CDC no longer recommends universal contact tracing, case investigation

The CDC no longer recommends universal COVID-19 case investigation and contact tracing, instead encouraging health departments to now prioritize those efforts for high-risk settings.

The guidance, updated Feb. 28, comes nearly two years after the agency called for 100,000 U.S. contact tracers to mitigate virus spread.  

Now the CDC is pushing health departments to focus solely on high-risk settings, such as long-term care facilities, jails and prisons, and shelters. Case investigation and contact tracing are separate processes, and decisions to begin either should be made separately, according to the CDC. Investigations should focus on COVID-19 cases and close contacts with exposures in the previous five days for groups at increased risk. Health departments should also offer COVID-19 vaccinations, education and other prevention strategies as part of case investigation and contact tracing efforts.

"The updated guidance is in response to changes in the nature of the pandemic and the increasing availability of new tools to prevent transmission and mitigate illness," Kristen Nordlund, spokesperson for the CDC, said March 1. She said the change was driven by the dominance of variants with short incubation periods and rapid transmissibility, along with high levels of immunity from infection or vaccines and the wide availability of vaccines for most ages.

"This is a big change," Crystal Watson, DrPH, senior scholar at Baltimore-based Johns Hopkins Center for Health Security, told The New York Times March 1. "It does reflect what's already happening in states and localities, particularly with omicron. There was no way contact tracing could keep up with that. Many of the cases are not being reported, so there's no way of knowing the incidence."

Dr. Watson, lead author of a 2020 report recommending the U.S. have 100,000 contact tracers, said she was concerned the new guidance could lead to a dismantling of the infrastructure implemented to support contact tracers.

"We anticipate that there will be a need for contact tracing," Dr. Watson said, "so some of the investments made in rebuilding the public health workforce should be used more broadly so we can call on them in the next emergency."

"I actually think that the federal government move is consistent with what states are doing," Hemi Tewarson, executive director of the National Academy for State Health Policy, told the Times. "They're already concentrating contact tracing on high-risk settings."

"As a longer-term plan, this is going to be more sustainable," she said. "We're at a different stage of the pandemic." 

 

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