Partner Call: Case Investigation and Contact Tracing

>> Hi everyone My name is Tiffany Fell, and I would like to welcome you to today’s CDC partner update call on COVID-19 This call serves as a way for CDC to share weekly updates on COVID-19 and our latest resources and guidance Today’s call will focus on case investigation and contact tracing guidance and tools First we will hear from the Medical Officer on the CDC COVID-19 Emergency Response He will describe where we are with the response and give us insight, recent scientific findings Then we will hear from a CDC scientist who will provide insights into tools and resources for COVID-19 contact tracing and case investigation And afterwards, our speakers will answer questions we received over the last week via email If you experience technical difficulties, or otherwise would like to review today’s call, you can find the recording on and on YouTube in 8 to 10 days All past other calls can be found there So please take time to review and share prior recordings If this is your first webinar with us, these calls occur every Monday at 3 P.M. Eastern Please see the link on the slide to subscribe and receive future call invitations Please note this call is not intended for media, although we welcome the media who may be here today Should media have questions, we invite you to reach out to Also we will have two short polls One now, and another at the end of the presentation to give feedback about the effectiveness of these calls Please answer the poll now as we get started, and then at the end before we start the Q and A sections These calls are designed to share the latest science, guidance, and resources from CDC’s website There are over 2,000 documents providing information and guidance for individuals, businesses, and the public on In addition to the resources we’ll discuss today, please check out these recent web additions First we have the Household Pulse Survey, which is a resource from the National Center for Health Statistics that captures data on mental, social, and economic health during the pandemic Second is the MMWR on allergic reactions that occurred after people received the first round of the Pfizer-BioNTech COVID-19 vaccine I would also like to share some updated guidance for ride share, taxi, limo, and other passenger driver-for-hire Finally we have our CDC COVID vaccine data tracker, which shares updated totals on vaccine distribution and administration I encourage you to check out the science update and MMWR pages when you have a few minutes There’s always something interesting to learn there So now please stay joined today by two CDC experts on the COVID-19 response Dr. Cliff McDonald is a medical officer serving in support of the Chief Medical Officer on the CDC COVID-10 Emergency Response, and Dr Melanie Taylor is a Deputy of the State, Tribal, Local, and Territorial Task Forces COVID-19 Contact Tracing Innovations Support Unit Now let me turn it over to Dr. McDonald for some updates >> Thank you Tiffany, and welcome to everyone joining us today My name is Dr. Cliff McDonald, and as mentioned I’m a medical officer serving in support of the Chief Medical Officer for the Response Today I would like to provide a brief update on the response and review some of the latest scientific developments First a situational update on cases and deaths You can see from the slide that both cases and deaths are increasing One important statistic here is that the weekly average of cases over the last 7 days is 18% greater than the previous week’s average This is a significant weekly increase in case counts Since three months ago on October 5th, when cases were nearly 43,000 per day, cases have increased 566% to about 243,500 per day It should also be noted that the weekly average of deaths over the past 7 days has increased significantly with a 19% increase over the previous week’s average These statistics provide us with very valuable information When these percentages are decreasing, this tells us that mitigation efforts are working When case counts increase, this tells us that we need to step up mitigation efforts to slow the spread of COVID-19 It is also important to note that there is increasing evidence that some racial

and ethnic minority groups, particularly Black or African American, Hispanic or Latino, and American Indian or Alaska Native people are being disproportionately affected by COVID-19 Inequities in the social determinants of health such as poverty and healthcare access affecting these groups are interrelated, and influence a wide range of health and quality of life outcomes and risks We encourage you to visit CDC’s data tracker for the latest stats and COVIDView for weekly summary of key indicators for the pandemic New this week I want to share some of what we’ve learned recently from three reports, two of which were summarized in the COVID-19 Science Update, and the third of which was reported in CDC’s Morbidity and Mortality Weekly Report, or MMWR In the interest of time, I will only briefly touch on the high points of these reports, and I encourage you to visit to read the full reports The December 22nd Science Update entitled Prevented — under the section, I’m sorry — under the section Prevention, Mitigation, and Intervention Strategies describes a peer-reviewed study on the safety and efficacy of the Pfizer-BioNTech COVID-19 vaccine This report included a total of 43,548 participants who underwent randomization, of whom 43,448 received injections Twenty-one thousand seven hundred and twenty with Pfizer-BioNTech BNT162b2 vaccine, and 21,728 who received placebo There were 8 cases of COVID-19 with onset at least 7 days after the second dose among participants assigned to receive the vaccine, and 162 cases among those assigned to receive placebo, or who received placebo BNT162b2, the vaccine candidate, was 95% effective in preventing symptomatic COVID-19 Similar vaccine efficacy was observed across subgroups defined by age, sex, race, ethnicity, baseline body mass index, and the presence of co-existing conditions Among 10 cases of severe COVID-19 with onset after the first dose, 9 occurred in placebo recipients, and one in a