1. Sweeney, Kellen F. MPH
  2. Halter, Heather M. MPH
  3. Krell, Kerry MPH, MCHES
  4. McCormick, Donald MSHI
  5. Brown, Janet MSc
  6. Simons, Aimee BSN, RN, NCSN
  7. Santiago-Rosas, Christian J. MPH
  8. Luna-Anavitate, Sylvianette Esq, MPH
  9. Ramos-Colon, Miriam V. MS, CGG
  10. Marzan-Rodriguez, Melissa DrPH, MPH, CPH
  11. Bezold, Carla P. ScD, MPH


Context: Active symptom monitoring is a key component of the public health response to COVID-19, but these activities are resource-intensive. Digital tools can help reduce the burden of staff time required for active symptom monitoring by automating routine outreach activities.


Program: Sara Alert is an open-source, Web-based automated symptom monitoring tool launched in April 2020 to support state, tribal, local, and territorial jurisdictions in their symptom monitoring efforts.


Implementation: As of October 2021, a total of 23 public health jurisdictions in the United States had used Sara Alert to perform daily symptom monitoring for more than 6.1 million individuals. This analysis estimates staff time and cost saved in 3 jurisdictions that used Sara Alert as part of their COVID-19 response, across 2 use cases: monitoring of close contacts exposed to COVID-19 (Arkansas; Fairfax County, Virginia), and traveler monitoring (Puerto Rico).


Evaluation: A model-based approach was used to estimate the additional staff resources that would have been required to perform the active symptom monitoring automated by Sara Alert, if monitoring instead relied on traditional methods such as telephone outreach. Arkansas monitored 283 705 individuals over a 10-month study period, generating estimated savings of 61.9 to 100.6 full-time equivalent (FTE) staff, or $2 798 922 to $4 548 249. Fairfax County monitored 63 989 individuals over a 13-month study period, for an estimated savings of 24.8 to 41.4 FTEs, or $2 826 939 to $4 711 566. In Puerto Rico, where Sara Alert was used to monitor 2 631 306 travelers over the 11-month study period, estimated resource savings were 849 to 1698 FTEs, or $26 243 161 to $52 486 322.


Discussion: Automated symptom monitoring helped reduce the staff time required for active symptom monitoring activities. Jurisdictions reported that this efficiency supported a rapid and comprehensive COVID-19 response even when experiencing challenges with quickly scaling up their public health workforce.