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With the COVID-19 infection spread across 178 countries all over the world as of March 2020, healthcare professionals, epidemiologists and most governments are working constantly to contain the spread of this highly-contagious viral infection. As yet, there is no cure or vaccine against COVID-19 and this makes treating the disease even more difficult.

However, not all nations are at the same level of contagion, which is the reason why the methods used to trace, isolate and treat COVID-19 patients varies from region to region. India is currently in the second stage of disease transmission, known as local transmission. This means that all the current patients of COVID-19 are either those who have a travel history of visiting places with high contagion levels, or are people who have come in contact with those with a travel history.

In such a type of transmission, contact tracing is the most effective type of epidemiological investigation to figure out how a disease progresses and how it passes from one person to another. Every time a new disease springs up, contact tracing is one of the primary means of investigation used by epidemiologists. Figuring out these details then plays a huge role in the creation of cures and vaccines - which are the greatest needs of this hour. 

Contact tracing is effectively and stringently being used in India currently to limit the spread of COVID-19. Here is everything you need to know about contact tracing.

  1. What is contact tracing?
  2. How can contact tracing help contain COVID-19?
  3. Types of contacts
  4. What to do if you think you are a contact?

Contact tracing is a type of epidemiological investigation which is conducted whenever a new disease or infection, or an old disease, breaks out. Epidemiologists start with the index patient or patient zero with whom the infection in a location originated. Interviews, tests and screenings are conducted to understand the patient’s symptoms as well as to figure out who he or she has been in contact with after getting infected. 

On the basis of these answers, epidemiologists then contact airlines, restaurants, people, etc the index patient has come in contact with to understand if similar symptoms are showing up with different types of contacts. This list of people and places can be quite extensive, especially if the patient zero has a travel history. Once all the people exposed to the index patient are accounted for, epidemiologists can tell if the disease has spread rapidly or slowly, what its incubation time is, who has minor symptoms and who has more severe ones, etc 

If the disease spreads too rapidly, contact tracing becomes even more wider in scope since all the primary contacts of the index patient would have further spread it to their contacts too. Contact tracing is therefore a painstaking, laborious process which takes a lot of patience. However, its significance is huge in calculating the current and future spread of an infectious disease.

COVID-19 is a highly contagious infection which is transmitted through human contact or after coming into contact with a contaminated surface. The disease originated in Wuhan, China, and spread to 177 other countries over a period of just three months (as of March 2020). Currently, there are over eight lakh confirmed COVID-19 cases all over the world, and the death toll is also globally on the rise. 

Contact tracing is the method used to identify patients and carriers of the disease in the initial stages of transmission. Once the transmission transcends the local stage and moves into the community stage, contact tracing can no longer be used. For example, in countries like Italy and the USA, contact tracing can no longer be effectively used.

However, in countries like India and New Zealand, where transmission is still at the local level, contact tracing is the best means of limiting the spread of COVID-19. Once the index patient and all his or her contacts are identified and quarantined, the spread of a disease like COVID-19 can be contained. Of course, awareness about the disease and government support in executing preventive measures also plays a huge role in containment of a contagious disease, but without the details provided by contact tracing, these data would be unavailable.

While contact tracing from the index patient, epidemiologists have a way of demarcating the different levels of contact to understand what advice to give to suspected patients and the general public. The following are the two types of contacts epidemiologists take into account immediately after a new disease or infection is discovered and the index patient identified.

  1. Close contacts
  2. Casual contacts

Close contacts

A close contact is someone who has had any or all of the following types of exposure to a confirmed patient:

  • Direct contact with bodily fluids or lab specimens of a confirmed patient.
  • Sharing a household or living space with a confirmed patient.
  • Face-to-face contact with a confirmed patient while standing/sitting within a distance of two metres for 15 minutes or more time.
  • Sharing a closed environment with a confirmed patient for 15 minutes or more, like in an aircraft, hospital waiting room, etc. 
  • Being seated within two metres of a confirmed patient in an aircraft, or serving a confirmed patient on an aircraft.

Casual contacts

A casual contact is anybody who came in touch with the index patient or confirmed patient, but did not meet the same criteria as a close contact does. This would mean, for example, someone who shared a flight or attended the same event as the index patient, but did not have close interaction or connection. 

This does not mean that casual contacts are in any way exempt or safe from infection, but indicates that the chances of infection could be low. Usually, a casual contact also goes through the same quarantine process that a close contact does.

Whether you came to know about the existence of a disease outbreak on the news or after epidemiologists contacted you, thinking that you’re a contact - close or casual - of a confirmed patient can lead to panic and fear. While these feelings are quite natural, especially if the disease is new and neither a cure nor vaccine is available for it, it’s important to pay attention to your health.

You should call emergency health services or your doctor and share your suspicion immediately, and not wait for symptoms to arise. Acting on the recommendation of healthcare professionals is the best way to go during a disease outbreak, especially a pandemic like COVID-19. If you’re asked to visit a hospital, quarantine yourself, or watch your health closely, do it. 

No matter how new or old a disease, early detection is always the best way to get diagnosed, access healthcare and recover faster. If you believe you’re a contact, it’s also your civic and moral duty to self-isolate and contact healthcare providers instead of going ahead with your normal life and risking the lives of others.

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References

  1. Ministry of Health and Family Welfare [Internet]. Government of India. New Delhi. India; Micro Plan for Containing Local Transmission of Coronavirus Disease (COVID-19).
  2. Ministry of Health, New Zealand [Internet] Wellington, New Zealand; Contact tracing for COVID-19
  3. World Health Organization [Internet]. Geneva (SUI): World Health Organization; Coronavirus disease (COVID-19) technical guidance: Early investigations protocols
  4. Centers for Disease Control and Prevention [Internet], Atlanta (GA): US Department of Health and Human Services; Evaluation of the Effectiveness of Surveillance and Containment Measures for the First 100 Patients with COVID-19 in Singapore — January 2–February 29, 2020
  5. ascella M, Rajnik M, Cuomo A, et al. Features, Evaluation and Treatment Coronavirus (COVID-19). [Updated 2020 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
  6. Korea Centers for Disease Control and Prevention, Cheongju, Korea. Contact Transmission of COVID-19 in South Korea: Novel Investigation Techniques for Tracing Contacts. Osong Public Health Res Perspect. 2020 Feb; 11(1): 60–63. PMID: 32149043
  7. Hellewell, Joel. et al. Feasibility of Controlling COVID-19 Outbreaks by Isolation of Cases and Contacts. Lancet Glob Health , 8 (4), e488-e496. PMID: 32119825
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