vaccine recipient Adverse reactions to the vaccine included short-term [coughs] — excuse me — mild to moderate pain at the injection site, fatigue, and headache [coughs] Excuse me The incidence of serious adverse events was low, and was similar in the vaccine and placebo groups Please see the link for more info Second in the December 22nd Science Update In Brief, there was a study that shows — reported a study that shows that the SARS-CoV virus spread rapidly in the Brazilian Amazon, and that without mitigation efforts, widespread infection can occur The attack rate is an estimate of the final size of a largely unmitigated epidemic A sample of blood donors showed that by June, one month after the epidemic peak in Manaus, the capital of the Amazonas state, 44% of the population had detectable antibodies Correcting for cases without a detectable antibody response and antibody waning, the authors estimate a 66% attack rate in June rising to 76% of all individuals in October This is higher than in Sao Paulo in southeastern Brazil, where the estimated attack rate in October was only 29% These results confirm that when poorly controlled, COVID-19 can infect a high fraction of the population resulting in a high mortality Please see the link here for more information Finally in the January 8th MMWR, there was a report on the nexus between participation and fraternity and sorority activities, and the spread of COVID-19 among residential communities at universities and colleges From previous studies, we know that preventing COVID-19 in colleges and universities requires mitigation strategies addressing on- and off-campus congregant living settings, extracurricular activities and social gatherings At the start of the 2020-2021 academic year,

COVID-19 cases increased rapidly at an Arkansas university Analysis indicated that 91% of gatherings were associated with fraternity or sorority activities, and that recruitment events held virtually were associated with fewer cases than those held in person Results from this study showed that given the potential for rapid COVID-19 transmission in on- and off-campus settings and activities, colleges and universities should work with local health departments and student organizations to ensure compliance with mitigation guidelines Check the link for more details Before we move to today’s speaker — speakers, I would like to remind everyone that the flu season is here With rare exceptions, the CDC recommends annual flu vaccination for everyone 6 months of age or older I encourage everyone on the call to get your flu shot, and to support flu vaccination efforts within your organizations Although we recommend that people get the flu vaccine earlier in the flu season, it is not too late for the flu vaccine to provide benefit so that even now remains a great time to get the flu vaccine With that, it is now my pleasure to hand you over to Dr. Melanie Taylor >> Thank you very much Dr. McDonald My name’s Melanie Taylor I’m a medical officer in the Contact Tracing and Innovations Section, and today I’m going to give you a tour of the case investigation and contact tracing guidance and tools for use in the United States This will be a brief overview with the idea that I won’t be able to go into any great depth on any individual tool, but to know that these can be used The slides that will be available and can be used as a resource and a reference But the specific context which is needed So this will be — this is the overview of what I’ll be presenting today We can go ahead and advance to the next slide I would like to start out by describing the CDC’s role and approach to case investigation and contact tracing This is summarized in this document And it describes the core principle of contact tracing during the COVID-19 pandemic We recognize that different states and jurisdictions are facing surges in cases and every jurisdiction prioritizes case investigation and contact tracing differently, but CDC continues to recommend case investigation and contact tracing as a component of the COVID-19 response And this document includes a list of the tools and resources for which I’ll be describing Next slide This resource specifically highlights basic principles of case investigation and contact tracing to stop COVID-19, and it provides detailed guidance for health departments And it also helps to support the improvement of the skill sets of case investigators and contact tracers Next slide Next I will advance into describing some of the more specific guidance document And the first is our anchor, or our resource of what we consider the case investigation and contact tracing bible This is the Interim Guidance on Developing a COVID-19 Case Investigation and Contact Tracing Plan It’s intended for health departments and it includes the primary recommendations of testing all close contacts, quarantine or isolation of those infected or exposed to COVID-19, and it also includes other standardized guidance This document is frequently updated, and continues to evolve to reflect evolving program science Next slide I’ll now walk through some of our recent updates to different guidance definitions and different situations The first I would like to describe is the definition of the infectious or transmission period And we define this period as the time period of 48 hours or two days before a person has any symptoms of COVID-19, or 48 hours or two days before the person tests positive if they are asymptomatic This is important to understand, because we are in a situation where CDC is also encouraging persons diagnosed with COVID-19 to identify and notify their own close contacts that they may have been exposed Next slide Additional guidance that was updated in December of 2020 include the definition of a close contact Our CDC guidance includes — states that a person should be considered a close contact if they have been within 6 feet of an infected person for more than a cumulative of 15 minutes At least 15 minutes, cumulative not consecutive And this time, the time interval of 24 hours was selected based on the consideration of the dynamics of viral shedding And also there are other factors that should be considered when defining a close contact,

