Contact Tracing for COVID-19: Domestic Policy Issues

Contact Tracing for COVID-19: Domestic Policy Issues

August 3, 2020
Contact Tracing for COVID-19: Domestic Policy Issues
Contact tracing is a classic tool of public health
usually request that exposed individuals voluntarily self-
investigation used to identify the close contacts of persons
quarantine and may conduct regular follow-up and/or
infected with a communicable disease, notify them of
facilitate housing and other support programs for
potential exposure, and enable control measures such as
quarantine. Experts generally advocate two approaches to
quarantining exposed persons. Contact tracing programs are
expanding U.S contact tracing—expanding the contact
generally subject to state, territorial, tribal, and local laws
tracing workforce and the use of new technologies to help
and policies. The U.S. Centers for Disease Control and
identify and notify potential contacts. Some domestic
Prevention (CDC) assists jurisdictions’ programs by
COVID-19 contact tracing efforts have faced initial
providing guidance, technical assistance, and funding.
challenges with individuals refusing to share information
with health departments, indicating potential individual
Several public health experts affiliated with universities
liberty and privacy considerations.
(e.g., Johns Hopkins University), policy research
organizations (e.g., American Enterprise Institute), and state
Workforce Considerations
associations (e.g., National Governors Association) have
Depending on the design of its contact tracing program,
posited that contact tracing (combined with adequate
jurisdictions may require an expanded workforce to conduct
diagnostic testing) could help prevent surges in infections,
interviews and manage contact tracing efforts. Johns
particularly when case counts are low. Contact tracing to
Hopkins University and the Association of State and
control Coronavirus Disease 2019 (COVID-19 has been
Territorial Health Officials have recommended between 4
used with arguable success in countries such as South
and 81 tracers per 100,000 population, based on level of
Korea, Taiwan, Iceland, and New Zealand—many attribute
illness in a given region.
their relatively low reported case counts, in part, to
successful contact tracing. However, several experts assert
Recruitment. Given the need to augment existing capacity,
that a successful contact tracing effort in the United States
several states have recruited paid and volunteer contact
would require additional workforce and possibly the use of
tracing staff from state employees, public health and
new technologies by jurisdictions. Federalism has led to
medical schools, AmeriCorps volunteers, and other
heterogeneous contact tracing efforts across states. As the
institutions. Some states have also worked with private
pandemic progresses, Congress may consider whether and
entities to manage contact tracing efforts. For example,
how to guide U.S. contact tracing efforts.
Indiana contracted with a private company, Maximus, to
manage a call center for contact tracing efforts.
What is Contact Tracing?
Contact tracing, a component of public health investigation,
Training. Contact tracers need specialized education and
is a core tool of communicable disease control. U.S.
skills, including an understanding of medical terms,
jurisdictions’ public health departments have used contact
knowledge of patient confidentiality requirements, and an
tracing to help control the spread of diseases like HIV and
ability to effectively interview and counsel patients. CDC
tuberculosis. Typically, when a confirmed case of a disease
has published online training for contact tracing programs.
is identified and determined to require a case investigation,
Several states have also implemented training programs in
public health departments contact the patient and conduct
partnership with non-profit organizations and universities.
extensive interviews to acquire information about persons
with whom the patient may have been in contact and
Contact tracing programs need individuals with varying
therefore possibly exposed to the disease. Those individuals
skill levels, including established public health experts to
are then notified by either the patient or the health
help manage programs as well as skilled tracers to contact
department and then referred for testing, prophylaxis,
and interview individuals. Jurisdictions may also consider
and/or treatment (if available) or asked/required to self-
the need for cultural competence and ability to engage with
quarantine (depending on the applicable jurisdiction’s laws
diverse communities affected by COVID-19, such as skills
and policies). Contacts are usually informed by health
in non-English language proficiencies.
departments of a potential disease exposure, but are not
given the identity of the individual who exposed them.
Technology Considerations
A challenge in traditional contact tracing is the difficulty
COVID-19 Specific Considerations
patients have comprehensively recalling close contacts,
Given that COVID-19 spreads easily from person to person
even with the assistance of trained public health workers.
and can be transmitted by asymptomatic individuals,
COVID-19 patients may be infectious long before receiving
controlling COVID-19 may require more robust contact
a positive test result, and thus may need to recall weeks of
tracing capacity than existed in many jurisdictions prior to
close contacts. Tools that use digital technologies to
the pandemic. In addition, given the lack of available
automate this aspect of contact tracing have been
vaccines or prophylaxis for COVID-19, health departments
developed, though their adoption in the United States has
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Contact Tracing for COVID-19: Domestic Policy Issues
been uneven. CDC has issued guidance to aid jurisdictions
by state rather than federal law. State law related to the
