COVID-19 Case Investigation and Contact Tracing Programs and Practice: Snapshots From the Field.

Between Fall 2020 and Spring 2021, the Association of State and Territorial Health Officials conducted 2 rapid queries to collect information from the field regarding the status of COVID-19 case investigation and contact tracing (CI/CT) programs and practice. These short surveys were distributed to senior deputies in state and territorial health agencies, yielding a response rate of 45.8% (November 2020) and 40.7% (April 2021). Findings indicated that CI/CT staff roles and assigned functions varied across jurisdictions, as did staffing levels/capacity, approaches for linking individuals to social supports, and program changes that were planned or underway. Agency-reported staffing levels/capacity and programmatic challenges changed over time, highlighting the dynamic nature of CI/CT program practice and implementation. While findings from the surveys cannot be generalized to the national level, they provide critical insights from the field on CI/CT program implementation, challenges, and changes in response to the evolving COVID-19 epidemic in the United States.

COVID-19 Case Investigation and Contact Tracing: Early Lessons Learned and Future Opportunities.

CONTEXT: Case investigation and contact tracing are fundamental public health strategies for controlling and preventing the spread of infectious diseases. Although the principles behind these strategies are not new, the capacity and operational requirements needed to support disease investigation during the SARS-CoV-2 (COVID-19) pandemic are unprecedented. This article analyzes the implementation of case investigation and contact tracing in controlling COVID-19 transmission during the early stages of the US pandemic response (January 20 through August 31, 2020). PROGRAM IMPLEMENTATION: Governmental public health agencies mobilized to expand case investigation and contact tracing programs in the early months of the pandemic. In doing so, they encountered a range of challenges that included rapidly scaling up the workforce; developing and subsequently revising guidance and protocols specific to COVID-19 as more was learned about the virus over time; defining job functions; encouraging public acceptance of and participation in case investigation and contact tracing; and assessing the utility of these activities during both the containment and mitigation phases of outbreak response. COVID-19 case investigation and contact tracing programs presented an array of opportunities for health departments to innovate, especially around technology to support public health efforts, as well as opportunities to address health equity and advance community resilience. CONCLUSION: Lessons learned from disease intervention specialists, guidance and resources from federal agencies and national partners, and peer-to-peer exchange of promising practices can support jurisdictions encountering early implementation challenges. Further research is needed to assess COVID-19 case investigation and contact tracing program models and innovations, as well as strategies for implementing these activities during containment and mitigation phases.

National Alliance for Radiation Readiness: Leveraging Partnerships to Increase Preparedness.

The National Alliance for Radiation Readiness (NARR) is an alliance of 16 national member organizations that have banded together to serve as the collective "voice of health" in radiological preparedness through: • participation in national dialogues on radiological emergency issues; • provision of thoughtful feedback on documents, policies, and guidelines; and • convening of partners to raise awareness of and resolve radiological emergency issues. NARR benefits from the intersection and interaction of public health, radiation control, healthcare, and emergency management professionals--all with an interest in bolstering the nation's preparedness for a radiological or nuclear incident. NARR is able to provide a unique perspective on radiological and nuclear preparedness by creating multi-disciplinary workgroups to develop guidance, recommendations, and provide subject matter feedback. NARR aims to build response and recovery capacity and capabilities by supporting the sharing of resources and tools, including technical methods and information through the development of an online clearinghouse. NARR also aims to identify and disseminate best practices, as well as define and educate on the roles and responsibilities of local, state, and federal government and the numerous agencies involved with the response to a radiological emergency.

Building the legal foundation for an effective public health system.

Work has been underway nationally since the mid-1990s to equip state and community public health systems with the infrastructure needed to perform essential public health services. Key components of that infrastructure are a competent workforce, information and communication systems, health department and laboratory capacity, and legal authorities. As part of this transformative work, standards and assessment tools have been developed to measure the capacity and actual performance of public health systems. In addition, a number of states have examined the legal foundation for public health services and have revised and updated those authorities to improve their system's capacity in the context of evolving health challenges. Among those states are Nebraska, New Jersey, and Texas, all of which, beginning in 1999, have adopted dynamic new approaches to aligning public health's legal authorities with new missions and expectations for performance and accountability. This article describes the approaches that these three states have taken to strengthen their legal foundation for public health practice, to illuminate the perspectives legislators and health officials bring to the process, and to give decision makers in other states practical insight into the potential benefits of reviewing and restructuring public health's legal authorities. The underlying stimuli for the states' initiatives differed significantly, yet shared an important, common core. What they held in common was concern that outdated elements of the public health system and infrastructure hindrered delivery of essential public health services at the community level. Where they differed was in the type of tools they found most suitable for the job of rejuvenating those structures. The approaches taken, and the policy tools selected, reflect the unique health needs of each state, establish relationships among state and community health authorities and agencies, and provide guidance by elected and appointed policy makers. Each state continues to refine its approach as it gains experience with the new authorities.