which can be found in the guidance, and that guidance is located in the website below We recommend that contacts be quarantined for the period of 14 days, and that persons with COVID-19 be isolated for 10 days, and I’ll explain that further Next slide Also in December we updated our guidance to reflect options to reduce quarantine for contacts who are exposed to COVID-19 or SARS-CoV-2 And this is based on the option that recognizes that local public health authorities of course have a final decision to make about how long quarantine should last, but based on local conditions and need, there are options to shorten quarantine And these are after 10 days without getting tested for COVID-19 or after Day 7 after receiving a negative test result that was collected, a specimen collected on Day 5 or later CDC continues to endorse 14 days when possible as an ideal quarantine period Next slide As I mentioned at the beginning, most all states and jurisdictions are experiencing surges in COVID-19, and we recognize that case investigation and contact tracing in this setting and circumstance are very challenging In December we released Principles for Prioritization of Case Investigation and Contact Tracing that focus on four key groups The first group is related to those cases and contacts, cases that are — for which diagnosis reports are received within 6 days of specimen collection to the health department And those persons or contacts that have been exposed to COVID-19 that are within the past 6 days of being named by the individual case interviewed — during the individual case interview The second group are household contacts, with a focus on those that have been diagnosed with COVID-19 in the past 6 days, and also preventing outbreaks in clusters with a focus on clusters and other groups of persons and people living or working and visiting congregant settings, recognizing these venues and situations as opportunities for expansive spread And then finally to protect people at an increased risk for COVID-19, both acquisition or poor outcomes due to — and these include persons older adults, people with certain medical donations, and other concerns that are listed in this guidance document Next slide Also in December, we released Guidance on Expanded Screening and Testing to Reduce the Silent Spread of SARS-CoV-2, recognizing the persons with asymptomatic and pre-symptomatic infection are significant contributors And this document includes considerations for groups to be prioritized for expanded screening and testing, outlines and follow-up steps for persons who test positive, and this document emphasizes the importance of sustaining and reinforcing other principle mitigation measures, including masks, hand hygiene, social distancing, and limiting all gatherings outside the immediate household in addition to case investigation and contact tracing Next slide CDC has specific contact-specific guidance on case investigation and contact tracing And I will present a few of these The first is a document that provides considerations for how employers can partner with state, tribal, local, or territorial health departments and work with their employees to support case investigation and contact tracing Next slide In November 2020, we released guidance for case investigation in kindergarten through 12th grade schools, and this guidance is intended to help administrators of these schools plan for the development and implementation of on-site case investigation and contact tracing in their schools And the guidance also highlights the potential collaboration between health officials in K through 12 school administrators that facilitate case investigation and contact tracing Next slide Similarly in November, we released Interim Guidance for Case Investigation and Contact Tracing in Institutes of Higher Education, which include universities and other higher education learning systems And this also has similar information as that for the K-12 document, however it does recognize different situations such as social distancing in classrooms, dining halls, campus housing, and additional testing strategies that can be implemented Next slide CDC also has guidance for persons that are part of the public health system Those public health workers that are engaged in public health activities that require face-to-face interactions with clients in clinic and field settings And this includes activities for other disease control programs such as tuberculosis, STDs,

and other infectious disease activities that would require outbreak or contact investigation, home visits or partner services Next slide In October, CDC related special guidance focusing on populations of refugee immigrant, migrant populations, and these considerations for health departments that are notable and unique to this specific population And this website is also available in Spanish, and it’s intended for public health officials — health departments, and community-based organizations to address the specific and special needs of refugee, immigrant, and migrant populations Next slide Next I will advance and describe some of the contact tracing implementation guides and tools for the public health workforce CDC has tried to be prescriptive and adaptive regarding the needs of the local health jurisdictions in providing as many templates and resources as possible This is one example of templates that have been provided to assist health departments in supporting staffing We recognize that many health departments are facing incredible increases in cases, and that many health departments may need to support surge staffing in order to maintain basic levels of case investigation and contact tracing This is a suite of job template descriptions And each job position includes a position summary, a list of essential functions, and the work environment and physical requirements of these jobs And so these are located here, and these can be used for jurisdictions to adapt and recruit and build their case investigation and contact tracing teams Next slide In addition to those types of tools, we have contact tracing implementation tools, which