Implementation of a volunteer contact tracing program for COVID-19 in the United States: A qualitative focus group study

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Abstract

Background

Contact tracing is an important tool for suppressing COVID-19 but has been difficult to adapt to the conditions of a public health emergency. This study explored the experiences and perspectives of volunteer contact tracers in order to identify facilitators, challenges, and novel solutions for implementing COVID-19 contact tracing.

Methods

As part of a study to evaluate an emergently established volunteer contact tracing program for COVID-19 in New Haven, Connecticut, April-June 2020, we conducted focus groups with 36 volunteer contact tracers, thematically analyzed the data, and synthesized the findings using the RE-AIM implementation framework.

Results

To successfully reach cases and contacts, participants recommended identifying clients’ outreach preferences, engaging clients authentically, and addressing sources of mistrust. Participants felt that the effectiveness of successful isolation and quarantine was contingent on minimizing delays in reaching clients and on systematically assessing and addressing their nutritional, financial, and housing needs. They felt that successful adoption of a volunteer-driven contact tracing model depended on the ability to recruit self-motivated contact tracers and provide rapid training and consistent, supportive supervision. Participants noted that implementation could be enhanced with better management tools, such as more engaging interview scripts, user-friendly data management software, and protocols for special situations and populations. They also emphasized the value of coordinating outreach efforts with other involved providers and agencies. Finally, they believed that long-term maintenance of a volunteer-driven program requires monetary or educational incentives to sustain participation.

Conclusions

This is one of the first studies to qualitatively examine implementation of a volunteer-run COVID-19 contact tracing program. Participants identified facilitators, barriers, and potential solutions for improving implementation of COVID-19 contact tracing in this context. These included standardized communication skills training, supportive supervision, and peer networking to improve implementation, as well as greater cooperation with outside agencies, flexible scheduling, and volunteer incentives to promote sustainability.

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Most cited references 50

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First Case of 2019 Novel Coronavirus in the United States

Michelle Holshue, Chas DeBolt, Scott Lindquist … (2020)

Summary An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient’s initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.

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The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

Stephen A. Lauer, Kyra Grantz, Qifang Bi … (2020)

Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID-19 and describe its public health implications. Design: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases. Primary Funding Source: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.

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Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts

Joel Hellewell, Sam Abbott, Amy Gimma … (2020)

Summary Background Isolation of cases and contact tracing is used to control outbreaks of infectious diseases, and has been used for coronavirus disease 2019 (COVID-19). Whether this strategy will achieve control depends on characteristics of both the pathogen and the response. Here we use a mathematical model to assess if isolation and contact tracing are able to control onwards transmission from imported cases of COVID-19. Methods We developed a stochastic transmission model, parameterised to the COVID-19 outbreak. We used the model to quantify the potential effectiveness of contact tracing and isolation of cases at controlling a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-like pathogen. We considered scenarios that varied in the number of initial cases, the basic reproduction number (R 0), the delay from symptom onset to isolation, the probability that contacts were traced, the proportion of transmission that occurred before symptom onset, and the proportion of subclinical infections. We assumed isolation prevented all further transmission in the model. Outbreaks were deemed controlled if transmission ended within 12 weeks or before 5000 cases in total. We measured the success of controlling outbreaks using isolation and contact tracing, and quantified the weekly maximum number of cases traced to measure feasibility of public health effort. Findings Simulated outbreaks starting with five initial cases, an R 0 of 1·5, and 0% transmission before symptom onset could be controlled even with low contact tracing probability; however, the probability of controlling an outbreak decreased with the number of initial cases, when R 0 was 2·5 or 3·5 and with more transmission before symptom onset. Across different initial numbers of cases, the majority of scenarios with an R 0 of 1·5 were controllable with less than 50% of contacts successfully traced. To control the majority of outbreaks, for R 0 of 2·5 more than 70% of contacts had to be traced, and for an R 0 of 3·5 more than 90% of contacts had to be traced. The delay between symptom onset and isolation had the largest role in determining whether an outbreak was controllable when R 0 was 1·5. For R 0 values of 2·5 or 3·5, if there were 40 initial cases, contact tracing and isolation were only potentially feasible when less than 1% of transmission occurred before symptom onset. Interpretation In most scenarios, highly effective contact tracing and case isolation is enough to control a new outbreak of COVID-19 within 3 months. The probability of control decreases with long delays from symptom onset to isolation, fewer cases ascertained by contact tracing, and increasing transmission before symptoms. This model can be modified to reflect updated transmission characteristics and more specific definitions of outbreak control to assess the potential success of local response efforts. Funding Wellcome Trust, Global Challenges Research Fund, and Health Data Research UK.

