DILG: Aggressive Contact Tracing is “game changer” to defeat COVID

August 17, 2020

The Department of the Interior and Local Government said that aggressive contact tracing is the key to the success of the COVID-19 response in Metropolitan Cebu and Baguio City and it will be a “game changer” to the entire country if Congress will allocate funds for the hiring and deployment of additional contact tracers under Bayanihan 2.

NTF Vice-Chairperson and DILG Secretary Eduardo M. Año gave credit to the extensive and aggressive contact tracing that is now being implemented in Cebu City for the reduction of COVID cases in the city. “We did a lot of things in Cebu but among all our interventions, we are making progress now because of contact tracing,” he said.

Año said that while contact tracing efforts are already being done by more than 7,000 contact tracing teams with a total of more than 85,000 contact tracers across the country, there is a need to hire at least 50,000 more to meet the WHO recommended ratio of one contact tracer for every 800 people.

“With a projected population of 108 million this year, we need 50,000 more contact tracers to attain the ideal number of 135,000 contact tracers to significantly ramp up our contact tracing efforts in all parts of the country but with emphasis on hot spots like Metro Manila and surrounding provinces,” he said.

He said that the current number of contact tracers cannot meet the recommendations of Contact Tracing Czar Mayor Benjie Magalong of a 1:37 patient to close contacts ratio in order to cut the transmission of the disease. “We need to significantly increase the number of contact tracers to meet the 1:37 ratio target recommended by Mayor Magalong which has been effective in Baguio and in Cebu City,” he said.

Dr. Takeshi Kasai, director of the WHO office for Western Pacific, and Dr. Rabindra Abeyasinghe, country representative, has also recommended to the DILG the ramping up of the country’s contact tracing efforts as part of the WHO’s continuing documentation of the country’s best practices in response to the pandemic.

The WHO has recognized as a best practice the new Contact Tracing system developed by Mayor Benjie Magalong which combined digital technology and cognitive interviews by contact tracers. Through the DILG, Magalong has been sharing the new system with other Local Government Units as part of his responsibilities as the NTF’s contact tracing czar.

The DILG Chief said that the additional contact tracers will be trained by the DILG’s Local Government Academy in utilizing the “cognitive interviewing technique” which is similar to the questioning technique employed by the police to retrieve information about a crime from eyewitnesses and victims. “Our LGA and PPSC has developed 4 modules in our training program and we will ensure that all those hired will be trained,” he said.

DILG Undersecretary and Spokesperson Jonathan Malaya said that the success in Cebu City can be attributed to the creation of cluster clinics, barangay isolation centers, and quarantine facilities; deployment of contact tracing teams; and widespread testing.

“But the biggest game-changer in Cebu City is the aggressive contract tracing. Before they only had 5 teams, now they have 130 teams implementing the Magalong formula of tracing 37 contacts per COVID patient. By doing so, they were able to immediately isolate those infected and cut the transmission before it infects the community. Now they see a downtrend and their cases are now manageable,” said Malaya.

He said that Cebu also implemented the data management system recommended by Mayor Magalong and hired encoders and analysts to study the trends.

The University of the Philippines said the replication rate in Cebu City has dropped from a high of 2 to 1.14 in the month the IATF/NTF stepped in to oversee the COVID response. From daily cases by the hundreds, the new cases have gone down to double digits, a trend that has continued even under GCQ. The positivity rate has also significantly dropped from 33% to 16%.

Malaya also agreed that that technology must be used in contact tracing just like in other countries but manual contact tracing must be done hand in hand with the use of digital technology because we cannot completely rely on digital applications.

“All countries use both – manual and digital technology. There are also limitations in just using technology because not everybody has a smartphone which is what is required in digital contact tracing. And even those with smartphones, compatibility of Android with IOS is another problem unless Bluetooth technology will be employed with approval from both. The phone owner should also always update the status of his health which needs cooperation from users,” he said.

He explained that manual contact tracing is done, on the other hand, through phone or any other means of communication or through face to face (with PPE) for those who cannot be contacted. “A contact tracer also shows empathy as he elicits information from the confirmed case and close contacts. Cognitive interview is also done. Therefore, the contact tracer is also a patient case manager,” he said.

Malaya said that the Contact Tracer also advises the patient and close contact on what to do. “He can refer him to an isolation facility. He monitors the case and close contacts every day for 14 days for symptoms and health status. Hence, direct communication with the COVID patient is important,” he added.

He said that with the expanded contact tracing, LGUs can open up their own contact tracing command center which will serve as the nerve center for data gathering. With just one click of our contact tracers in their phones, data will be automatically sent to the database and analysis can be done. Here is where technology comes in.”