Basics of Contact Tracing

for COVID-19
Emily S. Gurley, PhD
Johns Hopkins Bloomberg
School of Public Health
Learning Objectives

► Describe what contact tracing is and how it stops transmission of SARS-CoV-2

► Define a case of COVID-19 and a contact

► Explain the meaning and purpose of isolation and quarantine

► Calculate how long a case should isolate and how long a contact should quarantine

► Describe the connection between the infectious period and isolation and quarantine

► Identify high-risk settings for transmission that require extra action

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 Contact Tracing for COVID-19 Prevention

Copyright © 2020 Johns Hopkins University and Emily Gurley. Except where otherwise noted, this
work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 license.
A Case of COVID-19 Requires Action

► Diagnosing a case of COVID-19 is important because we have to act

► Support the person who is infected

► Ensure they have access to medical care and social services
● Offer treatment
► Limit their contact with other people

► Identify people they may have infected

► Notify them about their exposure and offer social services
● Offer treatment
► Limit their contact with other people

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Public Health Prevention for COVID-19

If we can limit contact between people who are infected and others, we can limit
opportunities for the virus to be transmitted

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 Timeline of Infection: Infectious Period

Image source: Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health. 6
 Timeline of Infection: Infected Contact

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 Timeline of Infection: Window of Opportunity

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Isolation and ► Stopping one
R0 = 2
Quarantine Can transmission chain
can prevent many
Have a Big future cases
Impact on
Reducing
Transmission

Image source: Johns Hopkins University. 9

Quarantine Can ► Stopping one What happens if we stop each case from
Have a Big transmission chain infecting just one person?
can prevent many
Impact on future cases
Reducing
Transmission

Image source: Johns Hopkins University. 10

 Defining Case, Contact,
Isolation, and Quarantine

Copyright © 2020 Johns Hopkins University and Emily Gurley. Except where otherwise noted, this
work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 license.
Cases and Contacts
► Case
► Someone who has COVID-19
► Usually has a positive laboratory test
► Suspect or probable case
► Someone exposed to a case who
develops symptoms, even if they have
not had a test yet
► Contact
► Someone who had contact with a case
while they were infectious
● During their illness
● 2 days before their illness began
► Three kinds of contact
● Physical contact
● Close contact: within 6 feet for 15+
minutes (10 or 30)
● Proximate contact: more than 6 feet
but in the same room for an
extended period
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Isolation vs. Quarantine

► Isolation ► Quarantine
► Keeps sick people separate from ► Restricts movement and contact of
healthy people healthy people who have been
► Restricted to home or hotel exposed
► Separate space in hospital to limit ► For 14 days since the last contact with
contact the person who is infected
► For duration of infectiousness
● 2 days before onset
● At least 10 days after onset of
illness; symptoms must be
improving and no fever within the
past 3 days

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 Calculating Isolation and Quarantine Duration

Copyright © 2020 Johns Hopkins University and Emily Gurley. Except where otherwise noted, this
work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 license.
 How Long Should a Case Be Isolated from Others?

► Short answer:
► Ideally, as long as they are infectious

► Longer answer:
► Until they fully recover
● By the time they are diagnosed,
they will already be sick
● Must monitor their symptoms
● Are no longer infectious after they
recover
**At least 10 days after symptom onset
and if other symptoms have resolved

Image source: Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health. 2
 Defining Their Infectious Period: Call the Case

► Let’s assume that you call the case on

May 10

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 Defining Their Infectious Period: Illness Onset

► Let’s assume that you call the case on

May 10

► They tell you that they became ill on

May 9

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 Defining Their Infectious Period: Calculate

► Let’s assume that you call the case on

May 10

► They tell you that they became ill on

May 9

► You know that they were infectious for

about 2 days before they became ill, and
will be for at least 10 days after their
onset

Image source: Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health. 5
 Defining Their Infectious Period

► Let’s assume that you call the case on

May 10

► They tell you that they became ill on

May 9

► You know that they were infectious for

about 2 days before they became ill, and
will be for at least 10 days after their
onset

May 9 + 10 days = May 19

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 Defining Their Infectious Period: Follow-Up

► The case will need ongoing follow-up to

really know when they can stop isolating
from others
► Need to know when symptoms resolve
(without medication)

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 Identifying Contacts in Their Infectious Period

► Let’s assume they do fully recover by

May 19

► Now that you know their infectious

period, you can help them identify their
contacts

► You call them on May 10

► You will ask about contacts they had
from May 7 through May 10

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 How Long Should a Contact Stay in Quarantine?

► Short answer:
► Ideally, as long as they could be
infectious
► Longer answer:
► 14 days following the last contact with
someone who is infectious
● Almost everyone who is infected will
develop illness within 14 days
► Last contact may have been days ago
► Contact may be ongoing
**If they have developed symptoms,
should be considered a case

Image source: Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health. 9
 How Long Should a Contact Stay in Quarantine?: Call the Contact

► Let’s assume you make a call to a contact

on May 13

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 How Long Should a Contact Stay in Quarantine?: Last Contact with
Case

► Let’s assume you make a call to a contact

on May 13

► Based on the call, you understand that

their last contact with the case was on
May 10

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 How Long Should a Contact Stay in Quarantine?: Calculate

► Let’s assume you make a call to a contact

on May 13

► Based on the call, you understand that

their last contact with the case was on
May 10

► So, they should receive instructions to

quarantine for 14 days since that last
exposure

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 How Long Should a Contact Stay in Quarantine?: 14 Days Since Last
Exposure