are checklists that can be used by health departments to — that correspond with the interim guidance on case investigation and contact tracing And the idea is that users can easily assess the inclusion of essential guidance components when they are working with their — or developing their case investigation contact tracing plans at their health department And then we have more specific guidance that can be used for self-isolation and self-quarantine, the home assessment list And these again are found at the website located at the bottom of the slide, as are all of these resources Each are linked to a website Next slide Community engagement is critical to the success of case investigation and contact tracing And CDC has developed a community engagement checklist with 6 priority elements related to increasing health equity, promoting social connection, and strengthening partnerships But also engaging and building trusting relationships with the community This guidance document is recommended to help build that trust such that persons have better connection and participation in case investigation and contact tracing Next slide I would like to mention that that document is available in Spanish as well Next we have an example of COVID-19 prioritization questions for non-healthcare worksite assessments by state, tribal, and local, and territorial departments And this is intended to help prioritize worksite assessments, and information sources that might include one or more employees of the company such as human resources, occupational staff, or safety professional Next slide We also have a WICAR tool The WICAR tool is interim and it’s customizable It’s a non-healthcare workplace infection control assessment, and it’s intended to assist health departments, employers, and occupational safety and health professionals with assessing their workplace infection prevention plans, and to develop controlled programs and practices in these non-healthcare workplaces Next slide CDC has developed a step-by-step or checklist for key information to collect during the case interview This is intended to be used as a training tool but also by case investigators so that the standard amount of information can be collected in order to complete a case investigation, and this includes contact elicitation Next slide As a follow-up to this, an even more specific script for case investigation has been developed It’s called — and it’s included in Talking With the Patient And this guide provides suggested language when interviewing a case from incorporating the principles in case investigation such as developing that very critical trust and rapport in order to elicit contacts Next slide And what follows from that is a script for notifying contacts The language that can be used to reach out and notify contacts of their exposure, and to help them understand their need to quarantine

It also includes suggested communication — suggested communication approaches as well as cultural nuances, exposure sites, and capture of epidemiologic data which is so important in understanding the effectiveness of contact tracing Next slide Here I’ll present two schematics that can be used for training and understanding the process and workflow of investigation and contact tracing This is an easy-to-follow outline of the case investigation and contact tracing process, and also the schematic depicts the case investigation workflow from the timing of diagnosis all the way through to patient interview and referral for care Next slide Similarly, we have a case contact tracing workflow And this schematic describes the same or similar process for tracing contacts Once the contact has been named by a case, the information is then reported to the local health authority, and the person is contacted and notified of their exposure and recommended to quarantine Next slide CDC provides a daily temperature/symptom log that can be used by persons that are in either isolation or quarantine, but it’s intended for those close contacts that are in quarantine so that they can monitor their symptoms as well as check in as needed if they do develop symptoms during that time period Next slide CDC has developed a technical assistant’s note for use by health department when they need to transfer a COVID-19 case or contact tracing record between jurisdictions And the idea is to prevent loss of follow-up due to inter-jurisdictional case diagnosis and contact tracing Next slide Now I will advance and speak briefly about some of our contact tracing case investigation and contact tracing evaluation tools We have the COVIDTracer and COVIDTracer Advanced which was just released approximately two weeks ago The COVIDTracer is a very important tool, a modeling tool, that allows for the input of data at the jurisdiction or health department level that then tracks and estimates the intervention’s effectiveness in preventing COVID-19 cases as well as it can project prevention of COVID-19 deaths We recommend that health jurisdictions interested in this type of modeling of local data download and save the COVIDTracer manual, and use the COVIDTracer tool which is a spreadsheet-associated tool that allow state and health department officials and policy makers to compare the three different contact tracing and monitoring strategies in reducing the background burden of COVID-19 Next slide CDC collects a standard set of case investigation and contact tracing metrics We use a cascade-type approach to quantify the ability of local contact tracing programs to reach cases and contacts You can see here on this slide that the proportion of cases reached, the number of contacts elicited, and the proportion of contacts reached for self-quarantine and monitoring are the key elements in the evaluation of the effectiveness of case investigation and contact tracing All of these indicators are — should be done on a timely basis, and thus this cascade analysis is collected based on time-based indicators as well And these indicators are reported to CDC through the Epidemiology and Laboratory Capacity Project that is funded by the CARES Act And these indicators again are reported to CDC and analyzed by CDC, sent in by the individual health jurisdictions Next slide CDC has supported a number of training resources to employ and build the workforce capacity to deliver case investigation and contact tracing Next slide Specifically I will speak about two individual training elements The first is Making a Contact, which is a training for COVID-19 contact tracers This guidance and training is available as a web-based learning system And it is supported by CDC through our partner ASTHO, the Association of State and Territorial Health Officials The training is free It is a knowledge-based online training, and it is intended for use

