Contact tracing for COVID-19

Contact tracing is a critical aspect of effectively preventing the spread of COVID-19 in our organisations and communities. It’s not just something that governments or hospitals do — it’s something that any organisation can do as part of its approach to manage the risk from COVID-19.

In this article I’ll get into the details of how we’re conducting contact tracing in the organisation I’m working with in South Korea, and some of the ways we’re making it faster and more accurate. Hopefully there are a few ideas and insights in here that you can apply in your own organisation to build resilience and assure continuity.

Background and context

I’m currently working with a company in South Korea that is an “essential service”. We aren’t able to stop working, and the majority of our operations aren’t done from an office, so employees can’t work from home. As a result, we have had to implement a robust set of mitigation and response measures to protect our employees, and to ensure we are able to rapidly respond to any possibility of an employee contracting the virus.

I arrived in Seoul on 24 February. At that stage the situation appeared dire. Cases were spiking, and it appeared that the virus was spreading exponentially. In context, this was the first major outbreak outside of China, and we had every reason to believe we would be the next Wuhan.

Fortunately, that didn’t happen.

The number of daily cases peaked on 29 February, and the total number of new cases per day has gradually gone down since then. Right now, the situation is significantly more stable. This is largely thanks to the government’s proactive approach to testing, contact tracing, and isolation. I would say that a key factor is the fact that pretty much everyone here wears masks when out and about.

South Korea is now being held up as a good example of how to effectively manage the pandemic. Sadly I don’t think this has mattered, as other countries have oriented too late and have either ignored the lessons we’ve learned here, or have tried to apply them too late.

In fairness, most of Asia was ready for this. South Korea, along with several other Asian countries, has already had to respond to SARS and MERS, so it was clear what needed to be done to stop the disease and minimise the impact on the community.

What is contact tracing, and why is it important

Contact tracing is an investigative approach used to determine who has had close contact with a suspected or confirmed case within the time period they may have been contagious. Those individuals who have been in close contact with a suspected or confirmed case are then placed on quarantine, and may be tested.

Contact tracing is an essential process in efforts to contain the spread of a virus like SARS-CoV-2, because it allows you to rapidly identify individuals who may have been exposed to the virus and isolate them from other groups to prevent further spread.

The process of contact tracing is well described from a medical standpoint. There hasn’t been much written on how a normal organisation should approach it in a way that effectively isolates potential cases, while at the same time minimising the level of disruption to the organisation. In this article I’ll focus on that.

How far to go back?

Before you start the contact tracing process, you need determine how far to go back. We use different requirements based on the way the case presents itself. We document this in our Case Handling Guidelines (this is our Rosetta Stone for handing different types of case presentations).

WHO guidance suggests contact tracing should “identify all social, familial, work, and health care worker contacts who have had contact with a confirmed case from 2 days before symptom onset of the case and up to 14 days after their symptom onset.” We’ve made the decision not to follow these guidelines. Instead, in recognising that the disease can be transferred by someone who is asymptomatic, we’ve deliberately taken a more conservative approach. We identify all close contacts in the workplace four days from the last date of contact with a confirmed case, or the date they started showing symptoms, with other variations depending on the way the case presents itself.

While a longer contact tracing period is more conservative, the obvious downside is that we increase the potential number of people that may need to be quarantined. This hasn’t been an issue for us, because we’ve been able to increase the accuracy of our contact tracing by applying the measures I describe below.

Who is a close contact?

The other aspect that impacts the number of people that may be affected or may need to be placed on quarantine is how we designate “close contacts”. We focus on sustained unprotected contact, which includes activities like sharing meals together or being in the same vehicle and not wearing protective masks. We are less concerned about people working in the same physical space with infrequent close contact, particularly given that everyone is wearing protective masks.

Our approach to contact tracing

We conduct contact tracing for suspected and confirmed cases. We’ve handled dozens of suspected cases (mostly individuals displaying symptoms, or individuals who have had sustained close contact with someone who has tested positive), but we’ve been fortunate not to have a confirmed case yet. For both types of cases, we conduct contact tracing and quarantine all employees that had close contact with that individual.

