The state of Uttar Pradesh continues to be one of the high-burden states and reported 474 054 cases and 6940 fatalities as of 27 October 2020. Being the most populous state of India, with a population of more than 199 812 341 (as per 2011 census), its fight against COVID-19 has been particularly challenging. When the cases surged post lifting of restrictions, as part of its surveillance response activities with support from WHO, the state government put in place a mechanism to evaluate the status and quality of contact tracing to guide policy level decision making for an informed public health response.
The World Health Organization (WHO)- National Public Health Surveillance Project (NPSP) team of medical officers along with 800 field monitors undertook a massive exercise to assess the status and quality of contact tracing amongst the 58 000 laboratory-confirmed cases of COVID-19 in 75 districts across the state during two weeks from 01-14 August 2020.
“A huge workforce of more than 70 000 front line health workers were working across the state reaching out to high-risk contacts of COVID-19 positive cases, recording as high as 90% coverage. However, we wanted to evaluate the quality of contact tracing through WHO as an independent evaluation agency, as the trend of COVID-19 cases was rising. WHO trained and deployed 800 field monitors to assess the contact tracing efforts. Their recommendations helped us tailor our response strategy accordingly to address the challenges”, stated Dr Vikasendu Agrawal, State Surveillance Officer, Government of Uttar Pradesh.
A well-trained team of 800 field monitors conducted telephonic interviews of laboratory-confirmed positive cases through a pre-determined set of questions developed by the WHO team to maintain a uniform response. The overarching objective of the survey was to check the testing status of the family members, reasons for non-testing and information on clinical symptoms. The WHO surveillance medical officers (SMOs) and sub-regional team leaders (SRTLs) conducted training for all the field monitors regarding the interview process and questionnaire. Data were collected daily at the state office for analysis and shared with the government regularly for their review.
The WHO field monitors also used this opportunity to strengthen public health education through the advocacy of necessary infection prevention and control measures.
Mr Ajay Srivastava, Field Monitor, WHO NPSP who was involved in the exercise shared that sometimes it was difficult to obtain information as some responders were apprehensive about sharing their details, considering the stigma and fear associated with the virus. As an additional awareness effort on infection prevention and control measures, the team also used this opportunity to educate responders about the key safety measures to fight against COVID-19 to ensure their safety and the safety of their family members.
The interview findings revealed that the average number of high-risk contacts per positive case was 3.5. A total of 1 63 536 high-risk contacts were identified during this exercise by field monitors, and 93% of the high-risk contacts had been contacted and tested for COVID-19. 
Although only 7% of the high-risk contacts were missed, there were 17 districts where more than 10% of the high-risk contacts were not tested since they were not identified by the district health teams. This draws attention to the fact that early and systematic tracking of contacts through a proper mechanism is imperative to put up a responsive public health response to contain the pandemic.
“The WHO team provided technical support to the state government to boost contact tracing efforts and strengthen capacity of field teams through training. Field monitors assessed the quality of contact tracing of 58 000 COVID-19 positive cases in 75 districts and found that 93% of the high-risk contacts were contacted and tested. This exercise helped the government in strengthening contact tracing in 17 districts where more than 12 000 high-risk contacts were missed for testing “, shared Dr Madhup Bajpai, Regional Team Leader, Uttar Pradesh Region, WHO-NPSP.
This massive effort led to identification of several cases that would not have been otherwise detected and helped in containing the further spread of the disease. Quality assessment exercise also enabled improved data collection and allowed authorities to make evidence-based decisions on containment measures. The government also deployed more teams to strengthen surveillance activities in districts with high-case load.
Acknowledging the key role of contact tracing as an essential public health tool for controlling disease outbreaks, Dr Roderico Ofrin, WHO Country Representative to India shares that systematic tracking of contacts through a proper mechanism is key, along with a well-trained health workforce to implement the surveillance activities.
“The UP government’s strategic response to COVID-19 by stepping up contact tracing efforts is exemplary and can serve as a good example for other states”, he adds.