Universal case investigation and contact tracing are not recommended. This tool can be used to interview priority cases.
A successful case interview allows for the collection of critical information about a person diagnosed with COVID-19 and exposed contacts, while providing support, referrals, and answers to questions the person may have. The goals of the case interview are to assess the person’s medical condition, gather information for continued monitoring and support, and obtain the names and locating information of people who may have been exposed to COVID-19 (close contacts).
The interview process should be more than just checking off boxes on a case report form. Developing trust and an empathetic rapport, while maintaining a professional relationship with the person, is key to providing the most effective support and collecting the most accurate information to inform the next steps in the contact tracing investigation.
Case investigators and contact tracers have a primary purpose of preventing further spread of COVID-19 through timely identification of cases and contacts to isolate or quarantine if indicated. Prompt case investigation and contact tracing should remain the primary goal of the case investigation and contact tracing workforce. These public health workers can also help connect people to important services and resources, such as COVID-19 vaccination.
This document provides suggested communication strategies for COVID-19 case interviews. Scripts may need to be modified to address locality-specific needs, including but not limited to highlighting available resources, cultural nuances, exposure sites, and the capture of epidemiological data. Appendix A includes a table to assist case investigators in thinking about the various exposure sites where people with COVID-19 may have interacted with close contacts. Interviewers should use what is helpful and the best fit for the interaction; all questions or statements may not be required, and additional probing questions may be necessary. Programs are encouraged to share best practices in framing and phrases as they are identified.
Language is important. Language sets the stage to build rapport with people with COVID-19 and opens the door to honest dialogue. It is critical to establish open communication with people diagnosed with COVID-19 so that they feel comfortable disclosing the names and location information of their close contacts. Open communication also helps people express their needs to safely isolate and helps them feel comfortable seeking help if their COVID-19 symptoms worsen.
When supportive statements and genuine concern are combined with active listening and open-ended questions, powerful information can be gathered to interrupt the spread of the virus. Asking open-ended questions prompts a dialogue and elicits more detailed information. Oftentimes, the information is helpful in learning more about the person and their circumstances. Remember, each person is unique, and this is not intended as a script. The interviewer should carefully listen to responses and add or subtract questions as appropriate.
Aims: Introduce yourself and establish credibility. Verify the person’s information, build rapport, address confidentiality.
Note to Case Investigator: Prompt case investigation and contact tracing should remain the primary goal of the case investigation and contact tracing workforce. Case investigators and contact tracers can proactively educate and link people to COVID-19 vaccine services. They can explain vaccine eligibility, answer questions, dispel myths, and assist with vaccine scheduling.
Case investigators are already engaging with people with COVID-19 to encourage them to isolate, monitor their symptoms, and seek information on other people who may have been exposed to COVID-19 (contacts). Case investigators can also emphasize the importance of obtaining a COVID-19 vaccine once someone has recovered from COVID-19. Case investigators can follow-up to help make linkages to vaccine services or facilitate vaccine appointments. When soliciting information about people who may have been exposed to COVID-19 (contacts), case investigators can emphasize the ways they can connect people to vaccine services and share resources. This may serve as an additional incentive for people to provide information on their contacts.
When contact tracers reach out to people who have been exposed to COVID-19 (close contacts) to encourage testing and explain the importance of staying home (quarantine), they can also discuss the importance of obtaining a COVID-19 vaccine when the person has completed quarantine. Contact tracers can follow-up after COVID-19 testing to help make linkages to vaccine services or facilitate vaccine appointments on the spot for people who test negative.
To assist with access to vaccination services, case investigators should have information related to vaccine and booster eligibility, safety, and availability. This includes access to:
Introduction
Verifying Identity
Confidentiality and Privacy
Reason for Call
Q&A with Person Exposed to COVID-19
Aims: Verify demographic and locating information. Establish the best way to reach the person. Obtain information on who resides with the person. Acquire emergency and alternate contact numbers.
Note for Case Investigator: Identify vulnerable populations through case management and surveillance databases, if available.
Introduction
Demographics
Locating and Contact Information
Work
Emergency Contact
Aims: Disclose positive test result or verify knowledge of COVID-19 diagnosis. Gain insight regarding the person’s knowledge of COVID-19. Provide disease-specific information and guidance for how to manage and assess COVID-19 symptoms, onset, and duration to develop a baseline for medical monitoring and contact elicitation window. Assess underlying health conditions that the person may have that place them at higher risk for disease complications.
