What’s Next for COVID-19 Contact Tracing
On July 9, the Development Academy of the Philippines Graduate School of Public and Development Management (DAP-GSPDM), in partnership with the Philippine Society of Public Health Physicians (PSPHP) and the Action on Economic Reform (AER), conducted a webinar titled “What’s Next for COVID-19 Contact Tracing”. Attended by over 150 participants from different regions of the country, the webinar served as an avenue for experts to share knowledge and insights on the current COVID-19 contact tracing protocols, as well as identify potential solutions and ways moving forward.
Call for Policy Change on Contact Tracing
Dr. Troy Gepte, an epidemiologist and currently a public health consultant for the Senate Committee on Health, has been involved in the country’s fight against public health emergencies and outbreaks, such as SARS, MERS-CoV, and Ebola. In this webinar, he shared firsthand experiences as the head of the informatics unit of the National Epidemiology Center (Epidemiology Bureau) during the Philippine SARS outbreak in 2003. He identified control measures that were immediately put into action, one of which is an exhaustive manual contact tracing. This led to the quarantine of contacts, isolation of cases and identification of areas of containment without having the need to implement a community quarantine and country-wide lockdown.
One of the points raised was on the use of both analog and digital approaches. “We need to consider how to use these new approaches while also committing to ‘legacy’ methods of disease surveillance”, Dr. Gepte emphasized. He made a call for support to LGUs in protocol development and capacity building, as well as the need for an interoperable information system. Dr. Gepte concluded his presentation by stating the importance of balancing out systems thinking and programmatic approach, which go hand in hand, to optimize our capacities.
Call for Digitalization and Automation of Contact Tracing
Mr. Wilson Chua, a data scientist based in Singapore, shed light on the current state of contact tracing protocols in the Philippines as compared to that of neighboring countries. He presented findings from a study published in the Lancet wherein various control measures were simulated to estimate the reduction of transmission. This study found that combining physical distancing measures with self-isolation and contact tracing achieved a higher percentage reduction in transmission than self-isolation or mass testing alone. The use of applications in addition to these measures further increased the percent reduction.
He then highlighted the gap in the current practice in Philippine contact tracing. The graphic analysis done by Andrei Diamante using the DOH data drop is shown below. Mr. Chua used this to highlight the gap. The Philippine situation has an unacceptable average delay of 15.8 days between the onset of symptoms and confirmation of results.
Based on a Johns Hopkins study, infected persons can be infectious around 2 days BEFORE the onset of their symptoms. Thus, COVID19 virus is unwittingly spread to more people by the index patient during these 15.8 days. Preventive action is delayed since DOH guidelines state that contact tracing will only begin AFTER the confirmation of results (circled in blue). If the average incubation period is 5 days, this means that contact tracing has to be done within the first 3 days of infection to help flatten the curve. In Mr Chua words, “We must trace in THREE to be COVID Free”.
With that, Mr. Chua provided his three recommendations: 1) trigger contact tracing earlier and combine digital technologies, 2) limit social contacts by managing access with technology, and 3) use data more effectively with network analysis by predicting “At-risk individuals”. In the diagram below, these are persons A and C.
Call for community engagement and empowerment
Lastly, Dr. Juan Antonio Perez III is currently the executive director of the Commission on Population and Development (POPCOM) and undersecretary for the Population and Development. He began his presentation by expressing the need for a paradigm shift from a clinical-based approach to a community-based approach as most of the current response actions focus on ensuring hospital-based care instead of contact tracing and patient recovery in the community. He stressed that given the limitations in capacity of hospitals, shifting the attention at the community level could greatly improve the COVID-19 response. “If we know where we are vulnerable, we can best defend ourselves and pursue the virus in the communities where it thrives”, he highlights.
Dr. Perez then presented a joint memorandum circular issued by the DOH-DILG-NEDA-POPCOM which seeks to provide data and technical guidance to LGUs in considering demographic characteristics as critical factors in implementing intervention strategies. He also mentioned challenges that would arise in a community-based approach, including insufficient and bypassing of data, low number of barangay-based contact tracing teams, and the lack of technical and operational support for LGUs. He provided recommendations to enhance structures in place at the community level.
PSPHP President Dr Lester Sam Araneta Geroy gave a synthesis. It appeared from the discussion that contact tracing will become an important knowledge and skill among local health and community workers; contact tracers will become a new public health cadre in communities. Dr Geroy also emphasized the value of investing in health information and new technologies. Decentralization is an important reality that goes with local decision making, autonomy and capacity building. Coordination goes in different ways, horizontal and vertical, political, technical and operational. Finally, Dr Geroy emphasized the value of pilots, models and initial drafts as ways to see how innovations and new ideas work.
Dr Eddie Dorotan, Convenor of the COVID Action Network (CAN), concluded that at the moment, there is still a lack of knowledge on contact tracing in the country. One way to address this, he proposed, is to engage leaders who have successfully contained the virus in their communities and provide them a platform to share their experiences and best practices. Dr. Dorotan encouraged the audience to learn from all the uncertainties and failures that would inevitably result from fighting against a novel virus. He also reiterated the need for health systems strengthening, decentralization and community empowerment, as well as the importance of coordination. As Mr. Chua mentioned, “the only way that we can flatten the curve is by doing it together”.
Other experts who shared views and thoughts during the webinar were Dean Lizan Perante-Calina who opened the event, Dr Aileen Espina who gave an overview, Dr Marthony Basco who moderated the discussions, and Assistant Secretary Manuel Felix from the DILG who reacted to the presentations.
The recording of the webinar can be found here or through the COVID-19 Action Network Philippines Facebook page.