State of COVID-19 Contact Tracing in the U.S.

Executive Summary

States will continue to grapple with scaling contact tracing programs for the duration of the COVID pandemic with their existing resources.  It is critically important that Congress appropriate additional funding for contact tracing in states and state legislatures continue to prioritize public health investments as they return in the coming months.  As we learn to live with this deadly virus until a vaccine or curative treatment is discovered, contact tracing is an important tool which can help states keep their residents safe.

USofCare Key Takeaways and Next Steps

• Congress should increase investment for contact tracing and self-isolation in the next federal COVID-19 relief package.  While states are launching creative approaches to meet this important need, federal funding will be necessary to scale and sustain this critical work.
• States should continue to implement contact tracing tracing programs as part of a comprehensive approach to stopping the spread of the disease.
• United States of Care will monitor the progress of states and identify best practices that can lead to scalable and sustainable contact tracing solutions and programs. 
• United States of Care will leverage collective knowledge by connecting states and cross-sector leaders with models and resources to support the rapid development of contact tracing programs.
• United States of Care will support the safety of all Americans by applying shared values and a people-centered lens to new approaches and solutions.

Contact Tracing in States

COVID-19  continues to spread rapidly through the United States and states need a frontline force to fight  the spread. Critical components of this effort must  include increased testing and contact tracing which will require funding levels states can’t currently afford. Contact tracing is a data-driven and effective public health strategy to slow and ideally stop the spread of communicable diseases – including COVID-19. Through contact tracing, public health officials inform individuals if they may have been exposed to the virus and encourage them to isolate during the 14-day incubation period. Public health experts have substantial experience  in this method but few have ever had to ramp up a contact tracing program as quickly or to staff up to the levels this pandemic requires.

States under both Republican and Democratic leadership are ramping up contact tracing because it is a critical component to beginning to reopen schools and businesses while limiting the  spread of Coronavirus. Technology can aid in contact tracing efforts, but contact tracing requires significant human capital in order to maintain daily communication with individuals who may have been infected. In addition, technology-based contact tracing tools should be vetted carefully to ensure they maintain appropriate privacy protections for individuals. 

United States of Care has called on Congress to significantly increase its investment in contact tracing in the next federal COVID-19 relief package. In  addition, former Acting CMS Administrator and USofCare Board Chair Andy Slavitt joined with former Trump Administration FDA Commissioner Dr. Scott Gottlieb to lead a letter of bipartisan public health experts calling on Congress to invest $46.5 billion for contact tracing and self-isolation.  Congressional leaders are currently developing the next round of federal COVID-19 response and contact tracing is likely to be a critical component of the next effort. USofCare has also recommended state policy makers continue to make investments in contact tracing as legislatures return in the coming weeks  to complete their work.  

Nearly all states are conducting contact tracing for COVID-19 in some capacity. However, their approaches are dictated not only by the spread of the disease in their state, but also resources available to conduct contact tracing.  States are approaching contact tracing in a variety of ways:  

• Hiring or Reassigning State and Local Government Employees
• Contracting with Outside Vendors
• Deploying the National Guard
• Recruiting Volunteers
• Utilizing  Technology

United States of Care is monitoring state action on contact tracing and also connecting  leaders with models and resources to support their contact programs.  The document below highlights ways states are ramping up contact tracing programs to keep their residents safe. 

Hiring or Reassigning State and Local Government Employees

• In Washington, officials are scaling up their contact tracing program to be deployed by the second week of May with the goal of a 1,500 person workforce including 500 from the National Guard. Governor Inslee announced a COVID-19 risk assessment dashboard with five metrics to gauge when and how to best lift restrictions around his Stay Home, Stay Healthy order. The state’s ability to conduct contact investigations is one of those metrics.
• Utah is assembling state employee volunteers into eight- to 10-person contact tracing teams with a supervisor who can provide on-the-job training. 1,200 state employees have signed up to help with this effort.
• Alabama has reassigned staff from within its Health Department to increase its  capacity to conduct  contact tracing.
• California plans to build a coalition of at least 10,000 state-employees to do contact tracing and build on the robust tracing already taking place in 22 counties. The Newsom administration partnered with the University of California, Los Angeles and the University of California, San Francisco to provide 20 hours of online and in-person training to the employees selected to be re-deployed. 
• Tennessee re-trained 230 state employees idled by the pandemic as health investigators and announced plans to hire an unspecified number of additional workers in the coming days. 
• Missouri state health officials announced plans to work with colleges and universities to recruit new contact tracers. 

