Objectives

We sought to (1) document how health departments (HDs) developed COVID-19 case investigation and contact tracing (CI/CT) interview scripts and the topics covered, and (2) understand how and why HDs modified those scripts. 

Design

Qualitative analysis of CI/CT interview scripts and in-depth key informant interviews with public health officials in 14 HDs. Collected scripts represent three distinct points (initial, the majority of which were timestamped May 2020; interim, spanning from September 2020-August 2021) current, as of April 2022.

Setting

Fourteen state, local, and tribal health jurisdictions and Centers for Disease Control and Prevention.

Participants

Thirty-six public health officials involved in leading CI/CT from 14 state, local, and tribal health jurisdictions (six states, three cities, four counties, and one tribal area)

Main Outcome Measure

Interview script elements included in CI/CT interview scripts over time.

Results

Many COVID-19 CI/CT scripts were developed by modifying questions from scripts used for other communicable diseases. Early in the pandemic, scripts included guidance on isolation/quarantine and discussed symptoms of COVID-19. As the pandemic evolved, the length of scripts increased substantially, with significant additions on contact elicitation, vaccinations, isolation/quarantine recommendations, and testing. Drivers of script changes included changes in our understanding of how the virus spreads, risk factors and symptoms, new treatments, new variants, vaccine development, and adjustments to CDC’s official isolation and quarantine guidance.

Conclusions

Our findings offer suggestions about components to include in future CI/CT efforts, including educating members of the public about the disease and its symptoms, offering mitigation guidance, and providing sufficient support and resources to help people act on that guidance. Assessing the correlation between script length and number of completed interviews or other quality and performance measures could be an area for future study.