The day-to-day life of the coronavirus "tracker": this is how those who keep track of infections in Spain work

They are not detectives, but almost. Trackers are an essential part of preventing the spread of the coronavirus. They are nurses who are dedicated to investigating all the people with whom a person who has tested positive for COVID-19 has been in contact. They must telephone each of them to indicate that they have to remain isolated and not come into contact with other people, cutting the chain of infections.

In Spain, different teams have been set up in each of the autonomous communities. In total, almost 2,000 nurses and trackers to perform epidemiological follow-up and surveillance of patients infected with COVID-19. Although there were already personnel who carried out this function from the start of the pandemic within their capabilities, specific teams have now been established for this function. We have spoken with some trackers to tell us what their day-to-day life is like after the storm in recent months.

"We are preparing to have a well-oiled system for autumn"

The health departments of each autonomous community, together with Primary Care, are the ones who form the teams in their corresponding areas. Not all of them have the same number of people to track, nor do they have exactly the same protocols. But they have a common and universal objective: to locate all the people with whom the person who has tested positive for PCR (a molecular technique that detects if we have the virus in the body) has been in contact, to prevent these people from turning come into contact with others.

In the case of Malaga, once someone appears as a new infected, they are interviewed briefly. He is asked where he has been in the last few days, with whom and what hygiene measures he has taken in each contact. Then, an attempt is made to locate suspicious contagion contacts by telephone. During that call, the suspect is explained that he has been in contact with someone who has tested positive for COVID-19 and he is briefly asked about symptoms, fever, cough, etc. If the answer is affirmative, the tracker requests a PCR and isolation practice for 14 days, until the result is known.

"Now the results of the confinement are seen and there are hardly any serious cases, we can pay attention to those who have mild symptoms or are asymptomatic"

Previously, these PCRs were only performed in the most severe cases hospitalized and in nursing homes. Now Primary Care can ask to do a PCR, according to María Ángeles Fernández Gómez, Epidemiologist of Primary Care of the Malaga Health District and coordinator of a tracking team: "When someone with mild symptoms called from home, they were ordered to confine themselves but not it was confirmed if he did indeed have COVID. Now the GP can check it in those who have mild symptoms or are asymptomatic. "

"Now the results of the confinement are seen and there are hardly any serious cases, we can pay attention to those who have mild symptoms or are asymptomatic," he explains to us throughout this de-escalation, "now many tests are requested and few test positive for the PCR "

In their case, they do not have a specific computer program to carry out the work, but the information is downloaded into the RedAlerta application, the support for all epidemiological surveillance in Andalusia. There is also a regulated training at the Andalusian School of Public Health to train staff in tracing. "We have been learning on the go and working together with the experience of the oldest and the will of those who had no previous experience, and now we are preparing to have the system greased by the time autumn arrives."

Ciudad Real now also has its own team of trackers. It was the province that hit COVID-19 the worst, reaching more than 190 deaths for every 100,000 inhabitants. Now they have 20 people who divide into two shifts, in the morning and in the afternoon, to stop the chain of infections from the beginning.

Pilar Ramiro is the coordinator of Nursing at the General Hospital of Ciudad Real and the one who has led the tracking team since May 15. He also tells us how the screening method has been outlined every day: "At the beginning there was little workload because there were few positive PCRs, since some doctors still did not have knowledge of how the protocol worked. But since they know it, they send to do more tests and therefore appear more positive, which come to us. "

The screening process begins the moment a patient comes to or calls a health center to report Covid symptoms. The Primary Care doctor takes care of the case and if he considers it suspicious, a nasopharyngeal smear is taken at the same health center for a PCR analysis. If it is negative, that is the end of your follow-up, but if it is positive, it is when they contact your contacts by telephone. They call the patient again and collect all the close contacts he has had since the two days of onset of symptoms. They then call such suspicious contacts and indicate that they must be confined for 14 days. They are then followed up on the first, fifth, ninth, and fourteenth days to monitor for symptoms.

"When the protocol was put on the table, this tracking was only done from Primary Care," he explains, recalling the first moments of facing this task, "but it did not cover people who were hospitalized, or those who came from nursing homes. or emergencies. We have been incorporating them little by little and improving the protocol to open more doors. "

"Now it also covers people who do not have symptoms but do provide a serology, either because they are health professionals or because they have done it privately. If the patient is asymptomatic positive but provides a serology that has positive IgG (indicates that the patient is in the infection cure stage) there is no isolation or follow-up on our part, that case would be solved because it prevails over a CRP. As long as it is asymptomatic. "

While the number of reported cases remains stable throughout these weeks, they have also created a database to which all doctors and health professionals have access. It is called EPISCAM and when a suspected or confirmed case is detected, it is notified through it.

"Inside there is a map of Ciudad Real province, with all the towns and others, with green dots indicating that they are discarded cases and red dots for confirmed cases. It is a very visual and quick way to see how many cases there are in each town. Good thing about this database is that no cases are duplicated, that they could be declared twice, nor do we have to send data to epidemiology every time a case is declared, since in all the managements there are computers with full access to information "

Now there is less of an influx of work also in Cantabria, as Alfonso Alonso Jaquete, resident doctor in Preventive and Public Health in the community, part of the team of trackers, tells us that now there are "between zero and three daily positive cases" . This enables them to "work hard to refine the system and update the data." Its tracking is similar to that of Ciudad Real.