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Author and article information

Contributors

Tyler Shelby:

ORCID: https://orcid.org/0000-0003-0581-4399

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Writing – original draft

Rachel Hennein:

ORCID: https://orcid.org/0000-0001-6855-0402

Role: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing

Christopher Schenck: Role: Data curationRole: Writing – review & editing

Katie Clark: Role: Data curationRole: InvestigationRole: Writing – review & editing

Amanda J. Meyer: Role: Data curationRole: Writing – review & editing

Justin Goodwin:

ORCID: https://orcid.org/0000-0002-9767-1171

Role: Data curationRole: Writing – review & editing

Brian Weeks: Role: ConceptualizationRole: SupervisionRole: Writing – review & editing

Maritza Bond: Role: ConceptualizationRole: Project administrationRole: SupervisionRole: Writing – review & editing

Linda Niccolai: Role: ConceptualizationRole: Data curationRole: Writing – review & editing

J. Lucian Davis: Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: ResourcesRole: Writing – review & editing

Lauretta E. Grau: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: Writing – review & editing

Jennifer Yourkavitch: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 5 May 2021

Publication date Collection: 2021

Publication date PMC-release: 5 May 2021

Volume: 16

Issue: 5

Electronic Location Identifier: e0251033

Affiliations

[1 ] Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America

[2 ] Yale School of Medicine, New Haven, Connecticut, United States of America

[3 ] New Haven Health Department, New Haven, Connecticut, United States of America

[4 ] Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, United States of America

[5 ] Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, United States of America

University of North Carolina at Greensboro, UNITED STATES

Author notes

Competing Interests: JLD, AJM and TS declare a contract with the state of Connecticut to assist with the state’s contact tracing program. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

[¤]

Current address: Norwalk Health Department, Norwalk, Connecticut, United States of America

* E-mail: Lucian.Davis@ 123456yale.edu

Author information

Tyler Shelby https://orcid.org/0000-0003-0581-4399

Rachel Hennein https://orcid.org/0000-0001-6855-0402

Justin Goodwin https://orcid.org/0000-0002-9767-1171

Article

Publisher ID: PONE-D-20-29667

DOI: 10.1371/journal.pone.0251033

PMC ID: 8099418

PubMed ID: 33951107

SO-VID: e09594ec-7c50-40d5-8801-cef65da48077

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 20 September 2020

Date accepted : 17 April 2021

Page count

Figures: 0, Tables: 2, Pages: 21

Funding

Funded by: Dean’s Office at the Yale School of Public Health

Award Recipient : J. Lucian Davis

This work was supported by a grant from the Dean’s Office at the Yale School of Public Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability Data cannot be made public because it describes participant experiences which are not de-identifiable and consent for release was not provided by study participants. The New Haven Health Department provides oversight for the data collected by and for its contact tracing program, and by policy requires any use of this data to be directly approved by the Health Department. For these reasons, data may only be made available upon request made to the Corresponding Author and the New Haven Health Department. Please direct data requests to the following non-author email at the Yale School of Public Health's Department of Epidemiology of Microbial Diseases: kimberly.rogers@ 123456yale.edu .

Outbreaks COVID-19

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Implementation of a volunteer contact tracing program for COVID-19 in the United States: A qualitative focus group study

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Abstract

Background

Methods

Results

Conclusions

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 50

First Case of 2019 Novel Coronavirus in the United States

The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts

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