP3SWzuD" %} [Three core steps](/what/three-core-steps) {% endcontent-ref %} {% content-ref url="/pages/-M6YBwmvu1scdvJUjn\_P" %} [Have questions? Get in touch with USDR](/about/have-questions-get-in-touch-with-usdr) {% endcontent-ref %} # Three core steps The basics of contact monitoring for COVID-19 ![CDC training algorithm for Ebola contact tracing](https://2141157483-files.gitbook.io/~/files/v0/b/gitbook-legacy-files/o/assets%2F-M6VOgDqF_xEySuiQTyy%2F-M6bPBz5a62AoN-9MYLO%2F-M6bPo4xwhGQJxJxak2V%2Ftraining_algorithm.jpg?alt=media\&token=0215709d-3c95-4ba0-a7f3-21696dfdb0e4) ### 1. Contact the confirmed case (“Case identification”) 1. Interview the confirmed case (i.e., person diagnosed with COVID-19), likely by one-on-one telephone interview, and determine symptoms, date of exposure, infectious period, and high-risk conditions. 2. Provide the case with education on COVID-19. 3. Provide the case with instructions on isolation and connect to any additional support needed (e.g., nutrition, social services, housing). 4. Elicit all possible exposed contacts during infectious period. ### 2. Notify, interview, and quarantine contacts (“Contact location and notification”) 1. Identify contacts if necessary and locate contact information. 2. Engage contacts to notify them of their exposure. 3. Provide education on COVID-19. 4. Provide contact with recommendation/referral for clinical evaluation and appropriate testing if symptoms are present. If test results are positive, the person would require full case investigation in order to elicit their contacts. 5. Provide instructions on quarantine and connect to any additional support needed (e.g., nutrition, social services, housing). ### 3. 14-day contact monitoring (“Contact follow-up”) 1. Ensure daily temperature checks and symptom monitoring for 14 days since last contact with the confirmed case. 2. Ensure continued quarantine of contact for 14 days since last contact to the confirmed case. 3. Provide contact with recommendation/referral for clinical evaluation and appropriate testing if symptoms develop. If test results are positive, the person would require full case investigation in order to elicit their contacts. {% content-ref url="/pages/-M6Y8DlW7DLTd\_5CuQZe" %} [Who is responsible](/what/who-is-responsible) {% endcontent-ref %} # Who is responsible What jurisdiction should own contact tracing? In many cases, local departments of health will implement contact tracing in partnership with state budget and infrastructure. Especially large or dense urban centers, however, as well as local jurisdictions with unique circumstances, may execute contact tracing independently of--but in communication with--state partners. To remain capable of responding quickly to this crisis, The National Association of County and City Health Officials (NACCHO) [encourages governments to remain flexible regarding how funding and resources are allocated between jurisdictions](https://www.naccho.org/uploads/full-width-images/Contact-Tracing-Statement-4-16-2020.pdf). Government partners may want to outline how responsibilities will be distributed, considering, for example, whether workflows like contact tracer staffing or data management should occur at the state or local level. They should also establish whether partners can selectively or entirely “opt-out” of portions of any program while still receiving services and/or funding. We recommend states charter task forces to review these options before stepping down stay-at-home orders. Key stakeholders to include are local and state public health officials, technology directors, data interoperability managers, and legal officials. {% content-ref url="/pages/-M6YUmAYM4bS8GWCvb1D" %} [Manual vs. digital](/what/manual-vs.-digital) {% endcontent-ref %} # Manual vs. digital Why not just do it with an app? [Exposure notification (also known as digital contact tracing)](< https://medium.com/u-s-digital-response/understanding-digital-contact-tracing-limitations-implications-and-recommendations-fb54d23f586c>) is a new and largely untested automated approach to contact tracing. Exposure notification uses information shared via mobile device to notify people who might have had contact with someone infected. While manual contact tracing can take time due to the need for individual interviews, exposure notification makes it possible to identify hundreds or thousands of at-risk persons almost immediately. This is usually done by logging “close contact” events between Bluetooth-enabled mobile phones. If someone is diagnosed, their log of contact events could be used to alert anyone physically near them within the infectious period. Because most applications so far only notify contacts--without collecting information about symptoms, providing isolation/quarantine information and support, and following up over the recommended two-week period--manual contact tracers will still be required. For that reason, Bluetooth-enabled apps are better described as [“exposure notification”](https://harper.blog/2020/04/22/digital-contact-tracing-and-alerting-vs-exposure-alerting/) than "digital contact tracing". ## Advantages of exposure notification * Immediate, once automated * Based on objective distancing/Bluetooth data * Removes notification burden from human workforce, empowering staff to focus on neediest cases ## Challenges of exposure notification #### Adoption remains low According to research, [60–80 percent adoption](https://ethics.harvard.edu/files/center-for-ethics/files/white_paper_5_outpacing_the_virus_final.pdf) is required to make exposure notifications effective. This level of adoption would require massive, population-level awareness, trust, and engagement of the sort few apps or features on the market enjoy. For reference, Android’s latest version, “Pie”, took a [year to achieve 20% adoption](https://venturebeat.com/2019/10/23/android-pie-passes-20-adoption-after-12-months/). However, iOS has [60% market share](https://gs.statcounter.com/os-market-share/mobile/united-states-of-america) and a faster adoption cycle. Here are the principles that are critical for apps or settings to achieve adoption: * **Data privacy.** People are understandably wary of sharing private health and location data with corporations and the government. To address this, solutions should implement solutions like [contact event numbers and decentralized local storage](https://tcn-coalition.org/). This [unified set of data and privacy guidelines for contact tracing and exposure notification](https://contacttracingrights.org/) was created to educate developers and inform end-users of the data rights they should expect any effective solution to respect. * **Interoperability.** Apps should be capable and willing to share data formats to enable data to be aggregated for broader public health use. Apple and Google allow one app per jurisdiction (state, city, or county) to deploy exposure notifications APIs, meaning there could be dozens of apps available. No single app is likely to reach 60%+ adoption, but all apps working together have a much better chance. Developers should use openly published protocols and work collaboratively to ensure their solutions are verifiable and interoperable. * **Trustworthy.