EDITORIAL PANEL : Chad T . Rodgers , MD , FAAP | Elena M . Davis , MD , MPH | Shannon Edwards , MD | William L . Mason , MD | J . Gary Wheeler , MD , MPS | Beth Milligan , MD , FAAFP , CHCQM , CPE
Physician ’ s Role in COVID-19 Contact Tracing
KRISTINA BONDURANT , PHD , MPH , ANITA JOSHI , BDS , MPH AND NATHAN RAY , MBA
The COVID-19 pandemic
presents many challenges to the public health and medical community . Current systems are expanding to meet the need of a rapidly evolving emergency infectious disease situation . Pandemic influenza plans have informed response and mitigation efforts while well-established infectious disease measures were implemented on a large population-wide scale . Tenets of an infectious disease public health response include testing , isolation of infected individuals ( index cases ) and quarantine of exposures individuals ( direct contacts ).
One critical public health measure is the rapid identification of positive index cases through testing . Once an index case is identified , investigation begins to collect demographics , household information , workplace and other exposures , travel history , contacts with the index case , and promptly placing the index case in isolation . Identifying and informing close contacts to the index case and quarantine efforts along with close monitoring for symptoms is the next priority for stopping the spread of COVID-19 .
According to the Association of State and Territorial Health Officials ( ASTHO ), contact tracing is the process of identifying , assessing , and managing people , or “ contacts ,” who have been exposed to a disease to prevent additional transmission . 1 The four main objectives for COVID- 19 contact tracing are identifying and notifying contacts , determining extent of exposure , establishing risk and providing quarantine guidance . All objectives require the establishment and use of specific criteria to define cases , contacts , and exposures . The setting of epidemiological definitions to standardize criteria is important and should always include the three classical epidemiological variables of person , place , and time . For example , based on current knowledge , the Centers for Disease Control and Prevention ( CDC ) defines a close contact for COVID-19 as someone who was within 6 feet of an infected person for 15 minutes or longer starting from 48 hours before illness onset until the time the patient is isolated ( i . e . during the case ’ s infectious period ). 2
Contact tracing has a long history in response to infectious disease outbreaks . Recent efforts worldwide for contact tracing include mobile device app solutions for COVID-19 and text messaging solutions for rapid identification of index cases and potential hot spots ; however , privacy concerns have limited the use of several systems within the United States . 3
The Arkansas Department of Health ( ADH ) has contracted with two vendors , including Arkansas Foundation for Medical Care ( AFMC ) to conduct case investigation and contact tracing for the state . The case investigators make initial contact with index cases and the contact tracers collect essential contact information ( direct contacts with dates of exposure ) which is utilized to reach individuals who may have been exposed to COVID-19 . As efforts evolve and progress , the amount of time from case investigation to reaching of direct contacts has reduced through the streamlining of case investigation and contact tracing processes . There are several factors that contribute to and can be used to measure effectiveness of the contact tracing process , including the amount of time to reach an
108 • The Journal of the Arkansas Medical Society www . ArkMed . org