as a preliminary course prior to the skills-based course that is supported by the National Network of Disease Intervention Training Centers The second training is an optional training that can be taken by persons completing the first training, Making Contact And this is a web-based training also, consisting of one week of one half-day sessions And these courses help to hone the communication and interview skills which are beneficial and essential for new and experienced case investigation — case investigators and contact tracers You can see that the websites are located there Again these trainings are free Next slide CDC also provides sample training plans, specifically curricula that can be downloaded and used Locally they can be adapted to local situations, and they can be used to help with training and maintain skill sets for contact tracers, case investigators, and team leads Next slide CDC goes further and provides case investigation and contact tracing guidance and training materials And this website provides kind of an overview of those resources available, and also detailed guidance for health departments and how to deliver specific contact tracing training Next slide As supplements to the contact tracing and case investigator training options and resources that CDC supports, we have guidance on the delivery of health department-related guides and these skills sets are intended to improve case investigators’ interviewing skills, and they are also available as — as a supplement to the contact tracing guidance Next slide We provide snapshots or examples of case investigation and contact tracing through scenarios, both for case investigation as well as contact tracing, and one specific example is how to respond in the situation of a disaster shelter as one specific situation that has been requested by health departments and developed by CDC Next slide CDC has developed numerous outwardly-facing public information documents, guidance tools, and media images for use in educating the general public about case investigation and contact tracing Next slide We maintain and frequently update a contact tracing resources webpage, and again this is intended to link to additional tools for use in specific situations and then among specific population It includes guidance documents, contact tracing information, communication resources, and additional information on digital tools for contact tracing In the next few slides, I will briefly update some of the specific CDC tools that are used — additional CDC tools that are used This is a very important landing site in order to reach out to some of the other guidance documents that I’ve been describing Next slide From that slide, you can then reach the communications toolkit slide And this interim toolkit was developed to specifically assist health departments in sharing information about case investigation and contact tracing with the public It includes a main message, examples of framing messages, talking to patients who have either been infected with COVID-19 or exposed to someone with COVID-19, and it contains examples public service announcements, social media posts, and frequently asked questions and answers This toolkit includes Facebook posts, Instagram links, and LinkedIn images that can be used and adapted to the local situation And all of this information is also translated into Spanish Next slide I will walk through some of these social media examples Thank you So the social media graphics and sample messaging — an example on this side shows two examples of what CDC has created And there are many more options that can be downloaded from the Communications Toolkit But you can see that these two demonstrate the scenario of a person exposed to COVID-19 being contacted by the health department And it also has several other images of case investigation and contact tracing

Next slide We also have a social media story for use on Instagram, and these social media platforms are an important part of CDC strategy to notify the public, so that they will be participants in the case investigation and contact tracing activities And this slide shows an example of a contact tracing Instagram story that was posted to CD’s — CDC’s website earlier in 2020 Next slide We also develop and maintain contact tracing infographics We also update these frequently to reflect most recent — the most recent guidance And this is a summary of the contact tracing process developed as an infographic so that we can develop some of the misconceptions and misinformation that continues to circulate about the contact tracing process, specifically related to privacy concerns and it also lays out what to expect if you’ve been exposed to someone with COVID-19 These resources are available in Spanish, Chinese, Vietnamese, Korean, and Marshallese And this graphic image was pulled and diversified for use across social media platforms such as Facebook, Twitter, and Instagram Next slide We also have information on what to expect while you’re waiting for your COVID-19 test results, and this resource explains what people specifically should do while they are waiting Again this particular infographic is available in five different languages Next slide We now have a one-minute contact tracing video that is available on YouTube that describes the process and what to expect during contact tracing The video addresses potential public health concerns related to security of information, and highlights that any information shared will be kept confidential It is also available as you can see from