** Brand matters. If an app is nefarious or perceived as such, it could create broad public distrust and lowering likelihood that *any* exposure notification technology gets adopted. #### Unlikely to improve conditions in the neediest areas and populations Digital contact tracing solutions are built by and for smartphone users. However, given that COVID-19 disproportionately affects the elderly and underprivileged, the impact these apps can have will be limited. For example, [19% of the US doesn’t have a smartphone](https://www.pewresearch.org/internet/fact-sheet/mobile/). [Rural areas have 71% smartphone adoption](https://www.pewresearch.org/internet/fact-sheet/mobile/) and [53% of those over the ages of 65 have a smartphone](https://www.pewresearch.org/internet/fact-sheet/mobile/). #### False positives Even with 100% adoption, opt-in, and Bluetooth enablement, there are still challenges with efficacy. A false positive occurs when a contact is notified who wasn't at meaningful risk of transmission. This can happen for a variety of reasons including: * The app isn’t aware there’s a wall between you and someone infected. * Not every contact is a transmission. False positives can hurt adoption due to distrust. For example, if someone chooses to quarantine, but doesn’t get sick, there’s a strong incentive to stop using it. Tests can alleviate this problem by limiting quarantines to those that are sick, but still create disincentive given the time, discomfort, and potential cost needed for the test. #### False negatives A false negative occurs when an app fails to register a transmission. These happen for a variety of reasons, including: * An infected person transmitted the virus without being in close contact (e.g., by touching the same surface). * Transmission occurred via someone who didn't have the app. * Bluetooth must always be on, your phone must always be in your pocket, and powered on. * For both exposure notifications and manual contact tracing ubiquitous, cheap, fast, and accurate testing is critical. Otherwise, false positives and quarantines will be significantly higher than needed. For exposure notifications, this means decreasing public trust and lower adoption. ## Summary In the long-term, digital contact tracing and exposure notification have the potential to streamline the contact tracing workflow, enabling the workforce to focus more on providing support to individuals in need. That said, given the challenges described above, there is no effective digital replacement for a manual contact tracing workforce. Governments should continue to aggressively ramp up manual contact tracing as an immediate solution. {% content-ref url="/pages/-M6YV5iWj\_wGSgWfcQIq" %} [Asymptomatic cases](/what/asymptomatic-cases) {% endcontent-ref %} # Asymptomatic cases How to approach cases and contacts with no symptoms [As many as 43% of COVID-19 cases may be asymptomatic](https://www.medrxiv.org/content/10.1101/2020.04.17.20053157v1). The protocol outlined above neither identify nor tests asymptomatic contacts. While all contacts are subject to a 14-day quarantine, untested asymptomatic cases will “slip through the cracks”, making it critical that contact tracing be implemented aggressively in response to *every* known and diagnosed case of COVID-19--regardless of whether the diagnosed case is experiencing symptoms. {% content-ref url="/pages/-M6Y8DlYayuBpZSq4tdO" %} [Contact tracing programs](/existing-solutions) {% endcontent-ref %} # Things to consider Under construction :) * Figure out your policy strategy around persons of interest definition, i.e. lab testing, confirmatory testing, CDC guidelines or your own case definitions, symptom checkers * Pin down your authoritative sources of case reports * Identify your existing data systems and sources for persons of interest; syndromic surveillance, health system case reports, community organization case reports * Pin down additional contact tracing criteria that aren’t tied to persons of interest at the population and geographic level, i.e. known and emerging hotspots, vulnerable and at-risk populations * Survey # Contact tracing programs What other governments have done so far Governments can learn from the COVID-19 contact tracing programs being scaled by federal, state, local, tribal, and territorial governments. We include those we're aware of here, and if we're missing information please [let us know](mailto:contact@usdigitalresponse.org). {% content-ref url="/pages/-M6Y8DlZZO6R6KtKSEZO" %} [Federal](/existing-solutions/federal) {% endcontent-ref %} {% content-ref url="/pages/-M6Y8Dl\_w\_urTm\_iJDyz" %} [States](/existing-solutions/states) {% endcontent-ref %} {% content-ref url="/pages/-M6Y8DlaOdpCLoj7kXqE" %} [City / County](/existing-solutions/city-county) {% endcontent-ref %} {% content-ref url="/pages/-M6YBwmvu1scdvJUjn\_P" %} [Have questions? Get in touch with USDR](/about/have-questions-get-in-touch-with-usdr) {% endcontent-ref %} # Federal The US is considering how to support contact tracing nationally In [a letter to congress](https://apps.npr.org/documents/document.html?id=6877567-Bipartisan-Public-Health-Leaders-Letter-on) on 5/27/2020, bipartisan health experts recommended congress spend $12b to hire 180,000 federal contract tracing workers over next 18 months. The Center for Disease Control has 500 staff to help state & local health departments and will allocate 650 more positions to do so. {% content-ref url="/pages/-M6Y8Dl\_w\_urTm\_iJDyz" %} [States](/existing-solutions/states) {% endcontent-ref %} # States States are beginning to scale their own programs **Massachusetts** Massachusetts established the country’s first state-wide contact tracing program, the [Community Tracing Collaboration (CTC)](https://www.mass.gov/lists/covid-19-contact-tracing-resources-and-information), in early April with a budget of $44m and a plan to hire more than 1,000 contact tracers ([job posting](https://jobs.crelate.com/portal/talentboost/job/3kyqki4zeqoyugdzsha5iynhce)) for the state’s 7 million residents. The CTC involves multiple state organizations, including the [Massachusetts Department of Public Health](https://www.mass.gov/orgs/department-of-public-health) [(MDPH)](https://www.mass.gov/orgs/department-of-public-health) and the [Commonwealth Health Insurance Connector Authority](https://www.mahealthconnector.org/) [(CHICA)](https://www.mahealthconnector.org/), along with public health organization [Partners in Health (PiH)](https://www.pih.org/) and consulting firm [Accenture](https://www.accenture.com/us-en). The CTC empowers the decentralized state’s 351 local health departments to execute contact tracing in every city and town in Massachusetts, and had spoken to over 5,000 residents by the close of April. [As outlined in the program’s brief](https://www.mass.gov/doc/community-tracing-collaborative-overview-presentation/download), the