Contracting with Outside Vendors

• In early April, Massachusetts officials announced their launch of a large-scale contact tracing program called the Community Tracking Collaborative. They are working with a nonprofit health organization, Partners in Health, and budgeting $44 million to hire 1,000 people to investigate and record instances of potential COVID-19 transmission across the state. The collaborative has hired over 1,600 contact tracers from a pool of 30,000 applications. Several states have mentioned following Massachusetts’ lead including  New York and Illinois. 
• Ohio has also partnered with Partners in Health and will increase the number of contact tracers from a few hundred to possibly nearly 2,000.
• Indiana Governor Eric Holcomb announced the state is partnering with Maximus to centralize contact tracing and investigations for Hoosiers testing positive for COVID-19.
• Maryland signed a contract with NORC-University of Chicago to quadruple its contact tracing capabilities, enough to track as many as 1,000 new cases per day.

Deploying the National Guard

• Some states, including Washington, Rhode Island, West Virginia, and Iowa, are using emergency infrastructure and activating the National Guard for contact tracing work. 
• North Dakota launched a pilot project “Operation Drive-In” to expand COVID-19 testing and improve contact tracing, which also utilized the National Guard for support.

Recruiting Volunteers

• Oklahoma, North Dakota, and Sedgwick County, Kansas have been using medical and public health graduate students to conduct contact tracing in exchange for academic credit. 
• Kansas’ state health department is bringing on 400 volunteers plus 20 medical students  to help assist the state’s contact tracing work.
• Michigan’s Department of Health and Human Services announced the launch of a large-scale effort expanding contact tracing capacity through a public-private partnership, with more than 2,200 trained volunteers to aid local staff and 130 state agency staff in contact tracing. Michigan is recruiting volunteers with a background in public health, health care fields, or community organizing.  
• Arizona launched the Arizona Testing blitz. Its health department is augmenting its contact tracing workforce by: training state employees; working with university partners to utilize faculty, staff, and students from different concentrations (including public health, medicine, nursing, and social work); partnering with the CDC Foundation; and onboarding new employees to staff up to 40 teams of public health investigators that can be deployed statewide to augment local health departments’ efforts.

Utilizing Technology

• San Francisco is working with the state’s Department of Public Health, University of California San Francisco, and DIMAGI, to digitize a workflow to support contact tracing and monitoring of people who are potentially infected with COVID-19. 
• Rhode Island is partnering with SalesForce to create a secure database allowing the state’s Department of Health and the National Guard to conduct contact tracing 
• Several states including Colorado, North Dakota, South Dakota, and Utah, are using voluntary cell phone tracking as a step toward reopening their economies. 
  • In Colorado, people feeling sick can fill out an online form and provide cell phone information allowing the state to record their GPS data. In addition, the Colorado Department of Health and Environment is releasing survey data from the Colorado Symptom Tracker to target outbreaks and help direct contact tracing.
  • North Dakota and South Dakota are using Care 19, an app allowing phone users to record their own movements. 
  • Utah recently announced the beta launch of Healthy Together, a strictly opt-in app to augment current contact tracing efforts.
• Kansas is using a recently launched platform analyzing anonymized cell phone data to track the location of state residents. 
• Vermont Governor Phil Scott announced efforts to increase Vermont’s existing contact tracing program to 14 days prior to symptoms. The state currently has 53 trained contact tracers and is implementing a plan to train additional tracers as needed. Contact tracing staff will engage with cases and their contacts using SARA Alert technology, a text-based monitoring system, enabling the state to handle 300-900 cases and their contacts per week under this new strategy.