Introduction
Reason for Testing/Health Care Visit
Verifying Testing Information
Let’s talk about your test results.
Verifying Vaccination Status
If Respondent Says “Yes”: Which vaccines have you received?
If Respondent Says “No” or Reports Receiving 1 Dose Out of a 2-Dose Series:
Disease Comprehension
Symptoms of COVID-19
COVID-19 can cause a variety of symptoms. Some COVID-19 symptoms can seem like a common cold, others are more severe, and sometimes people have no symptoms. Please let me know if you have had any of the following symptoms and when they started. [Note to Case Investigator: See Appendix B for a table of COVID-19 symptoms, with space to indicate onset and duration. This information can help to identify people who will need to be referred for medical evaluation due to current symptom presentation.]
[If yes, contact already seen by healthcare provider]
[If contact not yet seen by healthcare provider]
[For all people with symptoms]
Underlying Health Conditions and Other Risk Factors
What You Can do if You are at Higher Risk of Severe Illness from COVID-19
Recommendations on How to Manage Symptoms at Home
10 things you can do to manage your COVID-19 symptoms at home
What to do if you are sick
Q&A with Person with COVID-19
Aims: Cooperatively establish a plan to monitor health status daily. Discuss importance of daily monitoring and develop a clear plan to access medical services should the need arise.
Introduction
Monitoring Agreements and Tools
Responding If Symptoms Get Worse
Medical Provider and Other Support While Sick
Q&A with Person with COVID-19
Aims: Discuss parameters and importance of isolation recommendations. Assess the person’s concerns and resources to enable safe and healthy isolation. Cooperatively identify potential areas for support and referral.
Note to Case Investigator: All people (independent of vaccination status) with positive diagnostic test results should isolate at home or, if in a healthcare setting, be placed on appropriate precautions.
Most people with recent exposure, who have symptoms consistent with COVID-19 should get tested. While waiting for test results, they should isolate or stay away from others, including staying apart from those living in their household. (See If You Are Sick). People who are fully vaccinated have a low risk of infection. Infection risk is also low for people who have been diagnosed with and recovered from COVID-19 within the last 90 days. However, if these people experience symptoms consistent with COVID-19, they should stay at home (isolate) and be clinically evaluated for COVID-19, including SARS-CoV-2 testing, if indicated.
Details on ending isolation are located at CDC’s Ending Home Isolation
Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:
Exceptions to these standard recommendations for discontinuation of isolation may include
Ensure familiarity with state, tribal, local, and territorial (STLT) recommendations, policies, and procedures regarding discontinuation of isolation and return to work exceptions. Isolation support resources and referrals should be modified to reflect STLT policies and procedures and locally relevant information and resources.
Introduction
You will need to limit your interactions with people in your household. When interacting with others in your household, you should wear a mask over your nose and mouth. Your caregiver should also wear a well-fitting mask when caring for you. Children under age 2 or anyone who has trouble breathing should not wear a mask. Regularly wash your hands and follow other measures outlined in the CDC guidance. [Note to Case Investigator: Case Investigators should verbally review updated CDC guidance with the person during the interview and send information in a link or handout afterward.]
Assessing Concerns
Assessing Living Situation
Assessing Other Supports
Release from Isolation
When you can be around others (end home isolation) depends on different factors for different situations.
[Note to Case Investigator: Jurisdictions can find additional information on the discontinuation of isolation in CDC’s Contact Tracing Guidance.]
There are several ways you can look for vaccination providers near you.
Disclosure Coaching
Q&A with Person Exposed to COVID-19
Aims: Discuss parameters and importance of contact elicitation. Assess and alleviate the person’s concerns. Elicit close contacts who may have been exposed to COVID-19. Identify congregate living and work environments with potential exposure.
Note to Case Investigator: Contact elicitation should be conducted for all contacts (regardless of vaccination status)—determination of next steps with contacts includes assessment of symptoms, and verification of vaccination and/or testing.
Case investigators should compute the contact elicitation window: the time period for which close contacts, other people (contacts) who may be exposed to COVID-19, and activity history should be elicited. This timeframe includes both the infectious period and the source investigation period.
*All possible symptoms should be considered, with particular attention to those that may be mild and/or nonspecific (e.g., fatigue, muscle pain) and those less common.
For each contact elicited, step through a list of identifying, locating, and risk questions. (See Appendix C and Appendix D.) For elicitation of venues where exposure may have occurred see Appendix A and Appendix E.
