Volume 30, Number 2—February 2024
Dispatch
Adapting COVID-19 Contact Tracing Protocols to Accommodate Resource Constraints, Philadelphia, Pennsylvania, USA, 2021
Table 2
Characteristic | Period 1, before protocol change | Period 2, after protocol change |
---|---|---|
Calculated CICT effectiveness values | ||
% Case-patients and contacts isolated because of CICT (range)† | 17 (11.7–21.9) | 10 (6.7–12.5) |
Days from infection to isolation‡ |
9 |
8 |
Model-estimated CICT effectiveness | ||
No. cases averted by CICT | 657–968 | 1,156–1,609 |
No. hospitalizations averted by CICT | 16–24 | 28–40 |
% Disease prevalence averted by CICT | 8.4–12.0 | 6.8–9.2 |
Average staff hours per case averted§ | 21–30 | 8–11 |
Average staff hours per 1% disease prevalence averted¶ | 1,661–2,358 | 1,397–1,892 |
*CICT, case investigation and contact tracing. †Including contacts who later become case-patients. Calculated as follows using the observed performance metrics (Table 1), assumed compliance with isolation and quarantine guidance among cases and contacts (Appendix Table 1), and an assumed k = 1.2: [(% case-patients interviewed × compliance) + k × % contacts identified × (% contacts monitored × compliance + % contacts notified but not monitored × compliance)] / (1 + k), where k is approximated from the effective reproduction number (Rt), because undetected infected contacts will infect Rt additional persons on average. During the evaluation period, the average Rt in Philadelphia was 1.29 during periods 1 and 0.99 during period 2. If the assumed compliance was 100%, the estimated effectiveness could be as high as 26% for period 1 and 15% for period 2. ‡The average length of time from infection to isolation and quarantine between case-patients and contacts who later became case-patients. We assumed a 5-day presymptomatic period. We further assumed that interviewed case-patients and notified contacts began isolation and quarantine the day after their interactions with the health department (Appendix). §Calculated by dividing the total staff hours by the estimated number of cases averted by CICT. Lower value represents a more cost-effective program, given that it requires fewer staff hours to prevent each case. ¶Calculated by dividing the total staff hours by the estimated proportion of disease prevalence averted by CICT. Lower value represents a more cost-effective program, given that it requires fewer staff hours to prevent each percentage of disease prevalence.
1These first authors contributed equally to this article.
2These senior authors contributed equally to this article.
3Current affiliation: Novo Nordisk, Philadelphia, Pennsylvania, USA.