Contact Tracing

April 16, 2020

Epidemiology Bureau
04/16/2020
1 Department of Health,
 In Public Health, Contact Tracing is
• Process of identification of persons who may have come into
contact with an infected person ("contacts") and subsequent
collection of further information about these contacts

• By tracing the contacts of infected individuals, testing them for

infection, treating the infected and tracing their contacts in turn,
public health aims to reduce infections in the population

Epidemiology Bureau
04/16/2020
1 Department of Health,
Goals of Contact Tracing
• To interrupt ongoing transmission and reduce spread of an infection
• To alert contacts to the possibility of infection and offer preventive
counseling or prophylactic care
• To offer diagnosis, counseling and treatment to already infected
individuals
• If the infection is treatable, to help prevent re-infection of the
originally infected patient
• To learn about the epidemiology of a disease in a particular
population

Epidemiology Bureau
04/16/2020
1 Department of Health,
Ethical and Legal Issues
Privacy and duty to warn
• Public health practitioners often have legal requirements to act to contain a
communicable disease within a broader population and also cite an ethical
duty to warn individuals of their exposure.
• Simultaneously, infected individuals have a recognized right to medical
confidentiality.
• Public health teams typically disclose the minimum amount of
information required to achieve the objectives of contact tracing

Epidemiology Bureau
04/16/2020
1 Department of Health,
Ethical and Legal Issues
Confidentiality and Risk of Stigma
Fear of loss of confidentiality and subsequent stigma,
discrimination, or abuse as a result of contact tracing that may
discourage persons from seeking medical treatment

Note: Public health officials have recognized that the goals of contact
tracing must be balanced with maintenance of trust with vulnerable
and sensitivity to individual situations

Epidemiology Bureau
04/16/2020
1 Department of Health,
 Who is a Close Contact? Date when
Date when confirmed case first had a confirmed
sign or symptom case
(Fever, cough, respiratory signs REPEAT
and symptoms) TEST is
OR tested positive (if NEGATIV
asymptomatic) E

2 days before
onset 0 XX Days after onset of illness

Close Contacts:
Individuals who cared for, lived, worked, travelled, and transacted with confirmed
COVID-19 case during this time period

Epidemiology Bureau
04/16/2020
1 Department of Health,
 Close Contact Categories and Definitions
Category Definition

This includes passengers of a flight or sea vessel, bus, train, or other transportation/vehicle whose seat
A is located four rows in front, at the back, or at any side of a confirmed case who is still in the
Philippines
This includes passengers of a flight or sea vessel, bus, train, or other transportation/vehicle whose seat
B is located four rows in front, at the back, or at any side of a confirmed case who had already left the
Philippines
This includes persons who have had exposure when they lived with, worked with*, transacted
with*, or cared for a confirmed case.

C *WHO has recommended that this will include individuals who had a face-to-face contact with a
confirmed case for at least a 15-minute conversation within one meter from the confirmed case OR
was shared an enclosed space for a minimum of two (2) hours with a confirmed case.

This includes passengers or crew of vehicles/vessels taken/used by, and persons who lived with,
D worked with, transacted with, or cared for a suspect who died during their 14-day monitoring
period

Epidemiology Bureau
04/16/2020
1 Department of Health,
 Case Investigation Process 1. List of cases at home
requiring facility
isolation
2. Refer to appropriate
isolation health facility
1. Profile the case after clinical
NO
Submit to the assessment
2. Assess for Contact Tracing 3. Commence contact
Confirmed presence of sign and Monitoring Case is in tracing by designated
COVID-19 or symptom Team completed a health team
Case case profile and facility?
3. Identify and list close contact line
close contacts list
and contact YES
information Commence contact
tracing by designated
team
*Algorithm for close contact definition, assessment, testing
and referral in following slides

Local Government Unit

EB
DOH-CHD Local Bureau
04/16/20Ep emiology Epidemiology and Surveillance Contact Tracing and Monitoring Team Unit*8
id20 ment of Health, 8
Case Investigation
• COVID-19 CIF
• WHO Case Report
Forms\WHO-2019-nCoV-SurveillanceCRF-2020.2-eng.pdf
• Travel History

Epidemiology Bureau
04/16/2020
9 Department of Health,
 Epidemiology Bureau
04/16/2020
9 Department of Health,
 Epidemiology Bureau
04/16/2020
9 Department of Health,
 Epidemiology Bureau
04/16/2020
9 Department of Health,
 Epidemiology Bureau
04/16/2020
9 Department of Health,
6 Major Steps in Contact Tracing
1. Identify the confirmed COVID-19 case (confirmed case). This case will be reported to the primary health care
facility.

2. Interview the confirmed case to learn about their movements, whom they have been in close contact 2 days prior to the
onset of signs and symptoms up to the time the confirmed case’s laboratory test yielded negative result.

