At the start of the pandemic the main tool of Quezon City’s contact tracing system was a pen, paper, and a cell phone. The pen and paper were used to log a person’s location and health status. Mobile phones allowed health authorities to call suspected cases. These traditional methods were time-consuming and labour-intensive. But now when residents of this city in Metro Manila develop and report symptoms for COVID-19, public health authorities can respond faster, a critically important aspect of a successful response.
Quezon City is the largest city in Metro Manila and also the city with the highest number of daily COVID-19 cases. The pandemic has hugely stretched the city’s public health resources. As the number of infected residents grew, so did the number of people who needed to be identified and advised to quarantine or isolate.
New digital tools adopted by the City Epidemiology Surveillance Unit (CESU) are radically changing the speed and efficiency of their work. In Quezon City, authorities are using the Tanod Kontra COVID (TKC) information system along with the KyusiPass (QCPass). They are among the emerging tools used to do mass contact tracing to track and contain the spread of COVID-19. They involve harnessing digital technology to log people’s location or movements and match it against the location of people known to be sick.
“Technology plays an important role in contact tracing and early management. With the help of these digital tools, cases are reported to us right away. As a result, we were able to visit cases immediately, provide them the right support and help them to stay safe,” said Dr Rolly Cruz, Head of Quezon City’s Epidemiology and Surveillance Unit.
Dr Rolly Cruz (right), Head of Quezon City’s Epidemiology and Surveillance Unit, runs through the operations of the QC CESU with the WHO Philippines’ surveillance team. Photo: WHO/H Doroteo
The tools being used in Quezon City have a number of important features for public health authorities. These include the ability to send a high volume of text messages at a time, to link close contacts with index cases, and to direct case endorsements quickly from the city office to the district level down to the barangay level.
The system is also able to generate close contact mapping, maintain 14-day diaries of contact exposures, and generate 14-day exposure maps. It also collects feedback from citizens and tracks the performance of investigators. The tool is improving the capacity of health authorities to visualize contact tracing, testing, and management.
“The Delta variant of the SARS-CoV-2 virus spreads so quickly because of its higher transmissibility that there is an urgent need for new technologies and approaches to contain and control its transmission,” said Dr Rabindra Abeyasinghe, the World Health Organization Country Representative to the Philippines. “Quezon City is leading the way in adopting new technology to enhance the efficiency of contact tracing and management, critically important for proper outbreak response.”
Taken together, these features have led to quantifiable efficiency gains. There has been a 91% reduction in the manualized processes of data entry and text messages. Public health officials have been able to reduce the speed of contract tracing from 48 hours to about eight hours. Users of the digital tools, which include field tracers, phone tracers, district managers and data managers, are given access to all levels of the contact tracing ecosystem. This ecosystem links lab results, close contact listings, and case assignments.
This system is also permitting more responsive analysis and for the quicker detection of COVID-19 cases and clusters. Self-checks done using the triage function of TKC were over 95,000 between April 2020 and June 2021. About one in three of these users reported COVID-19 symptoms. Moreover, between June 2020 and July 2021, Quezon City has been able to maintain a verification rate above 95%.
Quezon City is not the first Local Government Unit (LGU) in the Philippines to experiment with contact tracing tools. Other LGUs have deployed similar tools, a reflection of the decentralized nature of the country’s public health system. Yet, there is a need to integrate these multiple applications to streamline the national contract tracing efforts, and the Department of Health (DOH) has expressed support for this initiative.
Having seen improvements in Quezon City, Baguio City is now piloting their tools and approach and the DOH aims to strengthen and expand surveillance of COVID-19 cases through the localized deployment of TKC.
Another digital tool being widely used by businesses and establishments throughout Quezon City is the KyusiPass that provides unique location-identifying QR codes for customers to scan. This platform stores customer data, making contract tracing more efficient. It replaces a system whereby businesses encourage customers to manually log by pen and paper their contact information. Digital copies of these logs are available through the CESU for any retrospective moment when tracing becomes necessary.
“Centralized collection of data is critical for effective contact tracing, helping LGUs better identify where infections and potential clustering of cases might be occurring,” said Dr Abeyasinghe.
For more details on the Quezon City experience in using digital tools for COVID-19 response, visit this link: https://tkc.doh.gov.ph/orientation