CTC distributes work across support organizations: * MDPH manages data, guides activities, and supports oversight * Including use of [Massachusetts Virtual Epidemiological Network (MAVEN)](https://www.mass.gov/doc/massachusetts-department-of-public-health-maven-infrastructure-overview/download) * PiH hires, trains, supervises staff, plus technical assistance * As of mid-April, the program has fielded over 15,000 applications for the 1,000 openings. * CHICA provides virtual support via call center (see [Phone scripts](https://www.mass.gov/doc/contact-tracing-scripts/download)) to contact cases and provides care resource management * [Buoy Health](https://www.buoyhealth.com/contact/) supports automated triage and referrals The CTC has outlined a [comprehensive media strategy](https://www.mass.gov/info-details/covid-19-community-tracing-collaborative-media-and-outreach-approach) to inform residents and increase engagement, including its [“just answer the call” campaign](https://www.mass.gov/doc/massachusetts-community-tracing-collaborative-flyer-for-media-and-outreach/download). Contact tracing staff are joined by 1700+ academic public health volunteers from the state’s colleges and universities who have been supporting the state’s contact tracing efforts. **North Dakota** North Dakota currently leads the country in contact tracing, with 352 trained contact tracers for its 762,000 residents. It is hiring for multiple roles related to data management and contact tracing program through its [Workforce Coordination Center](https://ndresponse.gov/covid-19-resources/get-involved-how-you-can-help). **North Carolina** North Carolina launched its own Community Tracing Collaborative and is hiring 500 people ([job posting](https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=e19abba7-a8ad-4c26-948f-cf26888754a7\&ccId=2714228523_1656&)). **Michigan** Michigan announced a plan to hire 3.5k volunteers for contact tracing as part of [a state-wide effort](http://michigan.gov/fightcovid19), and has since trained over 2k, but has since slowed efforts after it increased scrutiny around its contracts related to the effort. {% content-ref url="/pages/-M6Y8DlaOdpCLoj7kXqE" %} [City / County](/existing-solutions/city-county) {% endcontent-ref %} # City / County Dense urban areas are developing their own programs **San Francisco** San Francisco’s city-county Health Department has formed a task force in partnership with University of California, San Francisco (UCSF) to support its 883,305 residents. The SF Department of Public Health envisions a team of 150 medical students, city librarians, city attorneys. **New York City** The New York City Fund for Public Health is [currently hiring more than 1,000 contact tracers](https://1w20ju1nsz1k2xqrjx3ccsd1-wpengine.netdna-ssl.com/wp-content/uploads/sites/76/2020/04/CT-I.pdf), paying $57k with benefits. **St. Louis** Saint Louis County Department of Public Health is [hiring 100 contact tracers](https://www.governmentjobs.com/careers/stlouis/jobs/2770060/contact-tracer?page=1\&pagetype=jobOpportunitiesJobs). {% content-ref url="/pages/-M6Y8DlbfloVuvJ1L9Iu" %} [How to do contact tracing](/how-to-do-contact-tracing) {% endcontent-ref %} # How to do contact tracing What you'll need to consider as you get started {% content-ref url="/pages/-M6Y908a\_jEJFgKqjpVF" %} [Workforce expansion](/how-to-do-contact-tracing/workforce-expansion) {% endcontent-ref %} {% content-ref url="/pages/-M6Y9Bpi\_mRlu2787CJF" %} [Laboratory testing](/how-to-do-contact-tracing/laboratory-testing) {% endcontent-ref %} {% content-ref url="/pages/-M6Y9J37gewVg7-MSLU4" %} [Isolation and quarantine](/how-to-do-contact-tracing/isolation-and-quarantine) {% endcontent-ref %} {% content-ref url="/pages/-M6YA4vQbYd8mJrLlPW2" %} [Monitoring and evaluation](/how-to-do-contact-tracing/monitoring-and-evaluation) {% endcontent-ref %} {% content-ref url="/pages/-M6YA7uKULrTItKZeJE3" %} [Data management](/how-to-do-contact-tracing/data-management-systems) {% endcontent-ref %} {% content-ref url="/pages/-M6Y9juZKMIW1dz0U3XG" %} [Technology enablement](/how-to-do-contact-tracing/technology-enablement) {% endcontent-ref %} {% content-ref url="/pages/-M6Ykg3D890PtUecQrPq" %} [Review of vendors](/how-to-do-contact-tracing/review-of-vendors) {% endcontent-ref %} {% content-ref url="/pages/-M6YBwmvu1scdvJUjn\_P" %} [Have questions? Get in touch with USDR](/about/have-questions-get-in-touch-with-usdr) {% endcontent-ref %} # Workforce expansion Under construction :) While contact tracing is routinely performed to control STDs, TB, and other communicable diseases, local health departments have limited front-line workforce (e.g., epidemiologists, disease intervention staff, public health nurses) to support contact tracing at the scale and pace of COVID-19. The [CDC provides resources](https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/staffing.html) for training and supplementing existing staff for ongoing and surge support. ### Population-based estimates For contact tracing to be effective, every diagnosed case must be investigated, which means the contact tracing workforce must be capable of responding quickly even during surges. [Find the number of staff you’ll need](https://preventepidemics.org/coronavirus/resources/contact-tracing-staffing-calculator/) using this calculator provided by public health organization [Resolve to Save Lives](https://resolvetosavelives.org/), and review additional estimates below. | **Source of estimate** | **Estimated number of contact tracing staff per 100k population** | | -------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------- | | Massachusetts/Partners in Health (initial staffing, which PIH believes will need to be increased subsequently) | 14 | | Johns Hopkins/Association of State and Territorial Health Officers | 30 | | Resolve to Save Lives | 100 | ### Roles needed | **Role** | **Who can fill** | **Description** | | -------- | ---------------- | --------------- | | **Contact tracers** | |

Communicate with contacts to gather data and inform about quarantine procedures.

May work remotely during shelter-in-place (e.g., one-on-one phone interviews or text-based messaging services) or in-person.

| | ------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------ | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Case investigators** | |

Interview confirmed or suspected COVID-19 cases.

Interview newly diagnosed cases to determine period of infectiousness, elicit contacts, and identify clinical and other resource needs.

Delegate appropriate administrative work to contact tracers (e.g., finding contact information, reviewing isolation and quarantine recommendations and resources)

| | ---------------------- | -------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Care resource manager** | |

Arrange wrap-around services (e.g., food, medication delivery) for cases and contacts in isolation or quarantine.

Provide incentives, food, or referral to programs that provide financial assistance.