these images in Spanish Next slide In addition to the scenarios that I have presented earlier for use by public health investigators and contact tracers, we also have “what to expect” scenarios for the public And specifically these are developed as general contact tracing consumer pages, and the example here is the situation where a person has been exposed to COVID-19, what to do while they are waiting for the COVID-19 test results, and what to expect from contact tracing if you are diagnosed with COVID-19 Next slide CDC has developed and frequently updates frequently asked questions, and these frequently asked questions are for the general public, and they are specifically related to contact tracing In addition to these frequently asked questions, CDC has created contact tracing frequently asked questions for health departments And these FAQs can — are — describe the basics of contact tracing as well as digital tools that can be used for contact tracing as well Next slide And that leads me into a discussion and a presentation on some of the digital tools and exposure notification apps that we have available for use Next slide First we recognize that there are many different digital application and digital tools for use in contact tracing as well as exposure notification And CDC does not endorse any specific digital tool, however we do recognize that there are a basic set of criteria that should be minimal and preferred capabilities Next slide Specifically we recognize that the — these digital tools are varied and the uptake depends on the use and how successful these digital apps are is dependent on many factors And so CDC provides this minimum and preferred set of capabilities and capacity for these digital tools, whether they be developed locally or as part of a multi-state effort Next slide Now CDC supports the — supported the development of one specific tool, the Sara Alert and this has been used successfully in many health jurisdictions But we do recognize that the preliminary criteria for which the evaluation of digital contact tracing tools for COVID-19 be standardized And this document here provides this preliminary criteria, again defined as a minimum set of preferred characteristics and evaluation criteria that will help health departments to understand and overcome any obstacles And also to evaluate the effectiveness of this contact tracing scheme

Next slide As I mentioned briefly, CDC does endorse and did support the development of one specific contact tracing open source standard tool that supports the automated monitoring/reporting of COVID-19 close contacts Sara Alert is this tool It is available for — to health departments’ jurisdiction both at the state, tribal, and county level And CDC provides funding to mitre, to help implement that Next slide CDC provides a resource list for case investigation and contact tracing, and this is an inventory of all of the resources that I have described in this presentation such that they can be easily accessible, and they can be reached and accessed by website And then we also provide this list as a PDF document, and it should be available to those participating in the call today to allow them to access these resources that I have described Next slide This is a list of some of the additional guidance and references that were key references in — as primary landing documents that I described during this presentation And these are also located in that comprehensive list Next slide I would like to thank the conference organizers for allowing me to add this slide, and add it somewhat of a last-minute — and just to say that we do recognize that during this time period of vaccine rollout, there will be questions related to isolation and quarantine, as well as case investigation and contact tracing for those persons who have received the vaccine CDC is collecting information on a daily basis on data related to science involving the vaccine rollout, and the coverage of vaccine as well as the immunity that it stimulates However due to the dearth of information available at the moment, we need to wait for additional data prior to changing our recommendations related to case investigation and contact tracing, and also related to self-isolation if you are a case, and quarantine if you have been identified as a close contact We have made this evident on the three pages located at the bottom of that slide Specifically that we have not made any changes, and persons exposed or infected with COVID-19 should continue to isolate and quarantine using the currently available guidance I believe that’s my last slide, and I would just like to say thank you to everyone who has attended, and to the conference organizers for inviting me to speak Over >> Thank you Dr. Taylor for sharing those updates Next we will have our Q and A, but before we get started answering your questions, please take a moment and answer a couple of ours by taking the poll on your screen We received many great questions in advance, and we will get to as many of those as we can in the next 20 minutes or so OK. We’ll get started Our first question is for Dr. McDonald Can you please comment on the new strain of virus that has been discovered, and do we have any guidelines for this virus yet? >> Yes, I’d be happy to respond to this There are currently multiple SARS-CoV-2 variants circulating around the world Two in particular have been under significant discussion in the news recently One of these is the B.1.1.7 or the quote “UK” variant Although we don’t prefer to use that term And B.1.351 in South Africa Scientists are currently working to learn more about these variants to better understand how easily they might be transmitted, and whether currently authorized vaccines will protect people against them I want to emphasize that currently that these variants cause more severe illness or increase risk of death CDC is working with other public health agencies to monitor the situation, and detect — and to detect and characterize emerging viral variants Staff are also available to provide on-the-ground technical support to investigate the characteristics of variant infections We’d like to highlight the new CDC data tracker that shares in the information shown