Our objectives are to:

• Identify close contacts and place them on home quarantine to neutralise the risk of person-to-person transmission within the workplace.
• Minimise the impact on operations by being as accurate and as fast as possible, and by keeping the number of people quarantined to the minimum, based on evidence.

How do we go about this in practice?

First, we implement basic mitigation measures at all of our workplaces to reduce the risk of person-to-person and surface-to-person transmission at our facilities.

Second, we implement specific measures in the workplace to make contact tracing easier. These measures help to increase the speed and accuracy of the process.

Third, we have robust processes in place to conduct contact tracing quickly and accurately, ensuring we’re able to reduce the likelihood of person-to-person transfer at any of our facilities.

I’ll describe these below.

1. Basic mitigation measures

We implemented a risk-based mitigation plan very early in the pandemic. This enabled us to minimise (but not eliminate) the risk of an employee arriving at a facility with symptoms, and reduces the risk of person-to-person and surface-to-person transmission. We have processes in place to step up these procedures and incrementally tighten them should the situation worsen.

These mitigation measures include basic protocols like social distancing and the wearing of masks. Masks are mandatory in our facilities (you won’t be allowed in a facility if you’re not wearing one). If workers are handling common equipment, we require them to wear gloves. We also provide hand sanitiser stations around the work place. These measures are reinforced through briefings and awareness posters.

In offices, employees don’t have to wear a mask while at their desks, but masks are mandatory in lifts and in meetings (noting that we’re only conducting essential meetings face-to-face at this stage).

We’ve developed audit checklists so that facilities are able to apply the mitigation measures, and so we’re able to track any deficiencies.

We also ensure employees don’t come in if they, or anyone in their household, feel unwell. All of our facilities have thermal screening stations on entry, however we are aware of the limitations of these systems. That said, we’ve picked up a large number of people with fevers who we’ve sent home as a precaution.

These mitigation measures have an obvious impact on protecting our employees. They also make the contact tracing process a lot easier, providing confidence in the decisions we make regarding quarantining potential contacts.

2. Measures to make contact tracing easier

Contact tracing must be done quickly and accurately. To facilitate this, early in the process you should identify specific areas of your facility that are vulnerable to crowding. These will present challenges when you have to identify close contacts.

As a start point, you should increase the distance between work stations. This, plus the use of masks, significantly reduces the likelihood of person-to-person transmission. Once you’ve done this, you should then consider other areas where employees may congregate.

We identified several areas in our facilities where close contact occurs. We then developed specific approaches to make contact tracing fast and simple for these areas. I’ll outline these below.

Canteens

Canteens are a significant concern for us, because people take their masks off to eat. To reduce the risk of person-to-person transfer, we’ve applied the following procedures:

• Staggered meal timings, to reduce the total number of people in the canteen at any one time.
• Reduced seating positions per table (from 6 to 3, or 4 to 2), which prevents people from sitting directly across from each other.
• Where possible, we seat people in their work teams. If we get a confirmed case, this helps contain the outbreak to a single team and prevents spread across teams.
• Tables are continually cleaned, and we provide sanitising wipes so that employees can clean their own tables before using them.
• Each seating position has a QR code sticker. When employees sit down to eat, they scan the code to record their seating position. If we have a case, we’re immediately able to call up the seating location and identify the people sitting at the same table at the same time. We can then place these individuals on home quarantine.
• For canteens in higher-risk areas, we’ve installed cardboard dividers to ensure full separation between employees while eating at the table. This may seem extreme to people who aren’t operating in higher-risk areas, but it’s a necessary measure to ensure we’re able to keep operating and supporting our customers.

Buses

You might be surprised that we still use buses given the situation, but we have no other way to get employees to our facilities. To mitigate the obvious risks with people being in relatively close contact on buses, and to improve contact tracing, we’ve implement a range of measures:

• Buses are cleaned before and after use (all contact surfaced are wiped down with disinfectant).
• It’s mandatory for employees to wear masks on the bus. No mask, no ride.
• We ask employees to spread out so that they are not sitting next to each other.
• We maintain a log of where each employee sits, enabling us to quickly determine potential exposure if we do have a case. This avoids the scenario of having to quarantine everyone on the bus if we have a confirmed case.