| | ------------------------- | ------------------------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Clinical consultant** | | Provides clinical support to case investigators or contact tracers if cases/contacts become symptomatic or require referral to the hospital. | | ----------------------- | ----------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------- | | **Data analyst** | | Data monitoring and analysis | | ---------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------ | ---------------------------- | | **Data entry technician** | | Careful data entry, review, and correction | | ------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------ | ------------------------------------------ | ![](https://2141157483-files.gitbook.io/~/files/v0/b/gitbook-legacy-files/o/assets%2Fcontact-tracing-cookbook%2F-M6Y3SpY3FC-ogx3MMfC%2F-M6Y4FUgnmwc3ogzmNu0%2F0.png?generation=1588652741355281\&alt=media) ## # Laboratory testing Testing is essential to "slowing the spread" Increasing testing capacity and ensuring rapid turnaround time (from symptoms, to testing, to test result delivery to both the patient and the health department) are key to “slowing the spread”. ### Polymerase Chain Reaction (PCR) testing Polymerase Chain Reaction (PCR) testing is [the current gold standard](https://spectrum.ieee.org/the-human-os/biomedical/diagnostics/testing-tests-which-covid19-tests-are-most-accurate) for COVID-19. For contact tracing to be most effective, PCR testing should be widespread and available to all people showing symptoms. The CDC provides [detailed recommendations for testing protocol and best practices](https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html). ### Asymptomatic testing There is [increasing evidence of transmission from asymptomatic and pre-symptomatic cases](https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e1.htm), and it is likely that a significant proportion of patients would test positive for COVID-19 without symptoms (e.g., [20% in South Korea; 50% in Iceland](https://www.bloomberg.com/news/articles/2020-03-22/one-third-of-coronavirus-cases-may-show-no-symptom-scmp-reports)). Contact tracing will not prevent transmission from untested asymptomatic cases. Because asymptomatic testing accuracy and feasibility rates are still preliminary, even if communities *do* test asymptomatic contacts, negative results would not change quarantine recommendations. The CDC [provides guidance on testing asymptomatic contacts](https://www.cdc.gov/coronavirus/2019-ncov/php/guidance-evaluating-pui.html) of people diagnosed with COVID-19. ### Serology testing Serology testing for COVID-19 to identify past infection and presumed immunity is [still being developed](https://www.cdc.gov/coronavirus/2019-ncov/lab/serology-testing.html), and its role and potential use in contact tracing is still unclear. In particular, [sensitivity and specificity of serology tests vary widely](https://www.medrxiv.org/content/10.1101/2020.04.25.20074856v1) and must be further validated before guiding decision-making. {% content-ref url="/pages/-M6Y9J37gewVg7-MSLU4" %} [Isolation and quarantine](/how-to-do-contact-tracing/isolation-and-quarantine) {% endcontent-ref %} # Isolation and quarantine Isolation (the separation of persons with confirmed or suspected contagious disease) and quarantine (separation/restriction of movement of persons that have been exposed to a contagious disease) are critical to stopping COVID-19 transmission. Enforcing isolation and quarantine requires resources and systems, including strategies for securing location and ensuring food, nutrition, and medication, and financial support. People in isolation and quarantine require continued monitoring in case they require further care or testing. ### Location Case investigators and contact tracers will assess the most appropriate place for isolation and quarantine--either at home, in a government-secured location (e.g., hotel), or in a hospital. ### Provisions Care resource managers ensure access to nutrition and required medications, whether by neighbor, friend, family member, or delivery service. ### Other needs Case investigators? should assess for potential challenges of isolation and quarantine, including loss of income and loss of ability to care for others, that may make compliance difficult. Public health programs such as tuberculosis control programs have provided “incentives and enablers” for this purpose. Examples include covering mortgage or rent payments, providing daycare or elder care, and others. Direct financial compensation for those with lost wages should be considered. ### Legal authority Health officers have legal authority to order isolation and quarantine. Local programs may vary in their approach. Some issue orders immediately whereas others seek voluntary cooperation without a legal order initially. States may need to provide additional support if local health departments need mass provision, monitoring, or enforcement of legal orders. # Monitoring and evaluation Governments can use predefined performance targets to determine the efficacy of its contact tracing program. These metrics can be used in tandem with broader metrics tracking cases and mortality rate to consider loosening and tightening social restrictions. ### Example metrics and targets for contact tracing | **Possible criteria to loosen restrictions** | **Possible criteria to tighten restrictions** | **Other performance metrics** | | -------------------------------------------- | --------------------------------------------- | ----------------------------- | | | | | | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | \[Flow chart of data here] ### # Data management Under construction :) ## Principles of data management 1. Make collected data accessible: The format of a positive laboratory test result for COVID-19, as well as the necessary associated patient information, should be accessible to both clinical and public health entities in either “near real time” or in aggregate as necessary. Ideally patient data is ultimately shared with the patient’s provider. 2. Import relevant available health data: A system capable of automatically importing relevant prior contact, demographic, and clinical records would substantially reduce the burden on the contact tracing and medical workforce. Regulatory barriers to accessing this information (e.g., HIPAA Minimum Necessary restriction) can be overcome with a [statement from the federal HHS Office of Civil Rights](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/minimum-necessary-requirement/index.html) or an assertion from the State. 3. Make data usable: Investing in the above principles to aggregate and access relevant health information will be wasted if contact tracers and other public health employees aren’t clear on how to access it and then share relevant recommendations with cases and contacts. Ideally, programs have easy-to-use user interfaces for data review and entry, but, alternatively, detailed visual training programs can ensure the workforce is taking advantage of useful data. # Legal & data sharing frameworks Summary: * Establish legal data sharing frameworks within state jurisdictions, e.g. local/municipality to city (major metro), and direct to state. * Consider formulating policies and orders at the local jurisdiction level that refer to specific data sharing regulations that permit reporting; i.e. healthcare providers having the ability to share data with **specific entities** related to contact tracing efforts and what data will be released for broad public consumption vs. restricted public health use. * Designate certain collaborative entities with limited public health authority related to COVID-19 e.g. Health Information Networks, and Health Information Exchanges typically can’t easily share data bi-directionally with public health; state-based entities (e.g. New Jersey Health Information Network, Indiana HIE, SHINY) will be able to move faster on sharing clinical information with public health to scope contact tracing efforts * Define data sharing use cases that fall under the following: * Public Health Practice * De-identified Data (per HIPAA); aggregate and line-level * Consumer Data (non-HIPAA; regulated by FTC * Anonymous Data * Open Data (public consumption) * Patient and Consumer Consents * Data destruction policies ### State & Local Jurisdiction Data Sharing If there is a local NEDSS system in place, provide local jurisdictions with the ability to enter case reports. Establish a process to capture case investigations that relate to emerging contract tracing emergence of symptoms but confirmatory testing may not be in place yet (typically a quarantine section of the system to help prioritize confirmed case reports). ### Data Sharing Use Cases * Symptom checker information into a NEDSS * Symptom checker information connected with contact traced social network (identifiable, and aggregate level) * Contact-traced individuals to healthcare records/testing (consent) * Surveillance of negatives for a certain period of time with symptom checker & monitoring tools **Public Health Practice** Covers the following: * Healthcare provider to public health * Clinical data provider (Labs, EHRs, Payors & their vendors) to public health * Behavioral and mental health data provider to public health * Public health to public health; state and local jurisdictions * Local state agencies (e.g. Departments of Human Services, Prison & Correctional Facilities) to public health * Local public health to federal public health Permissible data linkages: * Identifiable data (PHI or PII) to consumer-consented data * Limited data to identifiable data * De-identified data to identifiable data (re-identification under public health practice) * De-identified data to de-identified data **De-identified Data** Covers the following: * Healthcare providers to public health **Consumer Data** **Open Data** # Negotiating data rights with vendors Software vendors may attempt to contract their ownership over data in an attempt to lock in customers. Programs must avoid this by specifying in the vendor contract that vendors do not own any data via a “data rights” clause such as: “Consistent with [FAR 52.227-14](https://www.acquisition.gov/content/52227-14-rights-data-general), which applies to this agreement, the State intends that data stored within the software provided by the Contractor will be owned by the State.” Programs must also specify in the vendor contract that the vendor agrees to export records in a machine-readable format (defined as “data in a format that can be easily processed by a computer without human intervention while ensuring no semantic meaning is lost”), and the software must likewise be demonstrated to provide such functionality. # Technology enablement Under construction! :) Technology cannot remove the need for scaled-up workforces to execute contact tracing. However, technology will enable contact tracing workforces to effectively address the unprecedented scale, speed, and accuracy demanded by the COVID-19 crisis. Cloud-based technology tools can accelerate key functions including: * Workforce management * Case management * Alerts * Call center and triage Contact tracing is not a concept that began with COVID-19. Your state, county, or city probably already has a process for it, some of which involves technology. Understanding the state of your pre-existing flow and infrastructure for contact tracing for infectious diseases like HIV or syphilis is a good first step for making decisions about how technology can support contact tracing for COVID-19. Chances are, your underlying technology infrastructure has not been heavily invested in. It probably involves a great deal of manual data entry, manual importing and exporting of files between systems, paper records, software that doesn’t have the right data structure, and one or two people in the IT department or at an external vendor who understand the software or can make changes to it. Your team has found a way to make it work, and come up with their own creative ways to work within the constraints they have been given. Your contact tracing-related databases, if you have electronic databases, can probably only be accessed on old Windows machines in-person at the health department by health department personnel. Your underlying technology and processes for STD or tuberculosis contact tracing already have found a way to: * Get information about positive test results from labs to the health department * Clean or correct the information from labs when there is an error * View or find contact information for the positive case * Get in touch with the positive patient and find to inform them of their diagnosis, connect them to care, and interview them about their contacts (this is not always done by the same person or at the same time) * Interview the positive patient about their contacts (that they might have exposed or might have exposed them), and prioritize based on likelihood of transmission * Decide which contacts will be notified by the positive patient vs the health department ([“provider referral” vs “patient referral”](https://academic.oup.com/cid/article/44/Supplement_3/S160/496779)) * For contacts that will be notified via patient referral, equip the patient with information and possibly referral cards * Decide whether to give the patient medication to bring their contacts (“expedited partner therapy”), and if so provide them with the necessary medication and instructions * Find contact information for the positive patient’s contacts who will be notified by the health department * Get in touch with the contact and find a time to talk to them * Inform the contact of their possible exposure, and connect them to testing & care as appropriate * Sometimes, follow up with contact to see whether they were tested * Train contact tracers on how to perform contact tracing effectively and ensure the privacy of patients and contacts Technology can play a role in all of these steps, and might already be used by your health department to supplement manual efforts. Chances are though that your underlying technology and processes are not meant to work rapidly for a new disease, much less at the speed and scale needed for comprehensive COVID-19 contact tracing. ## **Tech-enabled case identification, management, & prioritization** Technology can play a vital role in getting data about cases from labs to the health department. As there become more and more locations that offer COVID-19 testing, this issue of ensuring the quality, speed, and scalability of this process is essential to any contact tracing efforts. Every day of delay between when a patient was symptomatic or tested and when they are interviewed by contact tracers dramatically lessons the impact contact tracing will have. Your underlying database of positive cases was not built for COVID-19. You might use the state’s system to source new cases, or your county or city might have its own. Test results will come in from hospitals, clinics, private labs, and public labs. These results might come in electronically through an online integration or portal as HL7 feeds, CSVs, or other raw data files. They also might be entered in by hand to the city or state database from someone directly looking up information about the case in the clinic’s EMR (electronic medical record) system, by someone who has received a paper copy of the lab, or by a courier who has brought an electronic file to the city, county, or state on a thumb drive, CD-ROM, or floppy drive. Ideally, you would set up secure electronic integrations between labs and your state, county, and cities so that data can be sent instantly and without alteration. Even if you are able to get electronic data directly from the lab, the data from the lab will not be free of typos. Patient names and contact information will inevitably be misspelled, because usually this information is hand-written by the patient on a paper form, and then manually typed in by someone at the lab or by the healthcare provider. Anywhere along the chain, technology can play a role in flagging and even automatically correcting common errors, such as “gnail.com” or “gmail.con.” The earlier along the chain this correction happens, the better. Technologies that enable patients to register electronically