Contact tracing is one of the critical surveillance strategies for controlling the spread of COVID-19. Contact tracing is a process of monitoring persons who have been in exposed to another person infected with a specific disease. Contact tracing involves identification, listing and follow-up of persons who came into contact with an infected person. Within the context of COVID-19, a contact is an individual who has experienced the following exposures during the two days before or 14 days after the onset of symptoms of a confirmed or probable case:
- Face-to-face contact with a confirmed or probable case within a distance of one meter
- Direct physical contact with a confirmed or probable case
- Direct care for a patient with confirmed or probable COVID-19 diagnosis without proper personal protective equipment
- Other situations such as closed environment (shared transport, places of worship, classrooms, hospital waiting rooms)
The purpose of contact tracing during the COVID-19 outbreak is to aid early detection and prompt isolation of new cases. With person-to-person transmission, new cases are more likely to emerge among contacts. It is critical that all potential contacts of suspect, probable and confirmed COVID-19 cases are systemically identified and put under observation for 14 days from the last day of contact.
Because of their potential to develop COVID-19 and hence propagate the epidemic, it is extremely important that contacts strictly restrict their movements and exercise social distancing until they complete follow-up. During contact tracing, contacts are monitored for signs and symptoms COVID-19 and specimens are also taken tested in a laboratory to confirm whether the contact is negative or positive.
ELEMENTS OF CONTACT TRACING
Contact tracing is broken down into three basic elements: contact identification, contact listing and contact follow-up.
Contact identification: This is an essential part of epidemiologic investigation for all cases meeting the standard/surveillance case definitions of COVID-19. The cases are classified as suspected, probable or confirmed. Identification of contacts is done by asking about the activities of the case and the activities and roles of the people around the case from the time of illness.
Mr Joseph Magoola – Epidemiologist AFENET during a contact tracing visit in Central Kampala region, Uganda
Contact listing: All persons considered to have had significant exposure are listed as contacts, using the contact listing form. Efforts are made to physically identify every listed contact and inform them of their contact status. Contact identification and listing, including the process of informing contacts of their status, should be done by the epidemiologist or surveillance officer.
Dr Ben Masiira engaging the community during a contracting visit in Entebbe, Wakiso, Uganda
Contact follow-up: The epidemiologist/surveillance officer responsible for contact tracing should assemble a competent team comprising local surveillance and appropriate community members to follow up all the listed contacts. Follow up can be done by local surveillance staff/health workers from health facilities, community health workers, and volunteers such as health partners and community leaders.
Dr Kevin Mugenyi – Epidemiologist following a case in the outskirts of Kampala, Uganda
An efficient contact tracing system depends on trust with the community. Communities should have the confidence to cooperate with contact tracing teams and allow the referral of symptomatic contacts to designated isolation facilities.
After the orientation, the contact follow-up teams should be equipped with all the necessary tools, including: Contact listing, contact follow-up, reporting and monitoring forms. Pens. Digital thermometers, Alcohol-based hand rub solutions.
How do contact tracing teams should take precautionary measures to protect themselves?
AFENET and MOH contact tracing teams following a family in Kampala, Uganda
During home visits, teams should:
- Avoid direct physical contact like shaking hands or hugging.
- Maintain a comfortable distance (more than 1 metre)) from the person.
- Avoid entering the residence.
- Avoid sitting on chairs offered.
- Avoid touching or leaning against potentially contaminated objects.
- Eat earlier to resist the temptation of eating or drinking while visiting contacts.
- If the contact is visibly ill, do not attempt to take their temperature, but notify your supervisor.
- As part of the overall safety of the response team, all members of the contact tracing team should monitor their own temperature every morning.
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