International Journal of Environmental Research and Public Health Project Report The Containment Scouts: First Insights into an Initiative to Increase the Public Health Workforce for Contact Tracing during the COVID-19 Pandemic in Germany Dunja Said 1,*,† , Simon Brinkwirth 1,*,†, Angelina Taylor 1 , Robby Markwart 2 and Tim Eckmanns 1 1 Unit 37—Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany; [email protected] (A.T.); [email protected] (T.E.) 2 Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743 Jena, Germany; [email protected] * Correspondence: [email protected] (D.S.); [email protected] (S.B.); Tel.: +49-30-18754-5061 (D.S.); +49-30-18754-3882 (S.B.) † These authors contributed equally to this work. Abstract: The COVID-19 pandemic in Germany has demanded a substantially larger public health workforce to perform contact tracing and contact management of COVID-19 cases, in line with recommendations of the World Health Organization (WHO). In response, the Robert Koch Institute (RKI) established the national “Containment Scout Initiative” (CSI) to support the local health authorities with a short-term workforce solution. It is part of a range of measures for strengthening Citation: Said, D.; Brinkwirth, S.; the public health system in order to limit the spread of SARS-CoV-2 in Germany. The CSI is an Taylor, A.; Markwart, R.; Eckmanns, T. The Containment Scouts: First Insights example of how solutions to address critical health system capacity issues can be implemented into an Initiative to Increase the Public quickly. It also demonstrates that medical or health-related backgrounds may not be necessary to Health Workforce for Contact Tracing support health authorities with pandemic-specific tasks and fulfil accurate contact tracing. However, during the COVID-19 Pandemic in it is a short-term solution and cannot compensate for the lack of existing qualified staff as well as Germany. Int. J. Environ. Res. Public other deficits that exist within the public health sector in Germany. This article describes the structure Health 2021, 18, 9325. https:// and process of the first phase of this initiative in order to support health policymakers, public health doi.org/10.3390/ijerph18179325 practitioners, and researchers considering innovative and flexible approaches for addressing urgent workforce capacity issues. Academic Editors: Florian Fischer, Laura Arnold, Franziska Hommes Keywords: contact tracing; contact management; SARS-CoV-2; COVID-19; containment scouts; and Kerstin Sell public health workforce Received: 26 July 2021 Accepted: 31 August 2021 Published: 3 September 2021 1. Introduction Publisher’s Note: MDPI stays neutral The public health workforce is one of the essential components of a functional health with regard to jurisdictional claims in system and is directly linked to its quality [1]. However, underfunding of health systems published maps and institutional affil- has become an increasing issue in many European countries [2], which has resulted in a iations. shortage of staff in the public health sector [3]. As a result of the COVID-19 pandemic, health systems worldwide have been placed under even further pressure. The needs and tasks have increased rapidly across the health system, from preventative to acute care services; and many shortcomings, including understaffing, have become visible. Copyright: © 2021 by the authors. The public health workforce in Germany has been particularly impacted by the Licensee MDPI, Basel, Switzerland. pandemic, with limited capacities and resources already prior to the pandemic [4]. In This article is an open access article addition, the usual health workforce capacity has been depleted at times due to sickness distributed under the terms and absence as a result of COVID-19. The German government responded to the pandemic by conditions of the Creative Commons delivering its pandemic strategy [5] and comprehensively introducing measures at every Attribution (CC BY) license (https:// level of the health system (Figure1). creativecommons.org/licenses/by/ 4.0/). Int. J. Environ. Res. Public Health 2021, 18, 9325. https://doi.org/10.3390/ijerph18179325 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 9325 2 of 10 Figure 1. Germany’s technical strategy against the COVID-19 pandemic. The European Centre of Disease Control and Prevention (ECDC) recommended the following set of measures to address the pandemic and contain further outbreaks: physical distancing, hygiene measures, sufficient testing, contact tracing, and appropriate man- agement of contacts [6]. Contact tracing aims to break the chain of transmission through the systematic management of people (termed “contacts”) who have been exposed to an infected person. The main steps involve identifying, assessing, and following up on contacts. The tasks are typically performed by public health and medical professionals [7]. A major recommendation from a World Health Organization (WHO) mission in China in February 2020 was to increase workforce capacities and prioritise case finding through rapid and accurate decentralised contact tracing teams [8]. As part of the range of measures to address the pandemic in Germany and in response to ECDC and WHO recommendations, contact tracing and contact management of people with COVID-19 was introduced, one of the most time-consuming and labour-intensive pandemic activities carried out since the start of the pandemic [9]. The public sector alone is responsible for contact tracing in Germany, and the private sector does not play a role. This responsibility is shared by the Robert Koch Institute (RKI), the German national public health authority, which carries out international contact tracing, and the approximately 380 local public health authorities who are responsible for contact tracing within Germany (Figure2)[ 10]. In addition to the CSI, additional staff to support contact tracing in Germany have been drawn from other sources, including staff from the army (Bundeswehr), public servants from all state levels, and medical students [7,11,12]. The pandemic has required countries to quickly respond with approaches over the short term, making the pandemic a unique scenario for speed and innovation. The Con- tainment Scout Initiative (CSI) was developed as an innovative approach to address the public health workforce capacity challenge in contact tracing services in Germany. The RKI established the CSI in cooperation with the Federal Office of Administration (Bundesver- waltungsamt, BVA), inspired by the approach implemented in China. The purpose of this paper is to describe the concept and processes of this evolving initiative as well as the results from surveys conducted during the first phase (March 2020 to October 2020) in the context of the workforce capacity challenges experienced during the COVID-19 pandemic. This study seeks to describe practical rather than strictly theoretical insights per se, and it is therefore intended for health policymakers, public health practitioners, and researchers con- sidering innovative and flexible approaches for addressing short-term workforce capacity issues during the COVID-19 pandemic as well as other health emergency situations. Int. J. Environ. Res. Public Health 2021, 18, 9325 3 of 10 Figure 2. Public health system, outbreak management and reporting system in Germany. 2. Methods 2.1. Management and Funding The RKI and the BVA are responsible for the management of the CSI (Figure3). The RKI provides professional and technical support to the Containment Scouts (CSs) and local health authorities, and it organises and coordinates the CSs’ deployment with the federal state health authorities and local health authorities (Figure3). As the employer, the BVA is in charge of staffing aspects, such as recruitment and contract management (Figure3). Figure 3. Containment Scout Initiative: Recruitment and management. The German Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) funds the CSI. The project proposal was submitted in March 2020 and was initially ap- Int. J. Environ. Res. Public Health 2021, 18, 9325 4 of 10 proved until the end of 2020. The total cost for the first phase amounted to approximately 11.3 million Euros (~13.5 million US$), which funds the CSs (530 positions) as well as six employees at the RKI. 2.2. Project Participation and Coordination Of the federal states in Germany, 15 out of 16 participated in the first phase of the CSI. Prior to starting recruitment, local coordinators at each federal state health authority were contacted to assess the need and the distribution for CSs in their local health authorities. The theoretical number of CSs available per federal state was determined by population size. Recruitment started in Bavaria, Baden-Wurttemberg, and North Rhine-Westphalia due to their high COVID-19 infection rates. 2.3. Containment Scouts: Job Description, Job Profile, and Training Materials The job advertisements were published widely on 20 March 2020 via university mailing lists, as well as through social media and news websites. The CS positions were paid 2325 Euro per month before tax (2736 US$) and were advertised as a six-month, full-time job. The BVA conducted the selection process and telephone interviews. The suitability of the applicants was assessed based on professional backgrounds, which were