[INSIGHT] Contact Tracing, Weapon to Fight COVID-19 Infection-Monday, November 9, 2020

In pandemics and outbreaks, contact tracing is the key to preventing quarantine infections. Contact tracing not only guarantees efficient testing and early treatment before the prognosis worsens, but also provides reliable data in modeling to predict the spread of the disease.

Contact tracing is performed through surveillance by a team of observers, tracers, or epidemiologists. Each municipality’s COVID-19 Task Force has a monitoring team whose work is similar to a call center. Their daily duty is to call all COVID-19 patients and their close contacts.

A central task force, laboratory, or referral hospital treating a COVID-19 patient can also send the patient’s contact list to the monitoring team or contact tracer team. Observers call those patients. The first question is, “Who have you seen in the last 14 days?” Or, “Who do you live with?”

The problem is how to track a virus infection. However, there are some problems with the stigma faced by infected people. Interviewers usually resist and answer, “Who are you?” Or, “Can you give me a formal transfer letter?” In some cases, “Sorry, I’m not sick. I dialed the wrong number” to deny the infection.

Collaborative patients answer questions clearly. But another problem arises. The method of asking the patient to screen their memory is error-sensitive. In epidemiology, this tends to cause a bias called recall bias.

Observers who don’t get the information they want usually leave the form blank or use their own opinion to guess. In that case, contact tracing results in data inaccuracy.

Due to the long form of questionnaire that contact tracers and observers have to deal with, there may also be problematic data. For example, in Jakarta Beck, imagine an observer calling about 100 people each day and each interview lasting about 20-30 minutes. In fact, local task forces, which typically employ 10 observers, cannot complete their work in a few days if needed.

The contact tracer or observer also handles many data systems that are not integrated. This complicates the process of entering large amounts of data.

The incomplete data is used for task force calculations such as Rt calculations and effective reproduction numbers (modeling in the analysis of virus spread after intervention). The results usually suggest that the disease is controlled, even if the truth is the opposite. This is called “overestimation”.

Data issues can also mislead the task force in identifying COVID-19 infected clusters.

Even observers assigned to cities, which are considered benchmarks for dealing with pandemics, face these issues. Contact tracing in such cities has never reached 80% of the set goals.

There are two options to address these issues. First and foremost, develop technology for tracing or tracking. The COVID-19 Task Force and the Ministry of Health across the country have recognized this need from the beginning. They apply many data systems to their surveillance, the latest being an app called Silacak.

The new app was designed to ensure the effectiveness of contact tracing. However, recall bias and data integration are still obstacles.

Some countries use SIM card-based location tracking apps. The challenge with this method is that it can compromise patient privacy. It is protected by Hospital Law No. 44/2009 and Public Relations Law No. 14/2008. This method poses challenges to health surveillance and epidemiology, but some experts say it should work with the consent of the patient.

In Indonesia, when the pandemic began, this type of app was released by the Ministry of Communications and Information and required user approval. However, the COVID-19 Task Force and the Ministry of Health across the country have not done enough to promote it.

Next, we need to consider ways to optimize grassroots contact tracing and increase community participation. Tracer phones should not be perceived as a threat by the public. The government must make double efforts to convince the public about the importance of tracking down COVID-19 infections and eradicating stigma.

Our attention should also be directed to rural areas and indigenous communities that lack or lack internet and electricity. In 2019, the Ministry of Communications and Information reported that 24,000 villages had no internet access. These regions require a participatory model of contact tracing named Community Based Surveillance that works in rural Africa. This approach requires the participation of local community volunteers.

We hope that the government will prioritize contact tracing and surveillance to reduce COVID-19 infections and reduce mortality.

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Masdalina Pane is a health ministry researcher on infectious diseases and vaccines and a consultant for the Centers for Disease Control and Prevention-Indonesia Epidemiology Association (CDC-PAEI), COVID-19 Regional Empowerment.

Dhihram Tenrisau is a former Depok COVID-19 Task Force Contact Tracer.

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