Test and trace

Bloomberg, the financial and business media outfit, had a lead article yesterday that read: “It’s a national tragedy we’re not wearing masks more often or testing and tracing better.”

There’s more, of course, to the serious COVID-19 crisis in the United States, especially with leadership and governance, but let’s see what we can pick up for the Philippines.

We are truly fortunate that in the Philippines we have adopted masks wholeheartedly, although with some lapses in the way they’re used. Many Americans, in contrast, have rejected using masks for political reasons, seeing it as a sign of weakness, of being liberal (a bad word for many Americans, apparently), or even Leftist.

We’re OK then with masks, but with testing, we’re pretty much like the US, with all the well-publicized criticism of our testing continuing to be haphazard and without a sense of direction. I have written about this several times, as has my fellow columnist Mahar Mangahas: We need random testing or, to use epidemiological terms, sentinel surveillance, looking at all geographical areas and at different population groups, and not just the so-called high-risk ones.

Random (but systematic) testing is NOT mass testing. We do not need to test all 110 million Filipinos, but we do need to have representative geographical distribution so we can have early detection. Right now, we wait for an outbreak and then rush in to test, often by then overwhelmed by the speed of its spread, as is happening now in Cebu and, I’m afraid, Eastern Visayas.

What I worry about now is that even while we are improving, ever so slowly, on testing, we do not seem to be doing adequate contact tracing — that must go together with the testing.

Contact tracers look at the people behind the numbers. As early as when a person is identified as possibly having been infected, contact tracers ask the person who he or she might have been in close contact with the last few days before infection, from people living with them in the house, to office mates. They help the person to reconstruct activities where other exposure might have occurred — for example, being on a plane, train, or restaurant, and where they sat, so passengers around them can also be contacted.

It’s through contact tracing that we’ve had some of the very important information on superspreader venues: to name a few, homes (especially in areas with congested living conditions, as has been the case in our poorer barangays), facilities for the elderly, bars, and restaurants. The events are even more interesting and have included religious worship, choir practice, and, in the Philippines, a cockfighting derby (11 deaths!), and, yes, a birthday party (nine infections and one death).

The Department of Health would do well to publicize these superspreader events, even while guarding confidentiality, to warn people about the environments and circumstances for COVID-19 spread.

It’s hard work not just because of the attention to details that’s needed, but also because the contact tracer has to explain to the person why they need to go on quarantine (if an infection has not been confirmed) or to be isolated (with a confirmed infection). The contact tracer has to deal with fears, resistance, even anger to deal with issues of work, and separation from family and friends.

In the US, the contact tracer continues to follow up on the people interviewed, encourages them while they’re in quarantine or isolation, and checks if they need to be referred to a hospital or to agencies giving financial aid and other assistance.

Our government has admitted to the problem of a lack of contact tracers, and has called for recruitment from among health science and criminology graduates, which led me to sigh. I recently finished a contact tracing course, and will tell you it’s not so much one’s academic background than having an inquisitive mind and communication skills. Plus “tiyaga,” Filipino for a combination of persistence and patience.

The work of contact tracers has given us so much more important information on how COVID-19 spreads, as well as what can be done to prevent more infections. If you want three good examples, search on the internet for “El Pais: An analysis of three Covid-19 outbreaks,” which has a very informative presentation of how contact tracing mapped out the infections and produced recommendations on what can be done, all the way up to reducing background music in offices so people don’t need to speak out loud, which can mean more effective spread of the virus.

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