The Dos and Don'ts of effective contact tracing

How do we best enable our workforce of contact tracers?

Contact tracing is a painstaking but the most efficient way of curbing the spread of infection. It essentially involves finding and informing people that they have been in contact with another infected person; so that the primary and secondary contacts can seek medical care. Contacts of the suspected or confirmed case of COVID-19 should then be isolated (if sick) or quarantined (if well) to lessen further spread of the virus.

For effective containment and contact tracing hence it is important that:

1) We understand how the virus spreads and how it decides who to trace

The COVID-19 virus is located in the respiratory tract and is spread when someone coughs or sneezes, dispersing infected droplets in the air. One sneeze or cough can spread infected droplets everywhere, even onto surfaces that people may touch later and hence several people can get infected from just one COVID-19 positive patient.

Contact tracing under these circumstances is challenging. The identified case will have to recall their movements carefully to identify all close contacts.

2) We ask the right questions to enable effective contact tracing

During contact tracing it is also important to remember that probably only less than 20% of the cases will show any symptoms.

Close contacts are those who have had face-to-face contact with a confirmed case for a period more than 15 minutes, or those who have shared an enclosed space with a confirmed case for more than two hours.

The contact tracer will be especially interested to know:

  • who has this confirmed case met or talked with recently? Was it inside or outside?

  • who have they sat near, for example in a meeting, at a marketplace, at a mess/canteen or other enclosed space?

  • have they been to a big event like a religious gathering?

3) We use the right technological tools

AarogyaSetu an app launched and endorsed by Government of India can be an effective tool in contact tracing in more crowded urban centers. AarogyaSetu sends a notification in case an individual has come in contact with another person who might be positive and also shows risk of infection. The limitation with AarogyaSetu however is the requirement of an smartphone and hence the app isn't expected to be very successful among circles with mostly feature phones.

Some text-based tools such as Whispir can be used for bulk messaging and forwards which can then be triaged for identifying contacts. Such tools for the Indian context are still under development.

4) We enable active monitoring and ensure quarantine compliance

Once the contacts of the primary patient have been identified, it is essential that they are

  1. actively monitored

  2. provided proper guidance on home isolation and quarantine

  3. provided medical care as soon as symptoms progress.

5) We remove the environment of hostility associated with the coronavirus infections.

Being sick is not a crime. We need to appropriately counsel first and second-order contacts to encourage them to seek medical attention and also disclose names of those who they may have come in contact with. Option of medical anonymity should be provided to the suspected individuals so that they are encouraged to seek medical attention.