"One of the main complications we had in the beginning is technical support, we were not prepared, now we have been improving the computer system. We use Go.Data, a free software designed by the WHO, which was used for a long time with Ebola. This system helps us unite the data coming from the laboratory with the database we have, greatly improving the flow of information in real time, which is very important. Having this system well tied helps us to be better prepared for when autumn arrives , be more efficient in cutting the transmission chain. "

Go.Data was specially designed by epidemiologists to collect data from different cases and their contacts to stop the spread of contagious diseases. It was particularly intended for tracking teams.

"In general people are aware and willing to collaborate"

Toñi Vélez is a specialist nurse in Family and Community Nursing in one of the health centers in Hellín, municipality of Castilla-La Mancha with 30,000 inhabitants. She was a resident two years ago but, given the situation, she was informed, like other colleagues, that she was given a one-year contract as an epidemiological research nurse, commonly called a "tracking nurse", as of May 25.

"The circuit begins when the patient calls his family doctor because he thinks he has symptoms. If the doctor considers it, he orders the patient to perform the PCR test. While we are waiting for the results, he is called again by phone and He conducts a survey: where he works, where he has been, who he has been with ... He is invited to reflect, whether he tests negative or positive, so that he can prepare a contact list. PCR, there are places that automatically test all the contacts it provides, not here. They are asked to do 14-day confinement and then we call them as a follow-up the following days. "

"The workload goes for days," he tells us for this article, "the truth is that we have rarely activated the network protocol." They currently have fewer than ten people who are targeted because they tested positive for the PCR. "At the beginning, the list of contacts that they provided us was mainly made up of the family: fathers, mothers, children, brothers ... Now it is the patients themselves who tell you if they have left that circle, on one occasion I have arrived to make a network of twenty contacts. In addition there is trust, we are your usual doctors. "

Every morning, she and another colleague have a routine of calls that are divided between communications of affirmative in PCR, locate their respective contacts and follow-up of those who are already confined by having been in contact with a person infected.

"We had to call thirteen contacts, which took us an entire morning, to track down a single person, if they all live together it is easier, but if everyone lives at home we have to keep track and it lengthens"

Pilar and her team, in her case, have made up to 100 calls a day, but she agrees with Toñi in her experience. At the beginning of the de-escalation the list was reduced to the family, but we are going through phases and that circle is expanding: "Last week a boy we were tracking had seen his friends and we had to call thirteen contacts, which led us an entire morning, to track a single person. If those friends all live together it is easier, but if each one lives at home, we have to keep track and it lengthens. "

They tell us that on the other end of the phone people are usually aware of the situation and heed their instructions, although there are some exceptions. For example, Toñi has encountered people who "get angry when you explain to them that they have to seclude themselves for 14 days because they have been in contact with a person who has tested positive and that they have to leave work due to it." Alfonso tells us that they have also encountered this situation, especially the self-employed. If they openly announce that they do not want to do the confinement, "the pertinent legal actions are taken," but if they do not do it, it cannot be controlled that they are actually doing the confinement. Still agrees that they are exceptions.

In the case of Pilar, they have mainly encountered very old people who distrust the call "and they do not believe that a nurse is calling them, for fear of scams." It has happened that when they ask them for the contact list they give them false numbers, but he clarifies that "the vast majority of the time, people are very understanding and willing to collaborate."

All information is valuable

As we talked about before, with a less saturated situation, now you can pay attention to details. The search can sometimes go beyond simply who you have been in contact with, but in which places you have been (especially with regard to areas of Spain where it has passed to a more advanced stage). "He is asked about everything," explains Alfonso, "the day is reconstructed step by step with the person: who has he been with, where did he go, who did he see there, did he use public transport ... It is not asking with who has been and is already, remembers each step that has been taken. "

"When we call, we also make sure that the person has the means to do the confinement. If they live with vulnerable people or are in a situation where they cannot do the confinement safely, that is detected in the same call. We have a network of shelters that we have for these cases and where they can seclude themselves. Also if they live alone, ask if they have the option of someone coming to their house to bring them food, among others. We passed them on to Social Services and the Red Cross so that take care of helping you in all these cases. "

María Ángeles explains that normally the network of contacts "is limited to the family or friends, but for us it is also very important to know about the workplace, leisure and even information about mobility."

"It is key to make a good survey. If it has tested positive and the previous days you have been in a shopping center, which one have you gone to? Did you use public transport to get to it? In that case, which one? In what period of If I worked in one, how many clients have been seen in the establishment during those days? It is important to ask it because this way we know where the cases move and we locate the places with the highest risk of contagion. "

"The study of contacts is something that was already habitual before, for example when someone gets sick with measles or other contagious diseases. The difference with COVID is that we have to cover much broader dimensions."

Regarding differences with other contagious diseases, María Ángeles highlights that the only great obstacle is ignorance. COVID is a highly variable infection: the symptoms and their duration are very irregular from person to person.

"We do not know the same now as three months ago, nor is the availability of performing PCR the same now as before," continues María Ángeles, "these tools now help us to care for nursing homes, make us fine-tune the average and also make a diagnosis more accurate. In a nutshell, determining who has been contagious. The priority now is to detect people with symptoms and isolate them with a clear diagnostic test so that those who are asymptomatic do not infect others. "

Tracking Nurse Photo | Banc de Sang i Teixits Featured Illustration | Jesus Leon.

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