CDC Field Teams in the Early COVID-19 Response, January–July 2020

When a health department is overwhelmed, it can formally ask CDC for help, and CDC sends a field team. From January 21 to July 25, 2020, early in the COVID-19 response, CDC answered those requests on a scale this report sets out.

Image from CDC's report on COVID-19 deployments.

How it started

On January 21, 2020, CDC activated its Emergency Operations Center for the COVID-19 response — and the same day, at Washington State's request, sent a team to help investigate the first U.S. case, a traveler returning from China. On March 15, CDC set up a section dedicated to supporting state, tribal, local and territorial health departments: answering questions, connecting them with CDC experts, deploying teams on request, and coordinating with partners such as the CDC Foundation, the National Association of County and City Health Officials, the Association of Public Health Laboratories, the Association of State and Territorial Health Officials and the Council of State and Territorial Epidemiologists.

Deployers were briefed before and after each trip, medically cleared, given risk assessments, travel arrangements and personal protective equipment, and their feedback was used to improve later deployments.

The deployments

Teams went to state health departments (178, 85%), tribal (12, 6%), local (10, 5%) and territorial (8, 4%) departments. Of the 726 staff, 516 deployed once, 156 twice and 54 three or more times. The number of teams tracked the rise and fall of national case counts.

What teams did (a team could do several things):

The most common individual roles were epidemiologic support (422 deployments), leadership (137), infection prevention and control (88) and clinical support (65), along with data science, laboratory science, communications and outreach, veterinary science and behavioral science.

High-risk places and people

Many teams worked in crowded settings where people face higher risk of severe illness:

• long-term care facilities — 53 teams (26%);
• food processing plants — 24 (12%);
• correctional facilities — 12 (6%);
• homeless services — 10 (5%).

Surveys of knowledge, attitudes and practices brought community members in to identify barriers to services and preferred ways to communicate. In line with CDC's health equity strategy, 28 teams (13%) focused on transmission among racial and ethnic minority groups, including supporting tribal health departments and responding to COVID-19 among migrant farm workers; others focused on rural and frontier communities. Teams also built local capacity — designing data collection tools, training staff in case investigation and contact tracing, and improving public health IT systems.

What it produced

The field work fed directly into national guidance:

• Serial testing as a containment strategy was developed and used to interrupt spread in long-term care facilities in Washington, correctional and detention facilities in Louisiana, and homeless shelters in Washington. On April 2, the Centers for Medicare & Medicaid Services and CDC issued guidance for universal testing of long-term care residents, based partly on work in King County, Washington.
• Food processing: an analysis of cases among meat and poultry workers in 23 states found that 87% of cases with race or ethnicity reported were among racial or ethnic minority workers. On July 30, Tyson Foods — the world's second-largest processor of chicken, beef and pork — announced expanded weekly testing and symptom monitoring for employees, per CDC guidance and after that analysis.
• Social gatherings: investigations such as one of cases and deaths from two family gatherings in Chicago helped refine CDC's social distancing recommendations.

Of 90 COVID-19 reports published in MMWR through the August 28 issue, 30 came from these deployments.

Sources

Based on Dirlikov E, Fechter-Leggett E, Thorne SL, et al., "CDC Deployments to State, Tribal, Local, and Territorial Health Departments for COVID-19 Emergency Public Health Response — United States, January 21–July 25, 2020," Morbidity and Mortality Weekly Report 69(39), Centers for Disease Control and Prevention; a work of the United States government in the public domain. Original report.