Characteristics and Outcomes of Contacts of COVID-19 Patients Monitored Using an Automated Symptom Monitoring Tool — Maine, May–June 2020

Anna Krueger, MS; Jayleen K. L. Gunn, PhD; Joanna Watson, DPhil; Andrew E. Smith, ScD; Rebecca Lincoln, ScD; Sara L. Huston, PhD; Emilio Dirlikov, PhD; Sara Robinson, MPH


Morbidity and Mortality Weekly Report. 2020;69(31):1026-1030. 

In This Article


Contact tracing and symptom monitoring encourages exposed persons to quarantine while providing health departments an opportunity to promptly and proactively identify symptomatic persons, likely reducing SARS-CoV-2 transmission.[5] Because contact tracing can be resource intensive, using an automated symptom monitoring tool can reduce needed resources.[9] Contact tracing and the resulting postexposure quarantine and monitoring identified 190 (10%) of Maine's 1,869 reported COVID-19 cases during May 14–July 10.

These findings suggest that using a symptom monitoring tool with options to accommodate enrollees' preferences for monitoring method, time of day, and language, might be important for increasing enrollment and improving contact monitoring. Almost all (96.4%) monitored contacts chose automated over direct symptom monitoring. For most of this study period, Sara Alert provided messages in English only, with Spanish added June 10. Enrollees spoke a variety of languages, and French and Somali options were added after this study concluded.

Although the use of automated symptom monitoring tools might reduce staffing and resources needed to conduct active monitoring of contacts, there continues to be a considerable workload associated with contact enrollment, direct monitoring for nonparticipating contacts and follow-up of nonrespondents.[10] Maine CDC dedicates approximately 500 person-hours each week to enrolling and monitoring contacts using Sara Alert. Substantial human resources will likely be required to operate any contact tracing and monitoring program. By identifying options that meet communication and accessibility needs of their specific populations, jurisdictions can maximize available resources. However, continued support for jurisdictions to build and maintain contact tracing capacity is needed.

The findings in this report are subject to at least four limitations. First, determining the overall number of contacts identified by all Maine cases was not possible. Contact records in NBS sometimes referenced locations rather than persons, some contacts had no working telephone number or accompanying e-mail address, and an untracked number of contacts refused monitoring, so were not enrolled. Thus, enrollees described in this analysis do not represent the total number of contacts of COVID-19 patients in Maine. Second, during the study period, Sara Alert data extracts did not distinguish between contacts lost to follow-up and those removed based on symptom reporting, making compliance difficult to ascertain. Third, enrollees were not required to be tested for SARS-CoV-2, therefore enrollees with asymptomatic COVID-19 who were not tested were not identified as cases. Finally, although each person was given guidance on quarantine recommendations, adherence was not assessed and is unknown.

Using digital tools in support of a comprehensive contact tracing strategy can make the contact tracing and monitoring process faster and more efficient, as well as provide epidemiologic and clinical data which might result in an improved understanding of COVID-19. Although most contacts in communication with Maine CDC opted to enroll in automated symptom monitoring, the contact tracing program, including contact identification, communication, and monitoring, continues to require resources, including staffing. Automated monitoring tools can augment traditional contact tracing; however, they cannot take the place of a large, trained public health workforce required for a comprehensive COVID-19 response.