in the window, that shares information on cases of variant B.1.1.7 by state in the United States We will continue to communicate new information as it becomes available >> Thank you Dr. McDonald Dr. Taylor, you mentioned a number of resources earlier that can provide guidance for contact tracing Does the CDC have any plans to develop an app for tracing in the U.S.? >> That’s a great question And as I mentioned before, while CDC does not endorse any specific digital tools, CDC has supported a web-based open source monitoring system for persons exposed to or with COVID-19 And CDC has been — and this is entitled Sara Alert And CDC has works with MIT and Lincoln Labs to support the use of proximity tracing, exposure notification phone applications To — these exposure notification apps are available for Apple and Google phone systems And you can see the links in the chat for some additional information and resources on these They are widely available, and they are widely used by individuals as well as health departments and local jurisdictions And if you require any additional assistance on these ITT platforms, or would like to ask questions about their implementation in your local area, we will provide an email address for you to reach out for that type of technical assistance Thank you >> Thank you Another question for you, Dr. Taylor What is the best way to conduct testing and contact tracing in congruent — I’m sorry — in congregant settings where populations are transient, and accurate recordkeeping for follow-up testing and contact tracing is challenging? >> Yes. This is indeed a challenge And thank you for this question We recognize this is a challenging context, and a venue to deliver contact facing homeless provider sites in particular can present unique challenges for COVID-19 case investigation and contact tracing Because these sites can be crowded settings, the virus may spread easily among clients, staff, and volunteers We also recognize that clients at homeless provider sites are often older adults They may have underlying medical conditions These may increase their likelihood of severe COVID-19 illness We have location-based contact facing, which of course involves sites visited by persons with confirmed COVID-19 during the time they were considered infectious And this can help identify additional facilities that might need investigation and testing In addition, to conduct location-based contact tracing, we recommend that persons with COVID-19 be interviewed who are experiencing homelessness about the locations where they may have been; where they remember have being starting at least 48 hours before their symptoms began, or if they did not have symptoms, 48 hours before they were diagnosed with COVID-19 as I presented on one of the earlier slides The locations that are likely to have more people in close contact for extended periods of time may require additional follow-up, and our recently released guidelines on testing recommend in some situations that screening be done among these particular situations and venues And we also recommend working with homeless service providers, and to use homeless management information systems and other data collection systems to identify where the person with confirmed COVID may have checked in during the time that they were infectious I hope that helps Thank you very much >> Thank you Dr. McDonald, we have enough evidence to state that the COVID-19 vaccines are safe for humans What is considered quote-unquote “safe”? Is the COVID-19 vaccination safe for people of child-bearing years? >> Let me begin by saying that COVID-19 can have serious, life-threatening complications, and there’s no way to know how COVID-19 will affect you, the infection that is If you get sick, you could also spread the disease to friends, family, and others around you With regards to pregnancy, pregnant people are at an increased risk for severe illness from COVID-19 and death compared to non-pregnant people and may even be at increased risk for other adverse outcomes such as pre-term birth All COVID-19 vaccines that are being used have gone through the same safety tests and meet the same standards as any other vaccine you can get at your doctor’s office Clinical trials of all vaccines must first show that they are safe and effective before any vaccine can be authorized or approved for use And this includes COVID-19 vaccines

The known and potential benefits of the COVID-19 vaccine must outweigh the known and potential risks of the vaccine for use under what is known as the Emergency Use Authorization, or EUA Getting COVID-19 may offer some natural protection known as immunity Current evidence suggests that re-infection with the virus that causes COVID-19 is uncommon in the 90 days after initial infection However experts don’t know for sure how long this protection lasts, and the risk of severe illness, death from COVID-19 far outweighs any benefits of natural immunity COVID-19 vaccination will help protect you by creating an antibody or immune system response without having to experience illness from infection >> Thank you Dr. Taylor, is CDC developing guidance for quarantine of vaccinated close contacts? And if so, when will it be available? >> Thanks I know this is a question that has come up frequently in some of our technical assistants’ requests CDC is evaluating the incoming data on a continuous basis Like I mentioned before, we don’t have a lot of data for this particular situation in context And if you have — currently we recommend that if you’ve been vaccinated for COVID-19, you should still follow existing CDC guidance on when and how long to self-isolate if you have COVID-19 or self-quarantine if you are close contact And just as a quick reminder, close contact is someone who is within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period, starting from two days before illness onset, or for asymptomatic patients, two days prior to test specimen collection This is what we define as the infectious period And this is up until the time the patient is isolated And as I mentioned before, we will continue to