How did an urban academic medical center design and implement a volunteer-staffed COVID-19 contact tracing initiative in collaboration with the local health department?
In this case series of nearly 5000 health system patients and their close contacts, volunteer contact tracers played a key role in delivering infection control guidance and resources (eg, food and medication deliveries) needed for patients to safely isolate or quarantine and interrupt chains of transmission. Of 3324 participants who completed a questionnaire on unmet social needs, 27% needed assistance with securing basic resources to follow infection control guidance, and this was more common among Black than White cases and contacts.
These findings suggest that in addition to delivering outpatient and inpatient medical care, health systems may play important roles in prevention during public health emergencies working in collaboration with local health departments.
The COVID-19 pandemic has claimed nearly 6 million lives globally as of February 2022. While pandemic control efforts, including contact tracing, have traditionally been the purview of state and local health departments, the COVID-19 pandemic outpaced health department capacity, necessitating actions by private health systems to investigate and control outbreaks, mitigate transmission, and support patients and communities.
To investigate the process of designing and implementing a volunteer-staffed contact tracing program at a large academic health system from April 2020 to May 2021, including program structure, lessons learned through implementation, results of case investigation and contact tracing efforts, and reflections on how constrained resources may be best allocated in the current pandemic or future public health emergencies.
Design, Setting, and Participants
This case series study was conducted among patients at the University of Pennsylvania Health System and in partnership with the Philadelphia Department of Public Health. Patients who tested positive for COVID-19 were contacted to counsel them regarding safe isolation practices, identify and support quarantine of their close contacts, and provide resources, such as food and medicine, needed during isolation or quarantine.
Of 5470 individuals who tested positive for COVID-19 and received calls from a volunteer, 2982 individuals (54.5%; median [range] age, 42 [18-97] years; 1628 [59.4%] women among 2741 cases with sex data) were interviewed; among 2683 cases with race data, there were 110 Asian individuals (3.9%), 1476 Black individuals (52.7%), and 817 White individuals (29.2%), and among 2667 cases with ethnicity data, there were 366 Hispanic individuals (13.1%) and 2301 individuals who were not Hispanic (82.6%). Most individuals lived in a household with 2 to 5 people (2125 of 2904 individuals with household data [71.6%]). Of 3222 unique contacts, 1780 close contacts (55.2%; median [range] age, 40 [18-97] years; 866 [55.3%] women among 1565 contacts with sex data) were interviewed; among 1523 contacts with race data, there were 69 Asian individuals (4.2%), 705 Black individuals (43.2%), and 573 White individuals (35.1%), and among 1514 contacts with ethnicity data, there were 202 Hispanic individuals (12.8%) and 1312 individuals (83.4%) who were not Hispanic. Most contacts lived in a household with 2 to 5 people (1123 of 1418 individuals with household data [79.2%]). Of 3324 cases and contacts who completed a questionnaire on unmet social needs, 907 (27.3%) experienced material hardships that would make it difficult for them to isolate or quarantine safely. Such hardship was significantly less common among White compared with Black participants (odds ratio, 0.20; 95% CI, 0.16-0.25).
Conclusions and Relevance
These findings demonstrate the feasibility and challenges of implementing a case investigation and contact tracing program at an academic health system. In addition to successfully engaging most assigned COVID-19 cases and close contacts, contact tracers shared health information and material resources to support isolation and quarantine, thus filling local public health system gaps and supporting local pandemic control.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: July 13, 2022.
Published: September 23, 2022. doi:10.1001/jamanetworkopen.2022.32110
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Feuerstein-Simon R et al. JAMA Network Open.
Corresponding Author: Rachel Feuerstein-Simon, MPA, MPH, Center for Public Health Initiatives, University of Pennsylvania, Anatomy Chemistry Bldg, Rm 145, 3620 Hamilton Walk, Philadelphia, PA 19104 (firstname.lastname@example.org).
Author Contributions: Ms Feuerstein-Simon had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Feuerstein-Simon, Strelau, Naseer, Claycomb, Kilaru, Lawman, Watson-Lewis, Klusaritz, Van Pelt, Nelson, Hall, Weigelt, Summers, Paterson, Aysola, Thomas, Meehan, Merchant, Volpp, Cannuscio.
Acquisition, analysis, or interpretation of data: Feuerstein-Simon, Strelau, Naseer, Claycomb, Kilaru, Lawman, Van Pelt, Penrod, Srivastava, James, Aysola, Lowenstein, Advani, Merchant, Cannuscio.
Drafting of the manuscript: Feuerstein-Simon, Strelau, Naseer, Hall, Weigelt, Cannuscio.
Critical revision of the manuscript for important intellectual content: Feuerstein-Simon, Strelau, Claycomb, Kilaru, Lawman, Watson-Lewis, Klusaritz, Van Pelt, Penrod, Srivastava, Nelson, James, Summers, Paterson, Aysola, Thomas, Lowenstein, Advani, Meehan, Merchant, Volpp, Cannuscio.
Statistical analysis: Feuerstein-Simon, Naseer.
Obtained funding: Feuerstein-Simon, Cannuscio.
Administrative, technical, or material support: Feuerstein-Simon, Strelau, Naseer, Claycomb, Lawman, Klusaritz, Van Pelt, Penrod, Srivastava, James, Hall, Weigelt, Summers, Paterson, Aysola, Thomas, Advani, Meehan, Merchant, Volpp, Cannuscio.
Supervision: Feuerstein-Simon, Naseer, Klusaritz, Van Pelt, Nelson, Aysola, Volpp, Cannuscio.
Clinical work: Lowenstein.
Conflict of Interest Disclosures: Dr Merchant reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.
Funding/Support: The W.W. Smith Charitable Trust provided support for the salaries of Ms Feuerstein-Simon and Dr Cannuscio to facilitate management of the overall project.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: Dr Lawman contributed to this study in her own capacity, not on behalf of Novo Nordisk.
Additional Contributions: The work described in this study was made possible by 160 volunteers who generously donated thousands of hours to respond to the COVID-19 pandemic. Their tenacity, flexibility, and commitment undoubtedly helped slow the spread of COVID-19 in Philadelphia. Volunteers received no financial compensation. We would also like to thank the W.W. Smith Foundation for their generous support, which provided funding for 2 staff members.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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