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August 3,2020

Contact Tracing for COVID-19: Domestic Policy Issues

Contact tracing is a clas sic tool of public health
investigation used to identify the close contacts of persons
infected with acomimunicable disease, notify therof
potential exposure, and enable control measures such as
quarantining exposedpersons. Contact tracing programs ane
generally subject to state, territorial, tribal, and local laws
and policies. The U.S. Centers for Dis ease Control and
Prevention (CDC) as sists juris dictions' programs by
providing guidance, technical assistance, and funding.

Several public health experts affiliated with universities
(e.g., Johns Hopkins University), policy research
organizations (e.g., American Enterprise Institute), and state
associations (e.g., National Governors Association) have
po sited that contact tracing (co mbined with adequate
diagnostic testing) could help prevent surges in infections,
particularly when case counts are low. Contact tracing to
control Coronavirus Disease2019 (COVID-19) has been
used with arguable success in countries such as South
Korea, Taiwan, Iceland, and New Zealand--many attribute
their relatively low reported case counts, in part, to
successful contact tracing. However, several experts assert
that a successful contact tracing effort in the United States
would require additional workforce and possibly the use of
new technologies by jurisdictions. Federalis mhas led to
heterogeneous contact tracing efforts across states. As the
pandemic progresses, Congress may consider whether and
how to guide U.S. contact tracing efforts.

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Contact tracing, a componentofpublic health investigation,
is a core tool ofcommunicable disease control. U.S.
jurisdictions' public health departments have usedcontact
tracing to help control the spread of diseases like HIV and
tuberculosis. Typically, when a confirmed case of a disease
is identified and determined to require a case investigation,
public health departments contactthe patient and conduct
extensive interviews to acquire information aboutpersons
with whom the patient may have been in contact and
therefore possibly exposed to the disease. Those individuals
are then notified by either the patient or the health
department and then referred for testing, prophylaxis,
and/or treatment (if available) or asked/required to s elf-
quarantine (depending on the applicable jurisdiction's laws
and policies). Contacts are usually informed by health
departments ofa potentialdisease exposure,but are not
given the identity of the individualwho exposed them.

Given that COVID-19 spreads easily fromperson to person
and can be transmitted by asymptomatic individuals,
controlling COVID-19 may require more robust contact
tracing capacity thanexisted in many jurisdictions priorto
the pandemic. In addition, given the lackof available
vaccines orprophylaxis for COVID-19, health departments

usually request that exposed individuals voluntarily self-
quarantine and may conductregular follow-up and/or
facilitate housing and other support programs for
quarantine. Experts generally advocate two approaches to
expanding U.S contact tracing-expanding thecontact
tracing workforce and the use of new technologies to help
identify and notify potential contacts. Some domestic
COVID-19 contact tracing efforts have faced initial
challenges with individuals refusing to shareinformation
with health departments, indicating potential individual
liberty and privacy considerations.

Depending on the design of its contacttracing program,
jurisdictions may require an expanded workforce to conduct
interviews andmanagecontact tracing efforts. Johns
Hopkins University and the Association of State and
Territorial Health Officials have recommendedbetween4
and 81 tracers per 100,000 population, basedon levelof
illness in a given region.

Recruitment. Given the need to augment existing capacity,
several states have recruited paid and volunteer contact
tracing staff fromstate employees, public health and
medical schools, AmeriCorps volunteers, and other
institutions. Some states have also worked with private
entities to manage contacttracing efforts. Forexample,
Indiana contracted with a private company, Maximuis, to
manage a call centerfor contacttracing efforts.

Training. Contact tracers need specialized education and
skills, including an understanding ofmedicalterms,
knowledge of patient confidentiality requirements, and an
ability to effectively interview and counsel patients. CDC
has published online training for contact tracing programs.
Several states have also implemented training programs in
partnership with non-profit organizations anduniversities.

Contact tracing programs need individuals with varying
skill levels, including established public health experts to
help manage programs as well as skilled tracers to contact
and interview individuals. Jurisdictions may also consider
the need for cultural competence and ability to engage with
diverse communities affectedby COVID-19, such as skills
in non-Engis h language proficiencies.

A challenge in traditional contact tracing is the difficulty
patients have comprehensively recalling close contacts,
even with the as sistance of trained public health workers.
COVID-19 patients may be infectious long before receiving
a positive test result, and thus may need to recall weeks of
close contacts. Tools thatusedigital technologies to
automate this aspect of contacttracing have been
developed, though their adoptionin the United States has

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