COVID-19 Lessons Learned Inform Retrospectives of State Responses and Pandemic Preparedness

By Rawson Pino and Margot Thistle

As COVID-19 became a national pandemic in the United States in early 2020, states across the country scrambled to respond with public health strategies to slow the spread of the virus. The Centers for Disease Control and Prevention (CDC) recommended case investigation and contact tracing as a key strategy for preventing further spread of COVID-19 in state and local health departments (LHD). In response, many states and LHDs quickly stood up contact tracing programs or augmented existing programs. However, their capacity was quickly tested as the number of cases outpaced existing public health infrastructure.

Given a lack of guidance about and funding for contact tracing programs from Federal authorities early in the pandemic, many states developed programs with limited resources and on incredibly short timelines. Public health leaders have said it was like “trying to build the plane while flying it.”[1] As a result, each state determined and continually re-determined how to best respond to the needs of their communities during the pandemic. Some states performed contact tracing in-house, some entered partnerships to implement contact tracing operations, and others contracted with vendors to outsource contact tracing efforts.

As the country enters a new phase in public health preparedness with increased federal funding for public health programs and responses, PCG’s subject matter experts have reflected upon lessons learned and shared challenges faced during the pandemic response, while also assessing next steps for public health programs.

Our subject matter experts prepared a lessons learned report from our years of experience performing contract tracing at the state, local, and school level, as well as implementing testing coordination and vaccine mandate compliance.

A thumbnail of PCG's report, "Strategically Addressing States' Contact Tracing and Workforce Needs During the COVID-19 Pandemic." Click the thumbnail to read the report.Click the thumbnail on the right to read the report, which includes suggestions for states as they look back on the approaches utilized while simultaneously planning for future public health emergencies.

After-Action Reports

Many states, healthcare providers, and local governmental entities are in the midst of conducting after-action reviews, reflecting upon the actions taken and decisions made during the pandemic in order to learn and improve. After-action reports can range from emergency preparedness and incident reporting to an analysis of the effectiveness of a COVID-19 response.

The city of Burlington, Vermont published its COVID-19 Pandemic After Action Report in June 2021 at the request of the mayor. In this report, the pandemic response leaders provide eight principles, along with data and analytics, to catalogue the lessons learned. They also set forth the challenges yet to come—including vaccine hesitancy. Now, two plus years from the start of the public health emergency, report drafters benefit from the breath of publicly available data, including vaccine and case tracking data from sources such as COVID Act Now. This ensures accurate historical data is included and utilized.

Emergency preparedness-type reports, such as the one prepared by the National Homeland Security Consortium (NHSC)—COVID 19 Pandemic After Action Report, June 2021—include details like nationwide gaps in preparedness, failures in communication, where politics took precedence over health professionals, and ways to improve and create a more unified response.

The NHSC report provides a good example of a comprehensive after-action report; it is the result of six months of work and incorporates input from 22 associations. The report includes both issues and recommendations, as well as best practices for the future—some of which are shown below.

A table from the NHSC's after-action report, which lists issues and recommendations as well as best practices. The issues and recommendations are: Adherence to protective measures: to include behaviors from staff, businesses, and the public toward policies and public health orders; inadequate, confusing, and changing guidance: to include public health and other guidance issued at federal, state, and local levels, and keeping up with and implementing guidance; operational coordination: to include establishing a unified and coordinated operational structure that integrates critical stakeholders; and revenue shortfalls: to include state, local, territorial, and tribal budget shortfalls and their cascading effects on available services and resources. The best practices are: emergency powers and authorities: to include adoption of extraordinary measures to stop the spread of COVID-19 and expansion of authorities to support the response; information sharing and public messaging: to include sharing information among responding agencies and organizations, providing situational awareness, and conveying information to the public; and workforce resilience: to include mitigation of circumstances and stressors that can affect workforce productivity and mission success. One item is listed under both issues and recommendations and best practices. It is: Logistics and supply chain management: to include procuring, tracking, warehousing, and distributing personal protective equipment (PPE) and other supplies and equipment.

Source: COVID 19 Pandemic After Action Report, June 2021, Topics/Recommendations Included

Our PCG teams have spent time working with clients to reflect upon the approaches taken and decisions made during our contact tracing projects. With the expertise of our COVID-19 teams, in conjunction with our Emergency Medical Services team, PCG is ready and able to assist with after-action reports of all kinds. For more information about how we can support after-action planning, please email us at


[1] As Contact Tracing Programs Shrink, Health Agencies Plan for Future Pandemics: Shots – Health News: NPR

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