monitor the situation for information that could really lead to changes in our recommendations for quarantine of close contacts in this setting of vaccine rollout Thank you >> Thanks So adding on to something you just mentioned Dr. McDonald, if someone had COVID and recovered, can they get the virus again? And is the second time around more or less infectious? >> Well, cases of reinfection with COVID-19 have been reported, but they do remain rare at this time Based on what we know from similar viruses, to have some reinfection cases is not abnormal, and is to be expected Because we are still learning more about how soon reinfection can occur, and how severe these reinfections can be, the best method you can do right now to stay safe are to receive the vaccine if you are eligible, observe social distancing measures, wear a mask, and continue to practice good hygiene >> Thank you, Dr. McDonald CDC guidelines are clear about quarantining, but some local orders fluctuate on what is required from one time to another, based on surges and demands on healthcare facilities Do you have advice for employers who have employees saying their healthcare provider has quote “cleared” them to return to work in less than 14 days from them testing positive? >> Well, let’s start with workers who may have been exposed, but who have not yet taken a COVID-19 test To ensure continuity of operations of essential functions, CDC advises that critical infrastructure employees may potentially be permitted to continue to work following potential exposure to COVID-19, provided they remain asymptomatic, and additional safety practices are implemented to protect them and the community However, reintegrating exposed asymptomatic employees should not be misinterpreted as always being the first or most appropriate option to pursue Staying home may still be the most preferred and protective option for exposed employees Businesses have an obligation to limit, to the extent possible, the reintegration of in-person employees who have experienced an exposure to COVID-19 but remain symptom-free in ways that best protect the health of the employee, the co-employees, and the general public Re-integrating an exposed and asymptomatic worker should be used as a last resort and only in limited circumstances, such as when pausing the operation of a facility may cause serious harm or danger to public health or safety CDC recommends that any one who has had close contact with someone with COVID-19 should stay home for 14 days after their last exposure to that person unless the exposed individual has had a COVID-19 illness

within the previous three months and recovered and remains without COVID-19 symptoms If an employee tests positive for COVID-19, CDC advises that it is safe to be around others when 10 days have passed since symptoms first appeared, and they have had 24 hours with no fever, without the use of fever-reducing medications, and their other symptoms of COVID-19 are improving If the person was severely ill with COVID-19, they might need to stay home longer than the 10 days and up to 20 days after symptoms first appeared If the employee tests positive, but is asymptomatic, it is safe to be with others after 10 days have passed since they had a positive test for COVID-19 >> Thank you We’ll try to squeeze a couple more questions in Dr. Taylor, can you please explain what we should do when we are routinely screening our employees and someone receives a positive test but is otherwise asymptomatic? Does a full contact tracing need to be done? >> Thanks This is a good question, and as I mentioned earlier, CDC is still recommending case investigation and contact tracing for persons diagnosed with COVID-19 And COVID contact tracing should be performed in this situation, regardless of whether they have symptoms or not In fact we know that a large proportion of COVID-19 or SARS-CoV-2 transmission occurs from persons who are asymptomatic And two days is the window to use, specifically two days prior to the development of symptoms for those case who are symptomatic, but also two days for those asymptomatic cases, two days prior to the timing of the test collection date is the interval for use in determining the infectious period And that infectious period again is — we would look to identify all close contacts for two days prior to the date of specimen collection for those tests through the beginning of isolation And those persons should be elicited and notified of their potential exposure to a person who had COVID-19 And CDC encourages employers to collaborate with health departments when investigating workplace exposure to infectious diseases, including COVID-19 We ask for quick and coordinated actions including a case investigation and contact tracing because we know that this may lower the need for business closures to prevent the spread of the disease And we encourage employers to assist the health department by providing further identification of potential contacts who worked in that same area and on that same shift, or potentially in the same time, and hosting a site visit for health department personnel to observe the workplace, and to make workplace operation recommendations to help prevent further spread of the virus and facilitating communication with employees And as I mentioned earlier, we do have specific guidance for this situation regarding workplace situation recommendations and also workplace infection transmission risk, the WICAR tool And that was one of the slides that I presented Thank you >> Thank you, Dr. Taylor and Dr. McDonald I think that’s all the questions we’ll be able to get to today And so this concludes our time together We appreciate everyone for joining our call today A recording will be posted online on CDC’s COVID-19 webpage and on YouTube in a few days Slides will be included as well The subscription link to receive further updates and invitations is listed on the slide Thank you again Please join us next time on Monday, January 25th when our topic will be Engaging Faith Leaders, Advances Effective COVID-19 Responses: Lessons Learned Through Global Domestic Collaborations Until next time, happy new year, and be well