Failure to ensure effective contact tracing could spell a disaster as Covid-19 cases rise, experts sayWith lockdown lifted, there has been an increase in people’s movement, but government authorities have failed to keep up with contact tracing.
On Wednesday, a woman approached the Epidemiology and Disease Control Division to inquire why the division had not sent anyone to her home for contact tracing. The woman, in her early 30s, said her mother had tested positive for Covid-19 on Friday, according to Uttam Kumar Koirala, a senior public health officer at the division.
Her 55-year-old mother had returned from the United Arab Emirates in one of the chartered flights for Nepalis returning from the Gulf state and was staying at her home in Kathmandu. Officials at the division refused to provide details of their location of stay in Kathmandu Metropolitan City.
The elderly woman had sought a test voluntarily after she developed symptoms akin to Covid-19. When the virus was confirmed, she was sent to the isolation ward at Patan Hospital.
“We were at a loss for words as we could not provide an answer to the woman who came to our office asking why no one had reached her home for contact tracing,” said Koirala. “We could only tell her that health workers would visit her home soon.”
While officials appreciate the woman’s self-initiation to ask about contact tracing, they say they indeed have not been able to expand and expedite contact tracing.
Public health experts say failure to conduct contact tracing, at a time when Covid-19 cases have been rising in Kathmandu Valley, could spell a catastrophe.
As of Wednesday, 492 Covid-19 cases have been reported in the Valley. The nationwide tally has reached 19,273. The country so far has reported 49 Covid-19-related deaths.
Infectious disease experts say that contact tracing is an equally important tool in the three T’s—test, trace and treat–in the fight against Covid-19.
“Contact tracing is even more important than testing, as testing just shows who is infected and who is not,” said Dr Prabhat Adhikari, an expert on infectious disease and critical care at Grande International Hospital. “Without contact tracing, we will never know who has been infected with the virus from the person who has tested positive.”
The division said that it has alerted its case investigation and contact tracing unit to trace the contact of the woman.
The process, however, is fraught with bureaucratic hassles, and it could take days, if not weeks, until the contact tracing is completed.
After the division alerted the unit, it informed the Provincial Health Directorate, which again has to inform the district health office. The health office then has to inform the Kathmandu Metropolitan City, which in turn asks all the wards under it.
Getting the information back is again the same process in reverse.
Experts say by the time such byzantine process is completed, there are chances of more people getting infected, which triggers yet another chain of contact tracing, involving many more people.
Meanwhile, officials assigned for contact tracing have their own fair share of problems.
“It has not been easy for us,” said Gyan Bahadur Oli, Covid-19 focal person for the Kathmandu Metropolitan City. “Most of the times the contact numbers provided to us turn out to be wrong. Many people don’t even respond. We can hardly do anything.”
Oli could not say how his unit would respond to the woman who had approached the Epidemiology and Disease Control Division on Wednesday, as he had yet to receive the information, which has to pass through various channels before reaching his office. “I am not even aware of this particular case,” Oli told the Post.
With the lockdown lifted and increased people’s movement, public health experts say the only way to break the chain of transmission is increasing contact tracing.
Asian countries and territories like Taiwan, Hong Kong and Singapore have prevented the rapid spread of the virus by effectively employing contact tracing.
The number of polymerase chain reaction tests also has gone down since the lifting of the lockdown. And failure to expedite contact tracing could mean the virus soon spreading to communities, say public health experts.
So far, as many as 107 positive cases have been detected in Kathmandu Metropolitan City, including some cases reported among the people who do not have a history of travelling to the disease-hit areas or who have never come in close contact with the infected people.
For contact tracing to be effective, countries must have adequate capacity to test suspected cases in a timely manner, according to the World Health Organisation.
“If we have to slow the spread of the virus, contact tracing must be expedited,” said Adhikari. “Infections will spread in communities like wildfire if authorities keep on passing the buck. Expanding tests will be meaningless if we do not conduct contact tracing effectively.”
Of the total Covid-19 cases throughout the globe, around 50 percent are asymptomatic people. As the number of asymptomatic cases are high in Nepal, an infected asymptomatic person can pass the virus to many others if contact tracing is not carried out effectively, say experts.
Thakur said that the job of contact tracing, which is crucial in containing the virus, should not be left completely to the local level, as minor negligence or mistake could turn out to be costly.
“Quick diagnosis is equally important because if a person is infected and we take several days to provide results, by that time many others could be infected,” said Thakur.
These days, PCR test results are available within a day or two, contrary to a week in the initial days
Testing is crucial, but now with the cases rising, contact tracing has become even more important in Nepal, according to Adhikari, the infectious disease expert.
A Health Ministry study suggests that on an average, 13 people have come in contact with one infected person.
“One infected person can transmit the virus to several others,” said Adhikari. “There’s no other way than to apply contact tracing more effectively.”
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 2020
What is Covid-19?
Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19?
Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from?
The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 has spread to 213 countries and territories around the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe?
The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.