3. Identify individuals who cared for, lived, worked, travelled, and transacted with a confirmed case are
considered as CLOSE CONTACTS.

4. Contact all close contacts for an interview and to offer medical counseling. If a close contact is sick at the time of the
interview, assess if close contact shall fir COVID-19 case definitions and refer for laboratory testing and management, as
per guideline.

5. Isolate sick close contacts (e.g. required to remain at home or referred to a health facility or a hospital).

6. If contacts are not individually identifiable (e.g. members of the public who attended the same location), broader
communications may be issued, like media advisories.

Epidemiology Bureau
04/16/2020
9 Department of Health,
 Close Contact Data Flow
Data Generated By Submitted/Shared To
List of confirmed COVID-19 Cases EB and RESU RESU, LGU concerned
Operational Requirements and Gaps, LESU, RESU Local/Regional Task Force, EB, and
Monitoring Report Regional OCD
EB National OCD
Initial line list of close contacts RESU RESU to Regional DILG/RDRRMC and
LGU Contact Tracing Teams
Complete line list and profiles of close contact Contact Tracing Team Local Epidemiology and Surveillance
Unit who submits to RESU/EB through
COVID-19 Information System
Daily Monitoring of health status of close contacts BHERTS and other local Local Epidemiology and Surveillance
monitoring team Unit who submits to RESU/EB through
COVID-19 Information System
List of newly identified suspect/probable/confirmed LESU RESU/EB through COVID-19
COVID-19 cases among close contacts being Information System
monitored

Epidemiology Bureau
04/16/2020
Department of Health, 9
 Contact Tracing Process at the local level
Assess for the
Reported ONLY Home-based
following: PNP with Local Quarantine and for
Confirmed Identify
1.Presence of Health Authorities daily monitoring
COVID- contacts
YES sign or (ESU) generate
19 Case
symptom the list of close
2.Identify if contacts, locate Home-based Quarantine
contact is a +
Close them, further COVID-19 Testing
Contact? health worker identify and
profile other close
contacts and Health Facility
Provide classify as Isolation
information on +
infection
follows: COVID-19
NO
prevention and Testing
*Algorithm for close contact definition, assessment,
control
testing and referral in following slides

DOH Contact Tracing Team

- Local Government Unit
Epidemiology Bureau
CHD
04/16/2020
16 Department of Health,
16
 Epidemiology Bureau
04/16/2020
17 Department of Health,
Office of Civil Defense
• National lead for the contact tracing activity (Regional Task
Force to lead at regional level)
• Draft national plan of action utilizing technical guidelines issued by
DOH
• Coordinate with national, regional, and local agencies who shall be
involved/contribute to contact tracing and provide operational support
• Monitor national accomplishments and revise operational plans, as
needed

Epidemiology Bureau
04/16/2020
17 Department of Health,
Contact Tracing Team
Team Leader: City or Municipal PNP Chief

Co-Lead: City or Municipal Health Officer

Members: City or Municipal Philippine National Police; physicians,

nurses, midwives, and/or sanitary inspectors from the City or
Municipal Health Office, Bureau of Fire Protection, City or Municipal
Disaster Risk Reduction and Management Office, Barangay Health
Emergency Response Team

Epidemiology Bureau
04/16/2020
17 Department of Health,
Functions of the Close Contact and
Monitoring Team
Team Leaders: City or Municipal PNP Chief and City or Municipal
Health Officer
1. Reports to the Local Executives
2. Organize and deploy local contact tracing teams
3. Listing of close contacts endorsed for close contact tracing and monitoring
4. Prepare and provide needed logistic for contact tracing and monitoring such
as forms, communication allowance, thermometer, PPE, etc.
5. Coordinate with appropriate barangay officials
6. Ensures that reports are submitted on time to the Regional DILG and RESU of the
Center for Health Development through the COVID-19 Information System

Epidemiology Bureau
04/16/2020
17 Department of Health,
Functions of the Close Contact
Monitoring Team
Members: PNP, City/Municipal or Rural Health Physicians,
Nurses or Midwives, BHERTS
1. Conduct daily monitoring of close contacts for 14 days
2. Accomplish recording forms and submit to health office at the end of each
day
3. Facilitate transport for immediate referral of contacts who are
symptomatic for appropriate assessment and management
4. Provide health education and give instructions about what they need to do
5. Refer to appropriate offices non-health concerns/issues of close
contacts
6. Submit accomplished forms to local health office