during or before their visit to the lab, and that conduct field checks on the data entered by the patient (e.g. a phone number is missing a digit), will help ensure that the data seen by contact tracers is accurate. Your system might also need to adapt to treat patients who were never tested or whose test results are pending as presumptive positives in need of care and/or contact tracing. Lab data alone will not then get you the information you need, and further integrations and processes to get data from providers will be necessary. In addition to getting data from providers and labs, your system will need to know how to interpret those data to flag what cases should be interviewed. A patient could be tested twice with a PCR test on the same day, and have one test come back positive and another negative. A patient could get tested for antibodies and have a positive antibody test, but no longer be worthwhile to interview for contact tracing. Your database and processes will need to handle patients getting tested more than once, with multiple types of tests that mean different things, at many different locations. Even with a large number of contact tracers, you will need to have the ability to prioritize among positive patients, and your database needs to have the information in it that would guide this prioritization. Examples of data that would be useful (beyond “test result negative vs positive”) include: * Date of test * Type of test * Date of symptom onset (might not be available in lab data, but is helpful for determining infectious period & original date of infection) * Other test results for the same patient * Risk factors (?) Lastly, your contact tracers need to have access to the database of patients they need to interview (“index cases”), and know which ones to reach out to. This does not need to be the same database your health department uses because: * COVID-19 contact tracers only need access to data about a subset of all infectious disease patients, and a subset of COVID-19 cases * your department database might not be accessible to people who are not in-person using health department desktops * there might not be an underlying need for your department database to have information about COVID-19 contacts in it If you do separate your systems, you’ll need to figure out how to get data from your department database of cases into any database / technology being used by contact tracers, and identify which of these databases is the “source of truth” on COVID-19 cases. If it’s your department database, you’ll want to develop a process or integration that allows contact tracers to flag things that are “off” about COVID-19 patient information, such as a disconnected phone number or an email that bounces back, and ensure that information can be corrected in both the database that contact tracers are using and the database being used by the department for the tracking and management of COVID-19 cases. ## Tech-enabled case interviews, contact elicitation, & contact investigation Once you have your database of cases, cases need to be informed of their diagnosis and interviewed. Quite a bit needs to happen in order to connect the index case to care, ensure they are less likely to infect others (e.g. connect them to an isolation hotel if they can’t isolate at home), and elicit contacts. You’ll need to decide who is in charge of what part of this, and whether the person interviewing a patient about their contacts and possible sources of exposure is also performing other functions such as delivering test results or connecting patients to care. If they are performing these other functions, you’ll want to ensure that any database they use allows them to track these activities appropriately. Technology can play an important role in delivering test results, and even in helping supplement contact elicitation interviews that would otherwise be done on the phone. Some health departments are using third-party vendors like [Healthvana](http://healthvana.com/) to deliver COVID-19 test results and instruct positive patients on which contacts to notify and how to notify them. Index case interviews can be done digitally as well, by having patients fill out an online form about their close contacts and recent activities. These forms are not perfect - not all index cases will feel comfortable filling them out or have private internet access, the form won’t be able to ask probing questions that an interviewer might, and a form can’t build rapport or demonstrate empathy the way a human can. But these forms can scale well, can be available in multiple languages, can be filled out by the patient at any time, and can improve the speed of and accuracy of data collection versus a traditional interview. Technology can also help with prompting the index patient to remember their contacts or possible exposures. An interviewer can ask an index case to look at their calendar, their text messages, their food delivery apps, their phone geolocation data, and other sources of private electronic tracking and communication that can help the case to remember when their symptoms started, where they’ve been, and who they had in-person contact with. In addition to trying to elicit the names of contacts, an interviewer will also try to identify ways to reach out to the contact. The index case might have a variety of ways they communicate with or can locate their close contacts, some of which can be used by contact tracers and others that are best suited for conversations just between the patient themselves and their contact. These could include: * Phone number * Email address * Username in various social media platform (e.g. dating apps, facebook, instagram, etc) * Physical address * Place of work or places commonly visited Technology can support this by enabling the index case to search through their various contact lists for multiple methods of getting in touch with their close contacts. This could be done by an app the index case would download onto their smartphone, and then setting up integrations with their phone’s contact list, their email client, and their social media apps. The index case could then search for a given contact’s names in all digital locations simultaneously, enabling them to more easily notify those contacts themselves or provide this information to the interviewer. Once some information about a contact is given to an interviewer, they might want to do their own search for methods of contacting them, especially if the methods provided by the index case don’t seem to be working. This is also true for instances where the lab provides incomplete information about the index case themselves. Technology can make it easier to search multiple databases simultaneously to try to find alternate methods for contacting individuals. ## Tech-enabled contact prioritization & notification Once contacts have been elicited, they need to be prioritized for follow-up by contact tracers. In traditional contact tracing, often not every case is notified by the health department, or at least not for all infectious diseases. Often the patient themselves is asked to notify their close contacts as well, and provided with help doing so. This is for several reasons: * Index patients might not want to provide contact tracers with the names of all their close contacts, especially if the contact is undocumented or if one or both parties were not following local ordinances when they were in touch * Contacts might not answer the phone when called from an unknown number, or open an email from an unknown email address, whereas they would pick up if a friend was calling * Health departments rarely have the capacity to reach out to all possible contacts, and want to focus their resources on hard-to-reach contacts that can’t be notified by other means In addition to prioritizing contacts based off of which need to be contacted via provider-referral (vs peer-to-peer patient referral), a health department might also want to prioritize contacts who: * Are especially likely to have been infected by the index case. This would be influenced by: * the timing of the interaction - e.g. contacts who were with the index case three