With the Hyderabad techie reportedly spreading his infection to a large number of people that he came into contact with, the issue of tracing contacts becomes very crucial.
Beginning from the second phase of the epidemic — local transmission — which Indian Council of Medical Research Director-General (ICMR) Balram Bargava claims the nation is currently couched in, contact tracing is an integral part of fighting the epidemic on the ground.
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Properly done, contact tracing and follow-up health interventions will ensure that the infection spread is limited and retard or stop the pace of the epidemic to the third stage — community transmission.
What is contact tracing?
Contact tracing is the process of identifying, assessing, and managing people who have been exposed to a disease to prevent transmission. As per ICMR guidelines, which are also directions that have sound public health sense behind them, people who may have been exposed to the virus are to be followed for 28 days from the date of the probable last exposure/arrival from affected countries.
Any person who has had contact with the index patient under investigation/treatment for suspected, probable or confirmed case of SARS-COV-2, should be monitored for the appearance of symptoms.
Who is a contact?
Anyone who provided care for the suspect or confirmed case, including a health care worker (including those involved in cleaning, waste management, laboratory technicians, doctors) or family member, or any one who had close physical contact; anyone who stayed at the same place (lived with, or visited) while the index patient was symptomatic.
If symptoms appear within the first 28 days following the contact, the individual should be considered a ‘probable’ case and reported through the Integrated Diseases Surveillance Programme network to the National Centre for Disease Control.
Tracing contacts
As soon as the single event (confirmed SARS-CoV-2) is detected, contact tracing must be aggressively implemented, and preferably to be completed within 48 hours.
The contact tracing shall preferably be done by visiting the local residence of the contact(s) by a member of the health services team. In certain circumstances or for follow-up, phone calls may be made too, as per the rules.
On meeting the ‘contact person’, the visiting health worker should explain the purpose of contact tracing and collect data in a prescribed format. It is important to identify the social networks of the first patient and travel history during the 28 days after the onset of illness.
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The patient, his or her family members, colleagues, school or college mates are sources of information about the contacts, as are others with knowledge of the patient’s recent travel and activities.
Contacts should be traced and monitored for at least 28 days after the last exposure to the case patient for evidence of COVID-19 symptoms to emerge. Case-wise line listing of all exposed contacts will be maintained, with the following information: demographic information, date of last exposure or date of contact with the case patient, and date of onset of fever or other symptoms, if any.
Symptomatic contacts
Persons who have fever and cough and a history of contact with a confirmed case within the last 28 days should be referwred for isolation for strict infection control.
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Samples must be collected and sent to the designated laboratory for testing, and appropriate wmedical management must begin. If contacts show symptoms, they may be isolated at a health care facility or at home until the results come in. Once confirmed as positive for SARS-CoV-2, they must be shifted to a proper health facility.
Asymptomatic contacts
They must remain at home (home quarantine) for at least 28 days after the last exposure with the patient. The contacts should start monitoring their health and watch for symptoms of fever and cough, within 28 days of the last exposure to the patient, and maintain a list of people they are in contact with, on a daily basis.
If he or she develops symptoms, as defined, the contact must wear a mask, self-isolate at home, and inform the local health authority. For 28 days after this, health officials will do an active monitoring of these people.
Health workers
The rules also require the health officials to follow certain precautions while they meet contacts. They are required to maintain a distance of at least two metres from the contact, wear masks, and maintain standard infection prevention and control measures, especially hand-washing.
