Neglecting contact tracing

South Korea’s contact tracing program once more proved its efficacy when, earlier this month, it managed to track down 66 new COVID-19 infections and trace them back to a woman who visited a coffee shop in Paju, a city northwest of Seoul.

The woman, who stayed in the café for two hours, sat in front of an air-conditioning vent and talked while not wearing a face mask, likely dispersing contagious aerosol particles, experts said, and transmitting the virus to 25 other café visitors, who in turn infected 37 more. The woman also infected four persons related to her. But four of the café staff who were on duty were saved — they were wearing KF-94 face masks.

This incident only validates how wearing a face mask is a key defense against COVID-19. But, more importantly, it shows how a reliable system of contact tracing to immediately identify the source of infection, test contacts, isolate the positive cases, and treat them can prevent the disease from further spreading to a larger number of people and their communities. Back in May, the World Health Organization (WHO) already highlighted the importance of contact tracing, which, when properly applied, “will break the chains of transmission of an infectious disease and is an essential public health tool…”

In the Philippines, unfortunately, contact tracing has been a “little weak,” as the WHO put it politely in July. It noted that the rising number of cases — despite the lockdowns — was worrying because it meant that the transmission has not stopped. True enough, the number of cases has only continued to rise, breaching the 200,000 mark last Aug. 26.

There was hope that a proper tracking system would finally be in place after Malacañang appointed Baguio City Mayor Benjamin Magalong as “contact tracing czar” last July 13. Magalong, a former police investigator, had formed a contact tracing team as early as March and trained city personnel; Baguio’s COVID-19 response would eventually be recognized by the WHO as a model. Magalong also helped train contact tracing teams from neighboring local government units before his appointment as czar.

“I cannot overemphasize the value of contact tracing as one of the critical pillars in our fight against COVID-19, along with isolation, testing, and treatment,” Magalong said. But he added that “for all the other pillars to work, contact tracing should be done speedily and effectively.”

As it turned out, majority of LGUs, to which the Department of Health (DOH) has passed the responsibility of contact tracing since April, ended up implementing a shoddy, watered-down system. A frustrated Magalong lamented late last month that less than 1 percent of the 600 LGUs have reliable contact tracing, and that it was common for them to only trace household members or up to four or five contacts of COVID-19 patients.

This was far below his recommended 30-37 contacts for urban areas, and 25-30 for rural areas. The number of unaccounted contacts could be a factor in the unchecked rise in cases, he said, assuming there is a 10-percent positivity rate among close contacts: “If there are 2,500 unaccounted individuals in 10 days, we’re looking at 250 potentially infected persons who go about publicly and are unaccounted. That’s why the number of cases increases.”

Magalong also complained that only names, and no addresses, of the close contacts were encoded in the COVID KAYA Information System, a case and contact tracing reporting system developed by the DOH Epidemiology Bureau for use by surveillance officers, health care providers, and laboratory-based users.

But the bigger issue is the shortage of contact tracers to meet the WHO standard of one for every 800 individuals. The Philippines needs at least 135,000 contact tracers to cover its 110-million population. In June, the Department of the Interior and Local Government said there were 52,463 contact tracers in the country, but it needed 83,000 more. It has announced plans to hire 50,000 contact tracers next month — eight months after the start of the pandemic in the country — once the P5 billion fund under the Bayanihan to Recover as One Act is released. However, that number will still be short by about 30,000 contact tracers.

For months, medical experts have been urging the government to speed up its contact tracing as the country struggled to contain the virus. On Aug. 10, even as Metro Manila and outlying provinces were placed anew under MECQ, 6,958 new cases were reported, the highest recorded in a day. “It is a recognized fact that there is a community transmission… [it] is really the cause of the spike of cases,” admitted Health Undersecretary Maria Rosario Vergeire two days later.

No matter how many lockdowns the government imposes, such transmissions will persist unless, along with testing and treatment, a thorough, no-nonsense contact tracing program — already fatally delayed — is pursued.