Introduction
Discussing Contact Elicitation Window
Household Contacts
Workplace
People, Places, Activities and Events
Aims: Discuss importance and benefits of getting vaccinated. Assess person’s concerns and resources. Cooperatively identify potential areas for support and referral.
Note to Contact Tracer: Refer to CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States and Different COVID-19 Vaccines webpage for information on vaccine eligibility. Information that may be helpful to guide the discussion includes
To assist with access to vaccination services, contact tracers should have information related to vaccine eligibility, safety, and availability. This includes access to:
The following script is relevant for persons who are not up to date on vaccines.
Aims: Check-in on agreements. Answer remaining questions. Set stage for follow-up.
Check-in, Questions and Agreements
Acknowledging the Difficulty and Keeping the Door Open for Contact
Appendix A
This table is intended to assist case investigators in thinking about the various exposure sites where the person may have interacted with close contacts.
Please note this list is not inclusive of all possible types of contacts or exposure sites.
Type of Contacts
Type of Contacts
Locations
Locations
Household
Household
Place of residence
Place of residence
Family, Friends, and Social Acquaintances
Family, Friends, and Social Acquaintances
Family gatherings, social residential gatherings, exercise/workout settings, hiking outings, camping trips, hunting or fishing trips, cooking classes, yoga classes, dance classes, other enrichment classes, book club meetings, birthday
parties, baby showers, weddings, funerals, barbeques, weekend getaways, block parties, holiday potlucks, vacations, visits to family or friends at nursing home/group home, etc.
Family gatherings, social residential gatherings, exercise/workout settings, hiking outings, camping trips, hunting or fishing trips, cooking classes, yoga classes, dance classes, other enrichment classes, book club meetings, birthday
parties, baby showers, weddings, funerals, barbeques, weekend getaways, block parties, holiday potlucks, vacations, visits to family or friends at nursing home/group home, etc.
Transportation and Travel
Transportation and Travel
Lyft, Uber, carpool, bus, commuter van, light rail, train, airline travel, cruise, etc.
Lyft, Uber, carpool, bus, commuter van, light rail, train, airline travel, cruise, etc.
Workplace— Colleagues/Customers
Workplace— Colleagues/Customers
Businesses, meetings, conferences, restaurants, shops, clients’ homes (for example, carpenter, electrician, plumber), factories, hair salons, etc.
Businesses, meetings, conferences, restaurants, shops, clients’ homes (for example, carpenter, electrician, plumber), factories, hair salons, etc.
Community
Community
Schools, child care centers, grocery stores, drug stores, shops/shopping malls, restaurants, coffee shops, hardware stores, banks, worship centers, movie theaters, sporting events, concerts, bars/brewhouses, night clubs, libraries, bowling alleys, bingo halls, barber shops, hair salons, nail salons, brow or eyelash salons, day spas, tattoo shops, piercing shops, yoga studios, gyms, street fairs, festivals, county/state fairs, animal shelters, airports, polling
locations, etc.
Schools, child care centers, grocery stores, drug stores, shops/shopping malls, restaurants, coffee shops, hardware stores, banks, worship centers, movie theaters, sporting events, concerts, bars/brewhouses, night clubs, libraries, bowling alleys, bingo halls, barber shops, hair salons, nail salons, brow or eyelash salons, day spas, tattoo shops, piercing shops, yoga studios, gyms, street fairs, festivals, county/state fairs, animal shelters, airports, polling
locations, etc.
Health Care
Health Care
Hospitals, emergency rooms, physician offices, dialysis centers, laboratories, dentist offices, pharmacies, ambulance transports, chiropractors, physical therapy centers, etc.
Hospitals, emergency rooms, physician offices, dialysis centers, laboratories, dentist offices, pharmacies, ambulance transports, chiropractors, physical therapy centers, etc.
Congregate Living and Other Shared Housing Settings
Congregate Living and Other Shared Housing Settings
Medical: hospitals (in person); acute care facilities, skilled nursing facilities, long-term medical care facilities, etc.
Non-medical: long-term care residential homes, assisted living facilities, hospices, retirement homes, dormitories, group homes, correctional facilities (prison/jail/juvenile detention centers), homeless shelters, multigenerational households,
renting/sharing dorm rooms and/or beds based on the shift work at factories or food processing plants, etc.