days before symptoms appeared would be less likely to be infected than a contact from the day after symptoms appeared * the duration of the interaction - e.g. contacts who were with the index case for 3 hours would be more likely to be infected than those who spent two minutes with the patients * the location of the interaction - e.g. contacts who were indoors or in a contained environment like a car with the patient would be more likely to be infected than those who were outside in a park (we think) * whether the index patient was coughing or engaging in behavior that would increase the probability that an infectious dose of the virus would leave their body and enter the other person * Are especially likely to infect others, if not notified and/or provided with services, for example: * Individuals who live in close quarters with other people * Individuals who are working essential jobs and leaving their home regularly * Are especially likely to develop serious illness, if not notified and/or provided with services, for example: * Older individuals * Individuals with relevant underlying conditions or who are immunocompromised * Are especially likely to have infected the index case, for example: * Close contacts from 2-14 days, especially around 3-6 days, from before the index case started to show symptoms * These are generally prioritized less highly for provider-referral notification, because these contacts might already be past their infectious period Technology can play an important role in sorting through and prioritizing these contacts on these various vectors, enabling health departments to more rapidly prioritize who to notify in what order, and how much effort to expend on contacts who are not easily reached. In addition to supporting contact prioritization, technology can help with the notification itself. This can be done by providing contact tracers with templates for outreach that they can use for manual emailing or texting of contacts. This can also be done by automatically alerting contacts using pre-set templates (e.g. the software sends the text message rather than the contact tracer using their own phone), or with robo-calls to contacts. These interactions can be tracked or automated in a database such as Salesforce, enabling contact tracers to easily see that status of outreach to contacts. In addition to supporting the sending of a contact notification, technology can help with connecting the contact to testing and / or care. A number of COVID-19 testing location finders exist, such as [Google](https://www.theverge.com/2020/4/17/21225828/google-showing-covid-19-testing-centers-search-results) or [findcovidtesting.com](https://findcovidtesting.com/). ## Tech-enabled contact follow-up Once a contact has been notified, you may want to follow up with them to ensure they have been tested, encourage them to stay isolated for the 14 days after exposure, and learn more about their symptoms. An increasing number of technologies are being developed to support this, such as [CommCare](https://www.dimagi.com/commcare/) or [Sara Alert](https://saraalert.org/). ## Peer-to-peer contact notification Technology can enable patients to notify their own contacts (if they know their identities). Anonymous peer-to-peer mass partner notification systems already exist for STDs (e.g., [Tell Your Partner](https://tellyourpartner.org/), [Let Them Know](https://letthemknow.org.au/)), and are beginning to be adapted to support COVID-19 peer-to-peer notification (e.g., [Tell Your Contacts](https://tellyourcontacts.org/)). In addition to helping diagnosed individuals deliver the message, [templates](http://web.archive.org/web/20161222151021/https://www.sotheycanknow.org/inform/text) could make it easier to figure out what to say and [automated suggestions based on timing of test results and symptom onset](http://web.archive.org/web/20160910061632/https://www.sotheycanknow.org/chlamydia#inform_your_partner) could make it easier to decide who to notify. Technology could also enable automated information distribution to contacts about where/whether to get tested, symptom education and monitoring, guidance on isolation/quarantine, and available support and services. ## Tech-enabled recruiting and training of contact tracers As we consider rapidly scaling up the contact tracing workforce, technology can play a vital role in recruiting, selecting, and training contact tracers. [GC Talent Reserve](https://talent.canada.ca/en/response) ([open source code](https://github.com/GCTC-NTGC/TalentCloud)) is one example of how governments can use technology to recruit contact tracers who are already government employees to fill emergency roles. [Making Contact: A Training for COVID-19 Contact Tracers](https://www.ncsddc.org/resource/making-contact-a-training-for-covid-19-contact-tracers/) is an example of how technology can be used to rapidly train entry-level COVID-19 contact tracers. ## Emerging Bluetooth technology solutions Apple and Google recently announced a partnership to leverage Bluetooth LE technology to support voluntary proximity tracking. This could theoretically automate portions of contact tracing: once a case is diagnosed, apps could notify others who were in proximity to the diagnosed individual during the infectious period.[\[1\]](/how-to-do-contact-tracing) For privacy purposes, this technology relies on a “double opt-in”, meaning that both diagnosed and contacts would have to opt in to be traced or notified. While this technology has potential, it is in its early stages. Based on our review to date, we do not recommend it be a “load-bearing pillar” of contact tracing work for the following reasons: * **Insufficient coverage.** Since this approach is voluntary, coverage is limited to those who choose to participate. If only 40% participates (a liberal estimate given [adoption rates in other countries](https://www.reuters.com/article/us-health-coronavirus-apps/bluetooth-phone-apps-for-tracking-covid-19-show-modest-early-results-idUSKCN2232A0)), it would still only cover 16% of the population.[\[2\]](/how-to-do-contact-tracing) As a result, a manual contact tracing program is still necessary even with relatively broad adoption. * **Biased coverage.** We should anticipate [lower adoption in vulnerable populations due to language barriers, limited technology access, and more](https://www.pewresearch.org/internet/fact-sheet/mobile/). As a result, over-reliance on this approach could disproportionately divert resources from vulnerable populations. * **Still under development.** Google and Apple will be launching APIs in May, which will delay the creation of applications. In addition, accurate proximity algorithms are still under development, and issues such as rates of false positives and margins of error are unknown. * **Outstanding privacy and security questions.** While Google and Apple are pursuing a privacy-centric approach, ensuring privacy in practice is another matter. Privacy experts have expressed concern that location could potentially be inferred from proximity by, for example, hackers or aggressive nation states. # Review of vendors Under construction :) # Other resources * [CD](https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/contact-tracing.html)[C](https://www.astho.org/COVID-19/A-National-Approach-for-Contact-Tracing/) * [ASTHO](https://www.astho.org/COVID-19/A-National-Approach-for-Contact-Tracing/) * [Hopkins & ASTHO](https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200410-national-plan-to-contact-tracing.pdf) * [NCSD \* ASTHO](https://www.ncsddc.org/resource/making-contact-a-training-for-covid-19-contact-tracers/) * [NCSD](https://www.ncsddc.org/covid-command-center-std-program-resources/) * [Resolve to Save Lives](https://resolvetosavelives.org/) * [Massachusetts Community Tracing Collaborative proposal](https://www.mass.gov/doc/community-tracing-collaborative-overview-presentation/download) * [Guidance for long-term care facilities](https://docs.google.com/spreadsheets/d/12QMHyEweIlJRSfB0JpG8T-g-5nVTIhOtoauaeh18WIs/edit?ts=5eaf09cb#gid=0)
