When the Kenyan Government announced the country’s first case of COVID-19, clinician Jackson Njoroge was already hard at work. He and his colleagues from the Kenyan Ministry of Health’s Rapid Response Team had already drawn up a list of people who might have come into contact with the first patient. Now they were rushing to find them. His mission was to find another passenger from the flight that had brought Kenya’s case into the country. The World Health Organization (WHO) has already helped train 1,500 Kenyan health workers in various health facilities to prepare for just this situation. With the announcement, the country’s government and WHO Office shifted from a state of readiness to response mode.
Tracing the contact proved difficult at first: the patient had failed to observe self-quarantining guidelines for new arrivals and was not answering their phone. Contact tracing involves identifying anyone a confirmed case might have come into contact with from two days prior to the onset of symptoms to up to 14 days afterwards. Njoroge’s team is one of four Rapid Response Teams working from the Ministry of Health’s Emergency Operations Centre, each containing five trained medical staff. The Centre also has a hotline for members of the public to get information, report suspected cases, and ask questions. Thanks to combined efforts of the Rapid Response Team, a telecommunications company, and the national security services, Njoroge was able to trace the contact and ensure they were isolated for testing. “She was just scared but we are ready for this, ” he says. “We have been waiting for moments like this and all the challenges that will come as a result of the spread of the virus,”.
At the newly-established coronavirus isolation and treatment unit at Kenyatta National Referral Hospital, the traced contacts anxiously awaited their test results. Njoroge helped calm their nerves, playing the part of physician, teacher and counsellor simultaneously. Despite cracking a few light-hearted jokes with patients to ease the tension, he and his team treat the work with the utmost seriousness. “There is no room for mistakes,” says Dr Njoroge as he checks the personal protective equipment of Sharon Akinyi, a 20-year-old nurse and youngest member of the team.
Proving Dr Njoroge’s point, the contact’s test came back positive, Kenya’s third confirmed case of COVID-19. A new network of contacts has to be drawn up, and the meticulous process must begin again. Contact tracing is an essential component of a strong surveillance network. So far, the majority of cases in Africa have been imported. Only Senegal, South Africa and Algeria have seen local transmission. To prevent community transmission, cutting off the spread at an early stage is vital.
WHO has been supporting government health ministries across Africa strengthen their surveillance and contact tracing abilities by training health workers and ministry staff in best practices, as well as circulating tools for data collection, reporting and diagnosis. So far, WHO has trained 36 countries on Rapid Response Teams and contact tracing.
WHO Ethiopia has been training health workers in contact tracing at the Ethiopian Public Health Institute. Some of the existing contact tracing teams in Ethiopia already have experience in locating potentially sick or contagious people. But COVID-19 represents an unprecedented challenge, making these trainings all the more important.
For WHO emergency public health specialist Dr Abiy Girma, an essential part of this training is ensuring that health workers know how to keep themselves safe: “when you visit a contact, keep your physical distance and – apart from greeting and giving information – don’t engage in any social activity with the contact,” Dr Girma tells attendees.
Contact tracing is an important intervention in the fight against COVID-19 in Africa, particularly when so many countries have weak health systems that may be overwhelmed by a large-scale outbreak. “You are protecting the entire community when you put in place a good contact tracing,” says Dr Charles Lukoya Okot, Epidemiologist and Surveillance Technical Officer at the WHO Regional Office for Africa in Brazzaville. “It’s also a benefit for the person. When you seek medical attention at the earliest stage, your chances of improving or survival are very high. You can protect yourself and you won’t get the worst complications.”
Although COVID-19 is a new threat to global public health, contact tracing is a tried and tested method that has many other applications. “Contact tracing is one of the critical interventions” Dr Charles continued. “It came to prominence during the Ebola outbreak”. Contact tracing meant that those people unfortunate to enough to contract Ebola could be located, isolated and treated before they infect others in their community. Now, the skills and best practices honed during that outbreak are being shared by WHO throughout Africa and the rest of the world.