Medical: hospitals (in person); acute care facilities, skilled nursing facilities, long-term medical care facilities, etc.
Non-medical: long-term care residential homes, assisted living facilities, hospices, retirement homes, dormitories, group homes, correctional facilities (prison/jail/juvenile detention centers), homeless shelters, multigenerational households,
renting/sharing dorm rooms and/or beds based on the shift work at factories or food processing plants, etc.
Appendix B
This table is intended to guide the person with COVID-19 through an assessment of COVID-19 symptoms, onset, and duration. Information gleaned here will inform the contact elicitation window (48 hours prior to start of symptoms until the person is isolated).
Key: Y=yes, N=no, U=unknown, R=refused
*Emergency Warning Signs-People with these symptoms should be referred for emergency medical care.
COVID-19 Symptoms
COVID-19 Symptoms
Presence of Symptoms
Presence of Symptoms
Date of Onset
Date of Onset
Duration
Duration
Fever
Fever
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Cough
Cough
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Diarrhea/GI
Diarrhea/GI
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Headache
Headache
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Muscle ache
Muscle ache
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Chills
Chills
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Sore throat
Sore throat
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Vomiting
Vomiting
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Abdominal Pain
Abdominal Pain
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Nasal congestion
Nasal congestion
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
New loss of sense of smell
New loss of sense of smell
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
New loss of sense of taste
New loss of sense of taste
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Malaise
Malaise
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Fatigue
Fatigue
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Shortness of breath or difficulty breathing/trouble breathing *
Shortness of breath or difficulty breathing/trouble breathing *
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Persistent pain or pressure in the chest*
Persistent pain or pressure in the chest*
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
New confusion*
New confusion*
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Inability to wake or stay awake*
Inability to wake or stay awake*
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone*
Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone*
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Other symptom(s)
Other symptom(s)
Circle (Y/N/U/R)
Circle (Y/N/U/R)
Date of onset
Date of onset
Number of days
Number of days
Appendix C
This table is intended to assist in elicitation of contact names, location, risk, and other pertinent health information, and notification planning. This information will be used to locate and communicate with contacts regarding their exposure and prioritize follow-up of high-risk people and congregate living or work settings.
(Please note: All of the information contained in this table is “per the report of the person with COVID-19.” It is recommended that this information be gathered/verified through a direct conversation with the “contact” [the person exposed to COVID-19.])
Appendix D
This table is intended to provide a list of questions to ask the person with COVID-19 about each of their contacts (people that may have been exposed to COVID-19). This information will be used to locate and communicate with contacts regarding their exposure and to prioritize follow-up of contacts at high risk and contacts within congregate living or work settings.
Sample Open Ended Questions for Each Contact Elicited
Sample Open Ended Questions for Each Contact Elicited
What is their name? What name do they go by?
What is their name? What name do they go by?
Who old are they? What is their age, or date of birth?
Who old are they? What is their age, or date of birth?
What is their gender?
What is their gender?
What is their race/ethnicity?
What is their race/ethnicity?
What languages do they speak?
What languages do they speak?
What do they look like (distinguishing features)?
What do they look like (distinguishing features)?
What is the best way to reach them? Cell number? Email?
What is the best way to reach them? Cell number? Email?
Where do they live? Address? Who do they live with?
Where do they live? Address? Who do they live with?
Where do they work, and work location? City, State? What is their job, work function? Works in close proximity with others?
Where do they work, and work location? City, State? What is their job, work function? Works in close proximity with others?
When did you see them last? When did you last spend time with them? For how long (minutes/hours)?
When did you see them last? When did you last spend time with them? For how long (minutes/hours)?
What symptoms might they have had?
What symptoms might they have had?
Are you aware of any risk factors (like smoking) underlying medical factors (like the ones that we discussed earlier) they may increase their risk for complications from COVID-19? If yes, do you feel comfortable sharing that information? Tell me about them.
Are you aware of any risk factors (like smoking) underlying medical factors (like the ones that we discussed earlier) they may increase their risk for complications from COVID-19? If yes, do you feel comfortable sharing that information? Tell me about them.
What do they know about your COVID status?
What do they know about your COVID status?
Appendix E
This table is intended to assist in exploring locations or facilities (exposure sites) where the person visited or worked while infectious, identifying specific areas within each facility (exposure settings), and people who may have been exposed. This information can be used to inform both facility and individual contact investigations.
celebration (singing,
laughing, eating, games)
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