Epidemiology Bureau
04/16/2020
17 Department of Health,
Functions of the Epidemiology and Surveillance Officer in
Contact Tracing and Monitoring
1. Orient team members how to conduct contact tracing and monitoring; and,
use of recording forms
2. Oversee/supervise the Contact tracing and Monitoring Activities
3. Profile the reported COVID-19 case and generate line list of close
contacts
4. Endorse profile and list of close contacts to the Contact Tracing and
Monitoring Team
5. Consolidate all report forms for submission to the RESU every 5PM daily
6. Encode collected case and close contact profiled and daily monitoring data
using the COVID-19 Information System
7. Do local analysis and interpretation of local data
8. Submit report to the City/Municipal Health Officer for local dissemination

Epidemiology Bureau
04/16/2020
17 Department of Health,
 Close Contact Line list Form
Confirmed Case ID:
Onset of Illness of Confirmed
COVID-19 Case (mm/dd/yyyy):

Epidemiology Bureau
04/16/2020
17 Department of Health,
 Epidemiology Bureau
04/16/2020
17 Department of Health,
 Epidemiology Bureau
04/16/2020
17 Department of Health,
 Epidemiology Bureau
04/16/2020
17 Department of Health,
 Epidemiology Bureau
04/16/2020
17 Department of Health,
 Epidemiology Bureau
04/16/2020
17 Department of Health,
 Isolation Recommendations
Asymptomatic Symptomatic

Should ideally be in a Did not fit COVID-19 Fit COVID-19 Case

quarantine facility case definition Definition

If on Home-based
Quarantine, ensure Self-isolate Local Severe, Critical,
Mild disease +
adherence to quarantine monitoring team OR Mild disease +
Low Risk*
guidelines and daily to ensure High Risk
monitoring adherence to
quarantine
guidelines and daily ISOLATE ISOLATE
monitoring
Isolation may be in a Isolation SHOULD
non-health facility BE in a health
*Low risk: <60 years old, NO comorbidity,, NOT a high risk
pregnancy, NOT a health worker facility

Epidemiology Bureau
04/16/2020
17 Department of Health,
TO DO…

Epidemiology Bureau
04/16/2020
17 Department of Health,
By end of week
• Identify number of contact tracers per LGU
• Identify total number of local teams
• Conduct orientation of regional and local staff on contact tracing
• Inventory of logistics (Forms, Information System access,
thermometer, clipboards and other office supplies,
communication and transportation allowance, transportation
services, sample collection kits)
• Identify LGUs requiring training on laboratory sample collection

Epidemiology Bureau
04/16/2020
17 Department of Health,
By end of week
• List of the following facilities and their HRH requirement and gaps
• Community quarantine facilities
• Community isolation facilities
• COVID-19 health facility
• Referral facilities outside municipality/city/province
• Laboratory facility

No. of confirmed cases:

• No. initiated contact tracing
• No. of close contacts identified
• No. traced
• No. assessed
• No. asymptomatic
• No. suspect, probable, confirmed case
• No. symptomatic but NOT a suspect case

Epidemiology Bureau
04/16/2020
17 Department of Health,
Policies
• DILG Memorandum Circular 2020-073 dated April 13, 2020

• DOH AO on Interim Guidelines on Contact Tracing

• Joint AO on Guidelines on Local Isolation and General Treatment

Areas for COVID-19 cases (LIGTAS COVID) and the Community-
based Management of Mild COVID-19 Cases

Epidemiology Bureau
04/16/2020
17 Department of Health,
Other Matters

Epidemiology Bureau
04/16/2020
17 Department of Health,
Local Transmission

Epidemiology Bureau
04/16/2020
17 Department of Health,
WHO Global Surveillance Guidelines
March 20, 2020
• Local transmission indicates locations where the source of
infection is within the reporting location.

• Community transmission is evidenced by the inability to relate

confirmed cases through chains of transmission for a large number
of cases, or by increasing positive tests through sentinel samples
(routine systematic testing of respiratory samples from established
laboratories).

Epidemiology Bureau
04/16/2020
17 Department of Health,
What is local transmission?
A person whose source of infection CANNOT be attributed to be from
another area
• No travel history to another area within 14 days prior to onset of
illness (date of specimen collection for asymptomatic cases)

Epidemiology Bureau
04/16/2020
17 Department of Health,
WHO Global Surveillance Guidelines
March 20, 2020

Epidemiology Bureau
04/16/2020
17 Department of Health,
Clustering
1. 3 or more confirmed COVID -19 cases reported over two
consecutive weeks who:
a. Were from the same workplace
b. Passengers/Crew of same flight, sea vessel, bus, and other
transportation service
c. Attended the same event or social gathering
2. 3 or more households with at least one household member who is a
confirmed COVID-19 case located in the same barangay (highly
urbanized city) or municipality/component city
3. 3 or more residential units with at least one household member who
is a confirmed COVID-19 case in the same residential building

Epidemiology Bureau
04/16/2020
17 Department of Health,