Building case investigation and contact tracing programs in U.S. state and local health departments: a conceptual framework

The COVID-19 pandemic and earlier health events have demonstrated that when effectively implemented, case investigation and contact tracing (CI/CT) can break chains of transmission by promptly identifying, quarantining, and monitoring the contacts of infected cases, thereby limiting further spread of a disease in a community. Many public health experts agree that implementing CI/CT at the early stages of an outbreak can be an extremely effective approach to controlling an outbreak; as such, health departments must have CI/CT capacities in place prior to the detection of an outbreak to ensure readiness to respond. At the onset of the COVID-19 pandemic, and to this day, U.S. state and local public health departments lack comprehensive CI/CT guidelines that clearly define the capabilities, capacities, outcomes, and impacts of CI/CT programs. This research has resulted in the first comprehensive analysis of the goals, capabilities, and capacities of CI/CT programs, as well as a conceptual framework that represents the relationships between these program components and considerations. Our findings highlight the need for further guidance to assist U.S. state and local public health departments in shifting CI/CT program goals as outbreaks evolve. Moreover, training the public health workforce on making decisions around CI/CT program implementation during evolving outbreaks is critical to ensure readiness to respond to a variety of outbreak scenarios. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB) reviewed and designated study protocol (IRB No. 00019635) "exempt" and "not human subjects research.” I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors