Rapid Response Team (RRT) Training Package
Module – 2.a: How to conduct contact tracing in the
context of COVID-19?
Objectives
• This module is part of the Rapid Response Team (RRT) Training package,
adapted to specific issues pertaining to the COVID-19 pandemic and
focused on contact tracing in the context of COVID-19’
• The objective of this module is to enable users to conduct contact tracing
using the appropriate processes and tools in the context of COVID-19
Why is early detection of new cases important?
Exposure
to agent Early treatment improves
survival/outcomes
INCUBATION PERIOD CLINICAL DISEASE
Time
LATENT PERIOD INFECTIOUS PERIOD
Early isolation reduces
transmission
Incubation period: Time between exposure to the agent and the first symptoms
Latent period: Time between exposure of the agent and the start of infectiousness
Infectious period: Period when an infected host can transmit the agent to another host
What is contact tracing?
Contact: how is a contact defined?
A contact is a person who has had any one of the following exposures to a
probable or confirmed case:
1. face-to-face contact with a probable or confirmed case within 1 meter and for
at least 15 minutes;
2. direct physical contact with a probable or confirmed case;
3. direct care for a patient with probable or confirmed COVID-19 disease without
the use of recommended PPE; or
4. other situations as indicated by local risk assessments
Exposure to a symptomatic case: 2 days before and 10 days after symptom onset of
the case, plus at least 3 additional days without symptoms (including without fever and
without respiratory symptoms), for a minimum of 13 days total after symptom onset
Exposure to an asymptomatic case: 2 days before and 10 days after the date on
which the sample that led to confirmation was taken
WHO Contact tracing in the context of COVID-19: interim guidance, 1 February 2021
What is contact tracing, what is its goal?
Persons who may have come into contact with an infected person are
monitored for the maximum incubation period of the disease following their last
known exposure to a case
If persons who may have been into contact with an infected person become ill,
they can be quickly isolated and treated
The goal of contact tracing is to stop the transmission of the disease
Contact tracing is the process of identifying contacts of a person with the
disease to ensure that they are aware of their status and to communicate
expectations on what to do in the event they start to feel ill
Contact tracing in the context of COVID-19
Key components of outbreak surveillance in
the context of COVID-19
Most frequently reported via healthcare
Case notification networks. Other sources may include
morgues, community alert/hotline, etc
Cases without epidemiological links should
Case investigation be investigated to ascertain their source
and obtain other pertinent information
Investigations produce a list of close
Contact tracing
contacts who should be monitored for
and monitoring the maximum possible incubation
period since their last exposure to a
known case
How do we perform contact tracing in the context of
COVID-19?
Key step to perform contact tracing in the
context of COVID-19?
• Case investigation
• Contact tracing
▪ Identify
▪ Monitor
Case investigation: Steps
Overall objective: Reduce morbidity and mortality through early
identification, isolation, and clinical management of cases
DETERMINE IDENTIFY INFORM ENHANCE ENSURE
Determine if cases or a cluster of cases represent sustained
human-to-human transmission of SARS-CoV-2
Case investigation: Steps
Overall objective: Reduce morbidity and mortality through early
identification, isolation, and clinical management of cases
DETERMINE IDENTIFY INFORM ENHANCE ENSURE
Identify key epidemiological and clinical characteristics of cases
Case investigation: Steps
Overall objective: Reduce morbidity and mortality through early
identification, isolation, and clinical management of cases
DETERMINE IDENTIFY INFORM ENHANCE ENSURE
Inform current and future prevention and control efforts
Case investigation: Steps
Overall objective: Reduce morbidity and mortality through early
identification, isolation, and clinical management of cases
DETERMINE IDENTIFY INFORM ENHANCE ENSURE
Enhance surveillance
Case investigation: Steps
Overall objective: Reduce morbidity and mortality through early
identification, isolation, and clinical management of cases
DETERMINE IDENTIFY INFORM ENHANCE ENSURE
Ensure timely communication among stakeholders from all
relevant sectors to facilitate informed decision-making
Case investigation: information to be
collected
Background information
Contact information, method of
detection, case classification Patient information
ID assignment, demographic
Clinical information information, place of
residence
Clinical history, signs/symptoms,
comorbidities, date of onset,
Exposure/travel
admission and isolation
history
Dates of travel/exposures in
Laboratory data last 14 days, visits to health
Date of sampling, lab where care facilities or long-term care
facilities in last 14 days,
specimen was sent, type of
contacts with other cases
testing performed, test result
Contact tracing: key information to be
gathered
Who did the case come into close contact with?
What activities was case doing at the time?
Where did these activities take place?
When did case expose this contact?
Other key information to gather: Contact/follow-up information, health
status
Contact tracing: how does it work?
Social
Reduced number of contacts
distancing
Overall
reduction or
interruption
in
Reduce risk of transmission
Rapid
Contact transmission
isolation of
during the
tracing symptomatic
infectious
cases
period
Contact tracing: how to define risk
levels in aircraft contact investigation?
Infected Traveler
Medium Risk (Close Contact)
Low Risk
No identifiable Risk
Sample seating chart for a COVID-19 aircraft contact investigation
showing risk levels based on distance from the infected traveler
Contact tracing: groups that are high risk
contacts are:
• Age (elderly over 60, but severity increases from 40 years)
• Underlying co-morbidities such as cancer, diabetes, smoking,
hypertension, cardiovascular disease
• Close contacts like household contacts
Remember that: not all contacts are considered equally at
risk and when human resources are strained, contacts who
are at the highest risk for exposure or severity of disease
cannot be missed
Principles of interviewing
1. Practice
2. Be non-judgmental
3. Avoid leading the interviewee
4. Accurately record responses
5. Ensure confidentiality
6. Gently re-direct if they get off track
7. Be reassuring
8. Probe
9. Use interpreters if required
10. Thank the interviewee and explain how the information will
be used
Contact tracing: the process
After case investigation and contact identification/listing, the process continues
with (1) initial communication with contact and (2) contact monitoring
1. Initial Introduce yourself and answer any initial questions the
communication contact has
with contact Inform the contact they will have to quarantine for 14 days
Confirm any demographic and contact information
Ask about any exposure history and contact with case-patient
Ask about their health status and any presence of signs or
symptoms of acute respiratory illness
Contact tracing: the process
After case investigation and contact identification/listing, the process continues
with (1) initial communication with contact and (2) contact monitoring
2. Contact Contact follow-up should be performed on a daily basis for 14 days.
Monitoring Observe, if possible, or inquire as to the contact’s general
condition or any overt signs of illness
Interview the contact regarding health status (presence or
absence of specific symptoms)
Complete the “contact follow-up form”
Ask if the contact knows of anyone else who is sick
Hand over to contact the “Symptom diary for close contacts of
confirmed COVID-19 cases (Day 1–14)”
Contact tracing: what should be the
outcome of contact follow-up?
Contact is not
Contact is traceable:
Contact has absent: report to Continue tracing
epidemiologists contact until
symptoms: Contact remains
—finding and found; important
follow well for 14 days:
visiting this to try to account
government of monitoring can
contact is a for the contact
India guidelines stop
priority for the even after 14
for isolation
next day days have
passed
Contact tracing: process for Covid-19
in the community
Resources
Coronavirus disease (COVID-19) technical guidance: Early investigations protocols MoHFW
Clinical Management Protocol: COVID-19
MoHFW Clinical Guidance for Management of Adult COVID-19 Patients
MoHFW Guidelines for management of co-infection of COVID-19 with other seasonal
epidemic prone diseases
Guidelines for contact tracing of COVID-19 cases in community settings
SOP on preventive measures to contain spread of COVID-19 in offices
Guidelines to be followed on detection of suspect/confirmed COVID-19 case in a nonCOVID
Health Facility
Coronavirus disease (COVID-19) technical guidance: Surveillance and case definitions
Country & Technical Guidance - Coronavirus disease (COVID-19)