Our experiences in pandemic- COVID-19 contact tracers

Tracking close contacts of COVID-19 positive persons might come with some daunting challenges, but 24-year-old Hadiza Shehu remained committed to the arduous task of breaking the chain of transmission and slowing the spread of the virus.

Hadiza is one of the 40 in Sokoto involved in COVID-19 contact tracing- identifying and tracking close contacts of a person who tested positive for coronavirus. When she took up the responsibility as COVID-19 contact tracer, her family members were apprehensive; the initial dread the novel virus had sparked in public.

“But I told them there was nothing to fear. My parents prayed God protects me but stressed that I should take care,” said the public health worker.

“Because of the training on contact tracing, I exercised no fear, and I engaged in health talks in various communities during the pandemic.”

Hadiza is among very few females with the vigour to be in the frontline to interrupt the virus spread.

About 90 per cent of the contact tracers in Sokoto are males. Contact tracing, described as an essential public health tool for controlling infectious disease outbreak such as coronavirus, did not come with COVID-19. It has been around for decades as a key strategy in halting further disease spread.

World Health Organisation (WHO) describes contact tracing as a vital part of an epidemiologic investigation and active surveillance of COVID-19.

“Contact tracing -along with robust testing, isolation and care of cases -is a key strategy for interrupting chains of transmission of SARS-CoV-2 and reducing COVID-19- associated mortality.”

To effectively carry out their tasks, the contract tracers, many of who were health workers who had worked on the issues such as polio and other public health concerns, went through a specific training programme to build their skills and strengthen their capacities.

They received training on conducting a contact-tracing interview, eliciting close contact information, notifying contacts of exposure, and addressing concerns exposed persons may experience.

Though Sokoto State was contemplating having a digital application for the contact tracing, they have not used it; thus, they use the manual method. They fill a questionnaire of about three pages for each contact. The health workers take samples of those with symptoms for test and monitor those without symptoms for 14 days.

Halima was actively tracing suspected persons infected by COVID-19 in different communities in Shagari, Wurno and some other local government areas of Sokoto, Northwest Nigeria.

Another Contact Tracer and Focal Person for awareness on COVID-19 in the Gagi community in Sokoto South Local Government Area, Zubairu Muhammad, tracked contacts in 15 communities in the council.

Before being fully engaged as contact tracers and awareness campaigners on COVID-19, Muhammad took part in the Gagi District Head imitative to sanitise his domain. They track those coming back from other states.

“We fish out anyone suspected with symptoms, especially those who returned from travelling from other areas. I attended naming, marriage ceremonies, Friday prayers and other community congregations besides individuals’ house -to -house interactions.”

Another Contact Tracer, Malam Usman Umar, said he focused on youths and met them mostly at foosball fields and sitting places of groups.

RESULT OF TRACKING
During the first wave of COVID-19, Sokoto State flattened the COVID-19 curve in less than two months, a development Coordinator, Sokoto State Committee on COVID-19, Dr. Mohammed Ali Inname, attributed to active contact tracing.

“We tested those people who had contact with confirmed cases with or without symptoms. It helped us to contain the spread,” he states.

“So, even if you don’t have symptoms when you test positive, we remove you out of the community to reduce the chances of those who are asymptomatic spreading the disease.”

Inname, the State Health Commissioner noted that contact tracers are “very central to the control of COVID-19.”

“With them, we will pick people before they spread the virus because some people may not know that they have it.”

He also observed that from the contact tracing, they discovered that in the first wave, the infection ratio was between 1-1.5 – that is how many people that the positive case has infected, but in the second wave (November-January), it was up to 4.

A study of 391 coronavirus cases and their 1286 close contacts in Shenzhen, China, suggests that contact tracing reduced the time people were infectious in the community.

According to Chinese researchers, contact tracing sped up the average time for confirming new cases from 5.5 days to 3.2 days. They added that contact tracing reduced the time taken to isolate infected people from an average of four-six days to 2.7 days.

VOICES OF CONTACTS
In Sokoto, Mallam Abdullahi, contact of Covid positive relative, said health workers contacted him. I did not have a symptom. They gave me two weeks of observation, monitoring, calling me within that time to know if I have symptoms or not. They said it was necessary to track those in close contact with a COVID-19 positive patient, as they are at higher risk of being infected and might infect others.”

