The emergence of the novel corona-virus was a wake-up call for a public health emergency around the world. The virus emanated from the Chinese central city of Wuhan in the Hubei Province and has since spread to most countries of the world. The infective agent is known as Covid-19 and has been considered a public health pandemic by the World Health Organization.
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 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. The entire human race has been described as being involved in a war with an unseen enemy; some are tempted to label the COVID-19 pandemic as the third world war. No war in recent history seems to have had such a devastating effect on mankind as Covid-19 infection.
The World Health Organization (2015) defines Contact tracing as “the process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission”. In this case, all the people who may have been exposed to Covid-19 are systematically and strategically followed for 14 days (the maximum incubation period for the disease) from the date of the most recent exposure. This process allows for the quick identification of persons who have had contact with a suspected Covid-19 case with or without symptoms and promptly isolating them to reduce exposure to other persons, preventing further spread of the infections. Prompt isolation or quarantine of such persons it’s believed would enhance treatment, which will eventually improve the likelihood of survival (WHO, 2015).
When to conduct contact tracing
- 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 physical 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.
Importance of contact tracing in Covid-19 infection.
- Gives an understanding of how fast the disease can spread.
- Helps identify high-risk activities that will promote the spread of the disease.
- Reduces the rate of secondary infection in the community.
- Helps to identify how the disease spread.
- Enhances containment of community spread.
- Helps to promptly prevent Covid-19 from snowballing into an epidemic or pandemic.
- Helps to understand who might have been exposed or infected.
- Decreases the socioeconomic impact of Covid-19 infection.
- Helps identify vulnerable groups in the population who are more likely to be infected.
Three Basic Elements of Contact tracing
Contact identification: This is very important when conducting an epidemiologic investigation for all cases meeting the standard or surveillance case definition of COVID-19. They are classified as suspected or confirmed. When identifying contacts it can be done through clerking or asking about activities of the case and activities and roles of the people around the case right from the time of the illness. (AFENET, 2020)
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.
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.
The Indispensability of the Medical Social Worker
Alson’s (2001) definition of the Medical Social Worker is apt in explaining the usefulness of Medical Social Workers in contact tracing to control the spread of Covid-19. He described “Medical Social Workers as professionals, who are skilled in assessing social circumstances of clients, establish the extent to which these have contributed to ill health, and alleviate such negative conditions; plan adequate care and attend to those matters that may interfere with healthcare and ameliorate the social distress, including of families and friends, caused by illness.”
The Medical Social Worker is a highly skilled health professional vested with the understanding and knowledge of the human relationship. Their training exposed them to a rigorous process of both overt and covert social investigative techniques that will be highly beneficial in contact tracing of contagious disease conditions such as the Covid-19. These trainings have equipped the Medical Social Work professional not only to understanding the aetiology of disease, but also the remote and immediate factors that may facilitate its spread. The WHO (2015) had enumerated some vital tips that would enhance contact tracing. These include;
- Knowledge of the symptoms associated with the contagious disease
- Appropriate assessment skills
- Discreet investigative skill
- Ability to analyze evidences gathered.
For an effective result, the contact tracer “needs to be flexible and empathetic with the cases, contacts and their families”. Thus it is believed, “will build trust and good community relations” and give fluidity to the contact tracing process. WHO (2015) concludes that any “contact tracing that is undertaken without sufficient expertise and due consideration to individual, community, socio-cultural and religious sensitivities can alienate individuals and communities and thus, deter contact tracing efforts”. This will result to “closing in” or refusal to give useful information that will be of benefit in the contact tracing process. Above qualities form part of the embodiment of the training and grooming of the Medical Social Worker, hence setting him/her apart from other health professionals in contact tracing of Covid-19.
WHO Guideline on Home-visit for contact tracing:
- Avoid direct physical contacts 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 temperature every morning.
The importance of contact tracing for the novel Covid-19 cannot be overstated. It is so because; it will create a greater chance of preventing its spread and minimize socioeconomic suffering of citizens. It is necessary, therefore, to make use of the appropriate professionals to achieve the desired result within the shortest possible time. The Medical Social Worker, on the other hand, has a wide range of community acceptance because of always being available within the community at critical moments to helping them out during crises periods. Their training, experience and expertise in interacting with different classes of people, preserving their individuality and ensuring that none is stigmatized will greatly enhance societal participation.
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Thomas I. Ibe, B.Sc. (Swk), M.Sc., Ph.D (Medical Sociology)
National Vice President
Association of Medical Social Workers of Nigeria.