The Evolving Use of Government Technology for Case Investigation and Contact Tracing During the COVID19 Pandemic

Christie Clement, Chief, Public Health Services, Oakland County

Christie Clement, Chief, Public Health Services, Oakland County

Technology can significantly impact a local health department’s success in preventing and controlling communicable diseases like COVID-19. Case investigation and contact tracing are front and center in managing communicable disease outbreaks and pandemics. When conducting case investigation and contact tracing during a pandemic, public health staff gather large volumes of information and data, make sense of it and issue guidelines for containing and preventing a disease from spreading. Technology provides solutions to managing this information and data and supporting the large team of investigators to stay updated and on task.

Oakland County Health Division, the local public health department in Oakland County, Mich. maximized use of existing electronic platforms, and customized other technology products to manage case investigation and contact tracing efforts required for tens of thousands of COVID-19 cases. The primary system local public health agencies in Michigan use for disease investigations is the Michigan Disease Surveillance System (MDSS), launched in 2001 for reporting and surveillance of communicable diseases by local and state public health agencies. Discontinuing phone and paper-based reporting and using MDSS allowed for real time surveillance and much faster reporting and responding to emerging communicable diseases and potential outbreaks.

Prior to the COVID-19 pandemic, Oakland County Health Division’s 9-person Communicable Disease (CD) unit successfully managed several outbreaks, including a large measles outbreak in 2019 using MDSS. When initial Oakland County COVID-19 cases were reported, the CD unit conducted case investigation and contact tracing for each case and reached out to all close contacts immediately. Quickly, cases dramatically increased, and this practice model became unmanageable. Additional staff from throughout the health division and County– nurses, environmental health sanitarians, health educators, clerical staff, and others – were re-assigned to assist with pandemic response. It was “all hands-on deck”.

With this sudden influx of staff joining the CD COVID Case Investigation/Contact Tracing (CI/CT) team, training became the challenge - how to get everyone trained quickly and working in an area unfamiliar to them. The first step was utilizing an existing platform used at OCHD similar to Zoom called Blue Jeans. This allowed for large-scale staff trainings to ensure they were trained and proficient in case investigation and contact tracing as quickly and efficiently as possible. This included how to gain access to and use systems such as MDSS, OMS , and Sharepoint. These virtual trainings occurred at least weekly beginning in April 2020 and continued with the current, smaller COVID CI/CT team.

As the CI/CT team grew, so did Michigan Department of Health and Human Services (MDHHS) team and other locals throughout Michigan. These large teams meant exponentially more users in the MDSS, placing quite a burden on the system, resulting in crashes and extremely slow work at times. While the MDHHS team worked tirelessly on upgrades and system enhancements, local health departments like OCHD looked at how technology could help improve case investigation and contact tracing.

“With this sudden influx of staff joining the CD COVID Case Investigation/Contact Tracing (CI/CT) team, training became the challenge - how to get everyone trained quickly and working in an area unfamiliar to them”

Finding a solution for assigning cases and contacts to a very large case investigation/contact tracing team working remotely was crucial. Initially printed case report forms were used, which required staff to come into the office and created more work to manage large volumes of paper. The solution selected was Sharepoint,an existing secure, webbased site accessible to all county employees with an email and password. Daily spreadsheets listing cases were uploaded to Sharepoint and team members accessed the site securely from home, assigned themselves cases, and completed case investigations.

At this time, a state platform called Outbreak Management System (OMS) was used to list close contacts. This required a cumbersome process of writing close contacts names, closing MDSS, opening OMS and entering the information into that system. A separate team of contact tracers would monitor OMS and contact each close contact to advise on quarantine and perform daily symptom monitoring.

While MDHHS was looking for a more seamless solution to manage the ever-growing volume of close contacts, OCHD was doing the same. The staffing needed to make an initial call to close contacts, then make daily contact for the quarantine period was proving very difficult.

OCHD explored customizing existing technology being used for other purposes - (eMocha) and Qualtrics survey platform. Due to Qualtrics’ ability to quickly customize surveys to needed specifications, Oakland County selected this system to manage close contacts and discontinued using OMS. The Qualtrics’ product allowed for entering close contact information into a simple web-based survey form that exported to a secure Qualtrics dashboard. From here, contact tracers assign themselves close contacts, make an initial phone call, and arrange for automated daily symptom monitoring via text or email.

During the lulls and even into the second wave of the pandemic, these systems – MDSS, Sharepoint, Qualtrics and internal processes allowed an expanded CI/CT team that included over 100 Oakland County staff and 30 contracted staff to reach almost all cases and close contacts. A new staffing challenge emerged in late 2020.

Beginning December 2020 OCHD began vaccinating, which meant diverting staff to work vaccination clinics 7-days a week. This situation collided with the 3rd wave starting, resulting in less staff time available for case investigations and contact tracing, and more cases and contacts to reach. Since many cases were associated with several close contacts, there were thousands of people to reach. OCHD worked with Qualtrics to quickly adopt an automated text message system that sent a text to each close contact, thereby eliminating the initial phone call from a contact tracer. Attempting to reach every contact swiftly and provide important information on quarantine, testing resources, and symptom monitoring was no longer reliant on how many staff were working on contact tracing.

Meanwhile, MDHHS worked with a company called Patient Education Genius (PEG) to assist reaching out to and obtaining case information and close contacts for each person diagnosed with COVID-19. Every morning, newly reported COVID-19 cases are exported from MDSS to the PEG dashboard. PEG then sends a case investigation interview survey and links to COVID-19 educational materials to each case via text or email. Case investigators attempt to reach cases who do not respond to the survey. The PEG system allowed for attempting to contact 00% of reported cases within 24 hours of being reported.

Currently, with cases dramatically lower, the CI/CT team consists of eight contracted nurses. All other OCHD CI/ CT team members have returned to their usual roles at the health division. The CI/CT team is able to reach out to each reported case and close contact to complete case investigation and contract tracing in a timely, efficient manner using technology.

SharePoint