Ummu Aisha, whose husband tested positive, said: “When my husband tested positive, the health official tracked my children and me. They conducted tests and monitored us. But we remained negative.”

“It was a dispiriting period because even after my husband received treatment and became negative, people avoided us.”

A contact whose friend tested positive for COVID-19 said he initially avoided interaction with trackers because he did not want his family and community members to evade him.

“Later, I realised it is in our best interest to get to know our status for the prompt care and treatment.”

THE CHALLENGES
Hadiza and other contact tracers had to deal with resentment and antagonism from some quarters. “Part of the challenge that we have is that of acceptance. Denial and non-cooperation of some contacts,” she stated.

“We face challenges when seeking COVID-19 information from the public. Some people are very aggressive and unreceptive. We have to cope with the wariness of the people on the pandemic.”

Hadiza would not forget in a hurry the experience during which angry villagers almost hit her.

“A time we went to a community Shagari local government, we encountered problems with the parents of some almajiri children who had returned to Sokoto at the peak of the pandemic,” she said.

“That time that we went to the village, the villagers gave us fright how they stood and wanted to hit us; I won’t forget it.”

She continued: “Those we took for isolation started crying that they do not have COVID-19, but I sat the parents down and talked to them; we told them it is not a death sentence; it is pandemic. I told them they would see their wards after some days. They eventually understood, and we even cracked jokes.”

Hadiza added: “Sometimes, when we get a confirmed case in a house, the people do not give us the support we need; they do not want the community members to know that there are confirmed cases in their houses.”

“So, we will call them on the phone, and they give us the contacts. We call the contacts to confirm if they were in contact with them and for how long were they in touch.”

Another contact tracer, Bashir Gagi, had this to say. “People are running from us. Before you track a person, it isn’t easy because people are running away from us. We have to move from house to house, and some do not respond well. You are going to use your experience and technical skills to ensure you have all that you want to get from them.”

According to him: “The greatest challenge is that suffering house to house, it is difficult, and people are considering us as being sponsored by western people to spread their ideologies.”

“Another challenge is a poor understanding among people, as most could not think COVID-19 is real.”

Similarly, Umar noted the challenge is mainly people’s negative perception of western ideologies attributed to the source of the disease.

But even with the hassles, ensuring they reduce the number of people circulating with the virus gives Halima and others renewed enthusiasm.

She revealed that their strong communications skills come to play when contact tracers face challenging situations.

“We usually tackle a sticky situation by deploying appropriate communications skills.”

THE GRATIFYING, THE CRUSHING
What Halima enjoyed most was the conducive work experience. “We did not have delays. If there is a case and they said 7 am, prompt; everybody is there. We got a suitable vehicle that made the journeys very pleasant.

For Bashir: “What I relished most is the experience I got; now we have the expertise on how to manage this; we are on the frontline, so they train and retrain us.”

“But I did not like that when you go to meet people, they tell you, bring items such as rice for them; they would talk to you anyhow. But from experience, you got to be patient with people.”

However, some others say they did not like it when there was a delay in payment of their allowances at the initial stage.

“Initially, they did not pay our weekly allowances on time, we can go seven-eight weeks without being paid, but when they pay, we are happy.”

STAYING SAFE, POSITIVE
As frontline workers, the COVID-19 contact tracers said they are well aware of the risks; thus, they prioritise their protection.

“We observe all the COVID-19 protocols. Usually, after a day’s contact tracing exercise, we go to the office first and clean ourselves before going home,” Bashir explained.

Some contact tracers turned to prayer to stay positive and maintain their peace; others maintained constant communication with family and friends. These diligent workers also motivated one another to stay sane and ensure fear and uncertainties do not take a toll on their mental health.

UNSUNG HEROES
A social crusader, Aisha Aliyu, describes Contact tracers as COVID-19 heroes. “They help in controlling the spread of COVID-19. If they are not there to do the work of breaking the chain of virus transmission, the pandemic would be worse than it is,” she noted.

“However, despite being on the frontline, they do not get the deserved credit.”

She identifies constant engagement with communities and adequate public enlightenment as the key to effective contact tracing.

“Intensive contact tracing to find all infected persons and isolation play an indispensable role in tackling COVID-19,” she stressed.

*This article is part of Covid-19 Response: Together for Reliable Information project implemented by PAGED