3. Contact tracing procedures

Once we do have a suspected or confirmed case, we have detailed procedures in place to respond. These are well understood, and after doing this for almost two months, very well practiced.

At a high level, our contact tracing procedures involve interviews and checks of system records.

Interview the subject

The first step in the contact tracing process is an interview with the affected employee. This interview is the most reliable tool we have for determining close contacts.

We have developed an interview questionnaire to enable us to interview the subject. We do this during the same call when the employee first contacts us to notify us of symptoms, their intention to go for testing, et cetera.

We may only have one opportunity to do the interview before the employee is hospitalised, or is otherwise unable to communicate with us. It’s important to do this interview quickly and accurately.

An important point to note: At the stage we are at now, employees are far more aware of the need to recall who they’ve been in contact with, so are primed and ready for the questions and can answer accurately. Employees are willing to help to the best of their abilities, and are professional in how they go about it.

We also interview direct supervisors. As part of our communication procedures, we brief the affected employee’s direct team and ask them whether they had close contact at any stage.

Supporting techniques and tools

In addition to the processes described above, we utilise several other tools and techniques to make the contact tracing process a bit easier.

Risk categories for close contacts

Not all close contacts are the same, because their level of exposure is different. In recognising this, we have created different categories for close contacts. One reason for this to enable us to make better (more precise) decisions regarding who should go on quarantine. The other reason is that it enables us to flag and monitor the other contacts, just in case we do see individuals showing symptoms.

Remember that people will be justifiably concerned to know they’ve been in close contact with someone who has tested positive for COVID-19. It’s important to qualify the degree of contact as accurately as possible so that you’re able to communicate risk and put in place appropriate protective measures.

Visual Case Management

To make the contact tracing process even easier, we’ve developed a Visual Case Management Tool. This tool enables us to visually see who was sitting near the affected employee in work areas, canteens, and in transport. This is a great tool for explaining quarantine decisions to managers and executives, but more importantly it enables us to be confident in our approach.

Clear quarantine rules

Once contact tracing is complete, we place individuals who have been in close contact with the subject on home quarantine. For office workers with the means to do so, these individuals can work from home. Other employees simply get to put their feet up for a few days (14 days to be exact). Probably a well earned break for many of them given the pace of work since the pandemic started.

Note that we pay all of our employees a high proportion of their normal salary while they are on quarantine. We also have a well thought out Employee Assistance Plan and have established an Emergency Fund to support employees financially where needed (examples may be childcare assistance or putting up family members in a hotel for better separation during the quarantine period).

This is an aspect of crisis management I have strong views on. Employees will never forget how your organisation supported them in a crisis. If you don’t take care of them, they’ll never forget that either. It’s important that you step up and do what’s right. On this project I’m proud to be working with a company that genuinely cares about their employees, and literally couldn’t be doing anything more to keep them safe and to make sure they’re fully supported.

Don’t wait until the process is finished

We don’t wait until we’ve exhaustively completed the contact tracing process before we start placing individuals on quarantine. As soon as we identify a close contact, we’ll remove them from the workplace and send them home. As the contact tracing process continues, and we identify others, we send them home as well.

I hope this has given you some additional insights in how you might conduct contact tracing in your own organisation. If you have any questions, please feel free to get in touch. Happy to assist where I can.

I’ve written about contact tracing in some of my earlier articles relating to my work here. If you’re interested, you can dig those out on Medium and have a read.

For organisations that have no other option other than to work through the COVID-19 pandemic, the keys to protecting your employees and ensuring that your operations are able to continue are effective mitigation, sound case management procedures, and good communication. It’s not difficult in practice, but it certainly requires good planning, good leadership, and a significant degree of commitment.

Thanks for reading and stay safe out there.

If your organisation needs support during the COVID-19 pandemic, please feel free to reach out to us for advice and assistance. We can help you to implement mitigation measures, establish best practice for case management, or implement back to work plans that won’t place your employees at risk. You can learn more about what we do here.