► Let’s assume you make a call to a contact

on May 13

► Based on the call, you understand that

their last contact with the case was on
May 10

► So, they should receive instructions to

quarantine for 14 days since that last
exposure

May 10 + 14 days = May 24

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 Contacts Who Live With Cases May Need to Quarantine Longer

► The contact must quarantine themselves

immediately, and for 14 days following the
recovery of the case
► So, quarantine will be longer than 14 days
for some contacts

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 Contacts Who Live With Cases May Need to Quarantine Longer:
Illness Onset

► The contact must quarantine themselves

immediately, and for 14 days following the
recovery of the case
► So, quarantine will be longer than 14 days
for some contacts

► Let’s assume we call the case on May 13, and

the person they live with became ill on May 9

Image source: Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health. 15
 Contacts Who Live With Cases May Need to Quarantine Longer:
Calculate

► The contact must quarantine themselves

immediately, and for 14 days following the
recovery of the case
► So, quarantine will be longer than 14 days
for some contacts

► Let’s assume we call the case on May 13, and

the person they live with became ill on May 9
► Let’s also assume that the case will be fully
recovered by May 19 (10 days)

Image source: Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health. 16
 Contacts Who Live With Cases May Need to Quarantine Longer: 14
Days After Their Last Infectious Contact

► The contact must quarantine themselves

immediately, and for 14 days following the
recovery of the case
► So, quarantine will be longer than 14 days
for some contacts

► Let’s assume we call the case on May 13, and

the person they live with became ill on May 9
► Let’s also assume that the case will be fully
recovered by May 19 (10 days)
► Therefore, 14 days after their last infectious
contact would be June 2

Image source: Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health. 17
 Identifying High-Risk Situations

Copyright © 2020 Johns Hopkins University and Emily Gurley. Except where otherwise noted, this
work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 license.
Important Terms

► Congregate housing settings

► A shared living environment where each individual or family has private living quarters
and shares common dining, recreational, and other facilities

► High-risk subpopulation
► A segment of the population that has characteristics that increase the risk of infection
or severe disease

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Factors that
Increase Risk
for Infection
and Severe
Disease

► Populations at increased risk:

► Dense contact environment
► Difficult to contact trace and identify exposures
► Difficult to isolate or quarantine
► Higher risk of infection and severe disease or death

Image source: Center for Teaching and Learning, Johns Hopkins Bloomberg School of Public Health. 3
Dense Contact Environment

► Large crowds of people

► Close contact interaction

► Physical contact
► Within 6 feet for prolonged periods of time

► Can lead to a “super-spreading” event—an unusually high

reproductive number

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Dense Contact Environment: Examples

► Large crowds of people ► Examples

► Conferences
► Close contact interaction ► Mass transit
► Physical contact ► Religious services
► Within 6 feet for prolonged periods of time ► Demonstrations
► Workplaces
► Can lead to a “super-spreading” event—an unusually high ► Bars
reproductive number ► Gyms
► Schools
► Sporting events
► Concerts

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Difficult to Contact Trace and Identify Exposures

► Close contacts may be unknown

► Recall of close contacts may not be reliable

► There may be too many contacts, and difficult

to determine who is at highest risk for infection

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Difficult to Contact Trace and Identify Exposures: Example

► Close contacts may be unknown ► Example: homeless shelter

► May not recall all contacts
► Recall of close contacts may not be reliable ► Contacts may be spread out
through multiple jurisdictions
► There may be too many contacts, and difficult ► Difficulty locating or testing
to determine who is at highest risk for infection exposed homeless contacts

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Difficult to Isolate or Quarantine

► Unable to distance from others

► Design of house or facility
► Developmental disabilities
► Not enough resources
● Masks, gloves, staff
► Social pressures

► Unwilling to cooperate

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Difficult to Isolate or Quarantine: Example
► Unable to distance from others
► Design of house or facility
► Developmental disabilities
► Not enough resources
● Masks, gloves, staff
► Social pressures
► Unwilling to cooperate
► Example: intermediate care facility
► A home with individuals with special
needs
► Residents may be unable to cooperate
● May not understand the concepts of
hygiene and social distancing
● Difficult to remove those who need
care from infected people
● Harder to maintain resources (masks,
gowns) for effective infection
prevention
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Higher Risk of Infection and Severe Disease or Death

► May be more likely to get infected due to close

contacts

► More likely to have underlying medical

conditions (heart disease, respiratory
conditions, poor immune system)

► May get exposed to the virus multiple times

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Higher Risk of Infection and Severe Disease or Death: Example

► May be more likely to get infected due to close
contacts
► More likely to have underlying medical
conditions (heart disease, respiratory
conditions, poor immune system)
► May get exposed to the virus multiple times
► Example: assisted living facility
► Congregate living situation
► Most residents over 60 years of
age
► Multiple levels of care,
including skilled nursing
facilities, which care for
individuals with illness or injury

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Contact Tracers Must Help Identify High-Risk Situations

► Collect the necessary information to assess risk accurately:

► Location and type of interactions
► Contact information for venue
► Names of close contacts
► Specifics on flight number, movie name, conference name, class name, facility name

► The identification might depend on noticing a pattern between multiple calls

► Notify case that there may be additional follow-up

► Immediately escalate to a supervisor

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 Summary

Copyright © 2020 Johns Hopkins University and Emily Gurley. Except where otherwise noted, this
work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 license.
Summary of Contact Tracing

► We can stop transmission of COVID-19 if we can identify cases and their contacts quickly
and get them to limit their contact with other people

► Cases should isolate themselves as long as they are infectious—for at least 10 days after
they become ill

► Contacts must quarantine for 14 days after their last contact with an infectious patient

► Some cases may have close contact with many people because of where they have been
or where they live, and these situations should be immediately reported to your
supervisor