COVID-19 Contact Tracing in Two Counties - North Carolina, June-July 2020.

Contact tracing is a strategy implemented to minimize the spread of communicable diseases (1,2). Prompt contact tracing, testing, and self-quarantine can reduce the transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (3,4). Community engagement is important to encourage participation in and cooperation with SARS-CoV-2 contact tracing (5). Substantial investments have been made to scale up contact tracing for COVID-19 in the United States. During June 1-July 12, 2020, the incidence of COVID-19 cases in North Carolina increased 183%, from seven to 19 per 100,000 persons per day* (6). To assess local COVID-19 contact tracing implementation, data from two counties in North Carolina were analyzed during a period of high incidence. Health department staff members investigated 5,514 (77%) persons with COVID-19 in Mecklenburg County and 584 (99%) in Randolph Counties. No contacts were reported for 48% of cases in Mecklenburg and for 35% in Randolph. Among contacts provided, 25% in Mecklenburg and 48% in Randolph could not be reached by telephone and were classified as nonresponsive after at least one attempt on 3 consecutive days of failed attempts. The median interval from specimen collection from the index patient to notification of identified contacts was 6 days in both counties. Despite aggressive efforts by health department staff members to perform case investigations and contact tracing, many persons with COVID-19 did not report contacts, and many contacts were not reached. These findings indicate that improved timeliness of contact tracing, community engagement, and increased use of community-wide mitigation are needed to interrupt SARS-CoV-2 transmission.

Public Health 3.0 at Mecklenburg County Public Health.

One of the key recommendations from the CDC for achieving Public Health 3.0 is access to timely, reliable, granular-level, and actionable data. An organization must build its informatics capacity to bridge the clinical and technological aspects of health for the 21st century. This is an evolving realm of technology and will continue to have public health and health care implications.

Transforming Health Through Multisector Partnerships.

Communities across the state are working to develop systems of health that will improve population health and reduce costs. A number of models are being explored. Regardless of the model, efforts will be most effective if they include multisector partnerships, focus on socioeconomic issues, and explore ways to reframe the system.

The case for integrated health improvement.

Health, clinical, and regulatory factors are driving significant change in health and health care, leading to an increased emphasis on cost, quality, and results. To improve the well-being of all populations, we must focus on connectivity within a functional, community wide network of diverse partners.

Applying the model for improvement in a local health department: quality improvement as an effective approach in navigating the changing landscape of public health practice in Buncombe County, North Carolina.

In local health departments across the nation, problem solving and rapid change occur every day. Often, the results of these changes or problem-solving techniques may not be studied or evaluated fully to determine whether desired results were achieved. In fact, program evaluation, research, and technical assistance at the local level may be reduced or eliminated in many states during a time of rapidly diminishing resources and increasing demand for public health services. In delivering population-level programs, quality improvement (QI) methods may provide a much-needed alternative and more efficient approach than traditional research and evaluation to help answer public health practice questions such as "How do we know when a project or program really works, and, more importantly, how can we do it better?" This article focuses on the Buncombe County Department of Health's (BCDH's) experience utilizing a QI approach called the model for improvement (MFI), incorporating plan-do-study-act cycles and small tests of change, on a specific H1N1 influenza-awareness public health preparedness communication project. In addition, results of the BCDH's participation in QI initiatives and training resulted in success implementing change in other areas of the health department including decreasing wait time and addressing a backlog of prenatal visit appointments from 54 to 15 days, and more than doubling prenatal history efficiency uptake in a 5-week period. These case studies in the BCDH present how the MFI introduced the foundation of a culture of continuous QI within the organization.