Contact Tracing: Strategies for Identifying and Managing Healthcare Workers Linked to COVID-19 Cases

Background

Due to the rapidly evolving epidemiological situation regarding the novel coronavirus disease 2019 (COVID-19) epidemic, EU Member States are now not only reviewing their case management but also their approach towards people who have been in contact with recently detected cases (’contacts’).

This document can be read in conjunction with the WHO guidance " Home care for patients with suspected novel coronavirus (2019-nCoV) infection presenting with mild symptoms and contact management ."

Scope of this document

The aim of this document is to provide guidance to EU/EEA public health authorities on the management of people, including healthcare workers, who had contact with COVID-19 cases.

Target audiences

Public health professionals and healthcare professionals in EU/EEA Member States.

Purpose of contact management

The purpose of managing contacts of the COVID-19 case is:

Identify symptomatic contacts as soon as possible for isolation and treatment.
Facilitate rapid laboratory diagnostic tests.

Definition of contact persons

A contact of a COVID-19 case is a person who is currently asymptomatic , who has had or may have been in contact with a COVID-19 case. The associated risk of infection depends on the level of exposure, which, in turn, will determine the type of monitoring.

Establishing the level of exposure can be difficult and requires that the case be interviewed.

1. High risk exposure (close contacts)

A person who lives in the same household as a COVID-19 case.
A person who has had direct physical contact with a COVID-19 case (for example, shaking hands).
A person who has direct unprotected contact with secretions from a COVID-19 case (e.g., coughing, touching used tissues with a bare hand).
A person who has had face-to-face contact with a COVID-19 case within 2 meters and for more than 15 minutes.
A person who was in a closed environment (e.g. classroom, meeting room, hospital waiting room, etc.) with a COVID-19 case for 15 minutes or more and at a distance of less than 2 meters.
A healthcare worker (HCW) or other person providing direct care for a COVID -19 case or laboratory handling samples from a COVID-19 case without recommended protective equipment (PPE) or with a possible PPE violation .
A contact on an aircraft seated within two seats (in either direction) of the COVID-19 case, traveling companions or persons providing care, and crew members serving in the section of the aircraft where the index case was seated ( If the severity of symptoms or movement of the case indicates more extensive exposure, passengers seated in the entire section or all passengers on the aircraft may be considered close contacts).

Low risk exposure (casual contact)

A person who was in a closed environment with a COVID-19 case for less than 15 minutes or a distance of more than 2 meters.
A person who had face-to-face contact with a COVID-19 case for less than 15 minutes and at a distance of less than 2 meters.
Traveling together with a case of COVID-19 on any type of transportation. A longer duration of contact increases the risk of transmission; the 15 minute limit is arbitrarily selected for practical purposes. Based on individual risk assessments, public health authorities may consider extending contact tracing and management to individuals who had a shorter contact duration in this case.

health workers

Healthcare workers caring for COVID-19 patients in EU/EEA hospitals must register and monitor themselves in accordance with work health procedures/routines in their country of practice. Based on the high risk of transmission associated with medical care , and in line with existing recommendations from other institutions, the following specific measures are proposed for health workers.

Unprotected contact (high risk exposure). Active monitoring for 14 days.

AND

Suspension from work for 14 days after last exposure.

Contact protected with the use of recommended PPE:

Self-monitoring and self-isolation if respiratory symptoms occur.
Absence of suspension from work.

Contact management steps after a case is identified Immediately after a case is confirmed, the next steps are:

Identification and list of contacts; classification of the contact as having had a high-risk exposure (’close contact’) or a low-risk exposure.

Contact tracing and assessment (i.e. communicating with contact persons and assessing risk) • contact management and monitoring (i.e. informing, advising, following up, this includes testing if indicated).

Monitoring of contact tracing results by an outbreak control team.

Contact monitoring

Depending on the specific situation, public health authorities may support, promote or implement additional restrictions (for example, voluntary limitation of contacts by the person, or avoiding contact with crowds).

Contact tracking and management are based on the latest available knowledge, as described below.

Current estimates suggest a median incubation period of five to six days, with a range of up to 14 days .

A recent modeling study confirmed that it remains prudent to consider an incubation period of at least 14 days.
A case is thought to be most infectious when symptoms are present, but could possibly already be infectious before the onset of symptoms.
Transmission is thought to occur primarily through respiratory droplets. At present, it is still unclear whether airborne or fecal transmission is possible.
Additional measures are suggested for healthcare workers, based on existing evidence of frequent healthcare-associated (or “nosocomial”) transmission. In a series of 138 cases from Zhongnan Hospital in Wuhan, hospital-associated transmission was suspected for 40 (29%) healthcare workers and 17 (12.3%) hospitalized patients.

Main actions for contact people

Contacts with high risk exposure:

Active monitoring by public health authorities, for a period of 14 days after the last exposure.
Daily monitoring for COVID-19 symptoms, including fever of any degree, cough, or difficulty breathing.
Avoid social contact.
Avoid traveling.
Remain accessible for active monitoring.

Contacts with low risk exposure :

Self-monitor for symptoms of COVID-19, including fever of any degree, cough, or difficulty breathing, for a period of 14 days after last exposure.
Public health authorities can do more, depending on the specific situation.
Contacts, regardless of whether their exposure was high or low risk, should immediately isolate and contact health services if a symptom appears within 14 days of the last exposure.
If no symptoms appear within 14 days of the last exposure, the contact person is no longer considered to be at risk of developing COVID-19.
Implementation may be modified by public health authorities, depending on the risk assessment for individual cases and their contacts.

Contact Tracing: Strategies for Identifying and Managing Healthcare Workers Linked to COVID-19 Cases

Effective public health management of contacts, including healthcare workers, exposed to COVID-19 cases is crucial for mitigating transmission risks and containing the spread of the virus, highlighting the importance of robust contact tracing strategies in pandemic response efforts.