Effective contact tracing strategies for COVID-19: A municipal health department's model

ABSTRACT

Background: During the COVID-19 pandemic, contact tracing program as part of a larger epidemiological case investigation was effectively implemented by the local department of health in Paterson, NJ. The Paterson Communicable Disease Strike Team (PCDST) was established by leveraging skills and using existing public health staff of the health department team which led to a timely and robust public health intervention. Methods: PCDST comprised of 25 communicable disease investigators/contact tracers established in preparation for public health response in the event of large-scale communicable disease outbreaks pre-COVID. In March 2020 with initial COVID-19 cases in Paterson, PCDST was activated utilizing NJ DOH's Communicable Disease Reporting and Surveillance System (CDRSS). Additional staff members were cross-trained to augment team as new cases surged. A triage coordinator would identify and assign new cases to disease investigators at a 24/7 schedule. Disease Investigators would provide test results, perform epidemiological case interviews, elicit close contacts, and provide isolation/quarantine recommendations. Case-contact monitors followed up daily basis until completion of isolation/quarantine period. Results: As of June 15, 2020, 6537 cases tested COVID-19 (+) in Paterson, NJ. 91% of cases and their contacts were interviewed. Peak occurred in mid-April with 263 cases on a single day. By mid-June, daily number of cases declined to 7/day. Reported COVID-19 mortality rate in Paterson (4.65%), compared to surrounding towns in the same county of Passaic (6%), other large cities in New Jersey (Newark 8%, Jersey City 7.4%) and New Jersey state (7.59%). Conclusion: Despite limited resources, we were able to cross train and engage our frontline public health team (PCDST) to investigate and effectively contact trace new COVID-19 cases to help contain spread of infection. Although its unclear if our intervention impacted mortality rates, it is certain that contact tracing using a trained public health workforce is a model that has proven successful in Paterson. A local public health workforce vested in their communities can develop rapport needed to build trust and confidence in an intervention that elicits confidential medical information to limit viral transmission.