{% content-ref url="/pages/-M6YBwmvu1scdvJUjn\_P" %} [Have questions? Get in touch with USDR](/about/have-questions-get-in-touch-with-usdr) {% endcontent-ref %} # Glossary A glossary of terms * **Isolation** - the separation of persons with confirmed or suspected contagious disease * **Quarantine** - separation/restriction of movement of persons that have been exposed to a contagious disease * **Exposure Notification** - Notifying a person of exposure to Covid-19. See this [blog post](https://harper.blog/2020/04/22/digital-contact-tracing-and-alerting-vs-exposure-alerting/) # Other Playbooks A list of contact tracing playbooks from other organizations | Organization | Title | Link | Description | Publication date | | ---------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------- | | Resolve to Save Lives | Covid-19 Contact Tracing Playbook | [link](http://covidplaybook.resolvetosavelives.org) | This playbook aims to provide clear, comprehensive and actionable technical guidance and tools for U.S. jurisdictions to rapidly set up and implement contact tracing to support COVID-19 containment | 5/20/2020 | | Center for Disease Control | COVID-19 Contact Tracing Training: Guidance, Resources and Sample Training Plan | [link](https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/index.html) | This document contains a sample training plan including training topics that may be helpful for state and local public health jurisdictions to consider when designing their own training plan for COVID-19 contact tracers. Each heading represents the learning objective for that section. Suggested training modalities/formats are provided, as well as information about sample existing trainings and resources. This document may be updated as new resources become available. For the purposes of this document, contact tracers are those who notify close contacts of COVID-19 patients of their exposures | | | Partners in Health | Testing, Contact Tracing and Community Management of COVID-19 | [link](https://www.pih.org/sites/default/files/2020-04/PIH_Guide_COVID_Part_I_Testing_Tracing_Community_Managment_4_4.pdf) | Guide to testing, tracing, and community management | 4/4/2020 | | Center for Health Security (Johns Hopkins Bloomberg School of Public Health) | A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US | [link](https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200410-national-plan-to-contact-tracing.pdf) | National plan to enable comprehensive case finding and contact tracing in the US | 4/10/2020 | | State of Massachusetts | Rapid Design, Development & Operation of a Scalable COVID-19 Contact Tracing Workforce & Automation Capability | [link](https://www.mass.gov/doc/community-tracing-collaborative-overview-presentation/download) | Community Tracing Collaborative plan | 4/28/2020 | | Association of State and Territorial Health Officials | Making Contact: A Training for COVID-19 Contact Tracers | [link](https://learn.astho.org/p/ContactTracer) | Training for Contact Tracers | 4/28/2020 | | Association of State and Territorial Health Officials | A Coordinated, National Approach to Scaling Public Health Capacity for Contact Tracing and Disease Investigation | [link](https://www.astho.org/COVID-19/A-National-Approach-for-Contact-Tracing/) | Scaling public health capacity for contact tracing and disease investigation | 4/1/2020 | | National Coalition of STD Directors | MAKING CONTACT: A TRAINING FOR COVID-19 CONTACT TRACERS | [link](https://www.ncsddc.org/resource/making-contact-a-training-for-covid-19-contact-tracers/) | Training for Contact Tracers | 4/28/2020 | | Denver Prevention Training Center | Metro Denver COVID-19 Case Investigation Training Package | [link](https://drive.google.com/drive/folders/1uX4jvgfU9HYoCV1fkW1e69UuFWB8_Pa7) | Case Investigation Training Package | 4/8/2020 | | National Coalition of STD Directors | CONTACT TRACING SOCIAL TOOLKIT | [link](https://www.ncsddc.org/wp-content/uploads/2020/04/NCSD-Contact-Tracing-Social-Toolkit.pdf) | Contact Tracing Social Toolkit | 4/1/2020 | | Monroe County Department of Public Health | STD Program Resources & Trainings | [link](https://www.ncsddc.org/covid-command-center-std-program-resources/) | Suggested script for contact tracing staff | 4/1/2020 | | Monroe County Department of Public Health | Monroe County Department of Public Health | [link](https://www.ncsddc.org/wp-content/uploads/2020/04/Contact-Tracing-JAS.pdf) | Contact tracing job action sheet | 4/1/2020 | | CarePredict | How to Overcome Contact Tracing Challenges in Senior Living Facilities | [link](https://www.carepredict.com/blog/how-to-overcome-contact-tracing-challenges-in-senior-living-facilities/) | Overcome contact tracing challenges in senior living facilities | 3/31/2020 | | Pennsylvania Department of Health Services | Steps to Conduct Contact Tracing for a COVID-19-positive Case | [link](https://www.dhs.pa.gov/providers/Clearances-and-Licensing/Documents/Assisted%20Living%20Licensing/LTCF%20Contact%20Tracing%20for%20COVID19%20Case.pdf) | Contact tracing guidance for Long-term care facilities | 3/21/2020 | | SwipedOn | A Guide To Contact Tracing for Your Workplace | [link](https://www.swipedon.com/blog/contact-tracing-for-your-workplace) | Contact Tracing for your office | 5/5/2020 | | North Carolina Department of Health and Human Services | Ebola Contact Tracing, DGMQ Traveler Notification and Monitoring and Movement Documents | [link](https://epi.dph.ncdhhs.gov/cd/lhds/manuals/cd/ebola/tracing_documents.html) | North Carolina Communicable Disease Manual for Ebola Contact Tracing | 1/21/2015 | | World Health Organization | Implementation and management of contact tracing for Ebola virus disease | [link](http://apps.who.int/iris/bitstream/10665/185258/1/WHO_EVD_Guidance_Contact_15.1_eng.pdf?ua=1) | Contact tracing for Ebola | 9/1/2015 | | World Health Organization | Contact tracing in the context of COVID-19 | [link](https://www.who.int/publications-detail/contact-tracing-in-the-context-of-covid-19) | When systematically applied, contact tracing will break the chains of transmission of an infectious disease and is thus an essential public health tool for controlling infectious disease outbreaks. This document provides guidance on how to establish contact tracing capacity for the control of COVID-19 | 5/10/2020 | | U.S. Digital Response | USDR Contact Tracing Playbook | [link](https://contacttracingplaybook.org/) | A contact tracing playbook focused on tech enablement | 5/2/2020 | | | | | | | # About USDR U.S. Digital Response (USDR) helps governments meet the challenges of the COVID-19 crisis by strengthening decision-making and supporting their ability to effectively deliver critical services to the public at scale. We are a volunteer-run, non-partisan effort to help federal, state, local, tribal, and territorial governments with technology, data, design, operations, communications, project management, and more during the COVID-19 crisis. We provide free assistance to all government entities across the country; if we can help, we will. USDR was founded by former U.S. Deputy CTOs and seasoned tech industry veterans who led federal open data policies, and started up the U.S. Digital Service. [Learn more about our **Mission and Values**.](https://www.usdigitalresponse.org/mission-values) # Authors Many people contributed to this document. Here are a few: * Annie Steele () * Eric Schallock * Harper Reed () * Isabel Ostrer * Jasmine Phua * Jess Ladd () * Matt Kelly * Paul Schreiber * Randall Thomas * Sasha Targ * Tiffany Aike Ho () * Waldo Jaquith * Yun-Fang Juan # Have questions? Get in touch with USDR ## Have questions? We’re here to help: ## Governments If you work in government and need help getting through the COVID-19 crisis, we have more than 5,000 talented volunteers. Submit a request and we’ll figure out the rest. [Request Help](https://www.usdigitalresponse.org/request-help/) ## Volunteer When governments need help, we look to our thousands of volunteers. Whether you know how to build data pipelines for accurate reporting or a content strategy for informing constituents, we connect people with a wide variety of skills to the governments who need them most. [Apply to become a volunteer](https://www.usdigitalresponse.org/raising-your-hand/)