in choosing and implementing these tools.
privacy and security of data collected in the course of
contact tracing efforts varies. An overview of federal
Location and proximity-tracking. Technologists have
privacy law as it applies to digital contract tracing data is
been working to create smartphone-based applications
covered in CRS Legal Sidebar LSB10511, COVID-19:
(apps) to augment conventional contact tracing and
Digital Contact Tracing and Privacy Law.
notification. These use location or proximity tracking to
identify who has had close contact with infected individuals
Funding
during a specific window of time. Location tracking apps
Congress has appropriated funding in several supplemental
collect time and physical location data using Global
measures that can support contact tracing efforts by
Positioning System (GPS), cell tower, or Wi-Fi signals,
jurisdictions and the CDC. Funding available for
while proximity tracking apps use the exchange of
grants/cooperative agreements with jurisdictions for public
Bluetooth signals between devices to establish contact.
health programs (that can involve contact tracing as one
Apple and Google have developed a protocol to allow apps
component) include not less than $950 million P.L. 116-
developed by public health departments to work across both
123, not less than $1.5 billion in P.L. 116-136, and not less
Android and Apple operating systems. They have chosen
than $11 billion in P.L. 116-139. Additional CDC funding
not to support location data collection to address privacy
in the supplemental measures could also be used. For an
and security concerns. Contact tracing and notification apps
overview of CDC supplemental funding see CRS Report
have been adopted in several nations and some U.S. states,
R46353, COVID-19: Overview of FY2020 LHHS
with mixed results. For more information, see CRS In
Supplemental Appropriations.
Focus IF11559, Digital Contact Tracing Technology:
Overview and Considerations for Implementation.
Issues for Congress
If Congress considers contact tracing an important
Adoption. Contact-tracing apps require broad adoption and
component of the federal response to COVID-19, it may
self-reporting by infected individuals to be effective.
consider the following:
Researchers estimate that 80% of U.S. smartphone users
(56% of the population) need to use an app to effectively
Leadership and coordination. Currently, most contact
control COVID-19. Various polls estimate a range of 50%-
tracing efforts—including workforce and technology
60% of the U.S. population are willing to use a contact
components—are led by jurisdictions with guidance,
tracing app. One poll estimated that 29% of the U.S.
assistance, and funding from CDC. Congress may consider
population would be willing to share location data. Existing
whether the federal government should play a bigger role in
state app programs face adoption challenges. For example,
coordinating contact tracing efforts across jurisdictions and
as of June 24, 2020, 4% of North Dakota’s population was
helping standardize tools and practices.
using its tracking app.
Trust. Reports from existing efforts indicate difficulty
Effectiveness. Some experts have argued that technologies
obtaining needed information from individuals or
relying on only “exposure notification” would not be
encouraging technology adoption. Congress may consider
adequate for slowing COVID-19 spread, as they may not
how to facilitate public trust in contact tracing, such as by
allow for epidemiological analyses of cases necessary for
nationwide education and awareness efforts.
public health interventions. Rather, they argue that location
data is needed, along with building or improving states’
Privacy and security. Congress may consider whether new
data management systems. Some argue that public health
federal authorities related to the privacy and security of data
programs should consider other measures if digital
collected in the course of contact tracing are needed.
technology solutions are not widely accepted.
Several introduced measures address data privacy, as
discussed in CRS Legal Sidebar LSB10501, “Tracing
Other technologies. Several states currently use SaraAlert,
Papers”: A Comparison of COVID-19 Data Privacy Bills.
an open-source automated tracking and reminder system. It
Constitutional issues related to federal regulation of state-
allows public health departments to manage symptom and
collected data are discussed in CRS Legal Sidebar
contact data provided by patients and provide automatic
LSB10502, Constitutional Authority to Regulate the
notification, follow-up, and symptom reporting.
Privacy of State-Collected Contact-Tracing Data.
Individual Liberty and Privacy Considerations
Evaluation. States are employing many different contact
U.S. public health has long faced a tension between
tracing strategies, some of which may be more effective in
individual liberty considerations and measures required for
controlling disease spread than others. CDC has developed
population-level communicable disease control. Civil
a COVIDTracer tool to aid in evaluating approaches.
liberty and other groups have raised concerns that apps
Congress may consider how to ensure strategies are
tying location data to health data could be obtained by
adequately evaluated to help identify what works in the
malicious actors or used for broader government
United States and disseminate findings.
monitoring. A mistrust of government may also affect
traditional contact tracing efforts to collect information.
Kavya Sekar, Analyst in Health Policy
Laurie A. Harris, Analyst in Science and Technology
Contact tracing data security and privacy (collected by both
Policy
traditional means and by digital tools) is mostly governed
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Contact Tracing for COVID-19: Domestic Policy Issues

IF11609

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