Question

Consider COVID-19, Comment on how contact tracing is being employed in our current health crisis.

Answer 1

Contact tracing is a very significant tool that can help slow the spread of infectious diseases, such as coronavirus disease 2019 (COVID-19) and is defined as the process of identifying, assessing, and managing people who have been exposed to a disease to prevent further transmission of the disease.

NEED FOR CONTACT TRACING:lf used systematically,it can break the chains of transmission of the virus. The basic idea of contact tracing for COVID-19 is to identify the exposed persons and then following up daily for 14 days from the last point of exposure.

Steps in undertaking contact tracing

All confirmed cases require this and may be desirable for probable cases in the absence of proper testing.

Step 1:Defining contacts

A contact is defined as anyone with the following exposures to a COVID-19 case, from 2 days before to 14 days after the case’s onset of illness:

•Either being within 1 metre of a COVID-19 case for >15 minutes or having direct physical contact with a COVID-19 case;

•Direct contact with patients without the use of PPE(especially,health care providers)

If the confirmed cases are asymptomatic, contacts should be managed in the same way as for a symptomatic case with an exposure period from 2 days before the case was sampled, to 14 days after.

Step 2:Identifying contacts

This can be done through a detailed case investigation and interview with the patient or the caregiver .Officials dealing with public health officials will need to identify contacts depending on the locality

Some examples of identifying contacts in different settings

1.Household and community/social contacts

• Those who had face-to-face contact with a case within 1 metre and for >15 mins or direct physical contact with a COVID-19 patient

• Those who are providers of direct care for a COVID-19 patient in the home without proper PPE

• Anyone living in the household

Way of identiciation of contacts: Direct interview with the COVID-19 patient and/or their caregiver(s). This could be done in person or by telephone

2. Healthcare settings

• Health care workers who had a direct contact with a COVID-19 patient, without proper use of PPE.

• Contacts who got exposed during hospitalization,that is any patient hospitalized in the same room or sharing the same bathroom as a COVID-19 patient, visitors to the patient, or other patient in the same room; other situations as dictated by risk assessment

• Contacts exposed during outpatient visits,either in the waiting room or in a similar closed environment with a covid patient.

• Those within 1 metre of the COVID-19 patient in any part of the hospital for >15 minutes

Way of identiciation of contacts: Identify all staff who have been in direct contact with the COVID-19 patient or who may have been within 1 metre of the COVID-19 patient without PPE for >15 minutes without direct contact.

•By checking the list of patients hospitalized in the same room or room sharing same bathroom and of the visitors who visited the patient or another patient in the same room during the relevant timeframe.

Step 3:Informing contacts

A list of persons who had been in contact with the COVID-19 patient is to be made. They will be then contacted by phone or in person to confirm the contact. Each individual confirmed as a contact should be provided with information on:

• The process, criteria and need for contact tracing and information on quarantine.

• The place of quarantine quarantined and the symptoms to look out for during the monitoring period.

• Procedures to follow if unwell,whom to contact and so on.

• All other specific queries or concerns of the contact.

All these details are most commonly provided over the phone or in person, also other approaches such as text messages and emails could be considered when direct contact cannot be made.

Step 4:Managing and monitoring contacts daily

Quarantine: Quarantine aims at restricting the activities of a person who has been exposed,but is not positive,and monitoring their symptoms for ensuring the early detection of cases. Quarantine and isolation is different.

Daily monitoring: It refers to the regular communication between the contact tracing team and the contacts they have been assigned to monitor .

The various options for daily monitoring are:

1. Direct monitoring by the contact tracing team, monitoring potential signs and symptoms by phone or visiting them in person by following standard precautions and physical distancing.
2. Self-reporting, whereby contacts self-monitor and report any signs and symptoms to the monitoring team. It should be conducted daily, even if no signs or symptoms are present (so-called zero reporting). This is done on a daily basis with the use of electronic data capture tools wherever possible

Step 5:Data processes and analysis

Data flow:The information gathered should be entered into a database, including the link to the source case and information on the monitoring status which will be updated daily.If the contact becomes a case, proper changes will be made in the database

Analysis:Using key performance indicators such as proportion of cases seen,lost follow up,became suspected or confirmed etc need to be compiled daily and communicated to contact tracers.