Thread by @miamalan

[Thread]. 1. What does @HealthZA's circular about stopping all contact tracing and quarantining for #COVID19 mean and WHY was it issued?

Here we go (with lots of help from @hivepi).

2. What is contract tracing?

It’s when health workers try to trace the people 1 infected person could potentially have infected by asking the infected person who they have been in contact with and getting those people to then test or isolate if they test positive.

3. Why is @HealthZA stopping contract tracing?

In short: It’s too expensive for what we get out of it, so we spend a lot of money 4 very little gain (gain = picking up infected people + stopping them from infecting others). We could use the money better on other stuff/diseases.

4. How do we know there’s now little gain from contract tracing?

@hivepi, snr @nicd_sa epidemiologist:

1. Contact tracing data: In some provinces we find less than 1 contact per #COVID case
2. So we spend a lot of money on preventing very few infections this way

5. What's more, @hivep says, we’ve diagnosed only 10% of #COVID19 cases, so 4 90% of cases we don’t know people have #COVID and wouldn’t know 2 follow up on their contacts. Easy speak: What’s the point of chasing after contacts of 10% of cases if 90% = walking around undetected?

6. How many reported #COVID cases do we know of?
@hivep:
1. The #COVID cases @nicd_sa reports = less than 10% of actual cases
2. Why? Many people = asymptomatic, so they don’t test, people with mild symptoms, tests = not sensitive enough to pick up all cases

7. So how many people in SA have likely had #COVID19 and have some form of natural immunity?

@hivep says surveys show at least 70% of SAs have been infected (so more than 40 million people — but by Thu @nicd_sa had only recorded 3,374,262 cases)

8. So what’s changed, why is contact tracing no longer useful?
@hivep:
1. Variants have made #COVID spread much faster, so = 1000s more infections 2 track
2. Many people have some form of immunity (natural infection/vax), so they’ve become less vulnerable 2 falling seriously ill

9. Is contact tracing still useful in some settings?
Yes.
1. In congregate settings, especially old-age homes (older people = more likely 2 fall seriously ill)
2. In cluster outbreaks (e.g. church services) where = likely a large % @ meeting = infected + could infect others)

10. What about #COVID testing?
1. @HealthZA: Only get tested if you’ve got symptoms
2. Why? Asymptomatic people = less virus in their bodies, so = less likely than symptomatic people 2 infect others (so if u = exposed 2 someone with COVID but = no symptoms u don’t need 2 test)

11. What does this mean for quarantine and isolation?
1. What is quarantine? It’s when u isolate when u might have been exposed to the virus
2. What is isolation? It’s when u've been infected with #COVID, even if u don’t have symptoms (so you tested + confirmed your infection)

12. Quarantine:
1. @healthza says no one need to quarantine (so if you were exposed to someone with #COVID19 and develop no symptoms, you don’t need to quarantine)
2. If you develop symptoms, go and get tested (and then follow the isolation rules for people who test +)

13. Isolation rules (the rules for people who tested #COVID positive):

These rules depend on what your #COVID looks like, so if you have no symptoms, mild symptoms or serious symptoms

14. Isolation for people with NO #COVID19 symptoms (so if you tested positive, but = asymptomatic):
1. No need to isolate
2. Monitor yourself for 5-7 days for symptoms and stay away from large gatherings and wear a mask to avoid infecting others

15. Isolation for people who tested positive for #COVID19 and have MILD symptoms:
1. Mild symptoms = fever, cough, sore throat, muscle pain, shortness of breath, etc
2. Isolate for 8 days
3. Always wear a mask (also at home) to avoid infecting others

16. Isolation 4 people who tested #COVID19 + and have SEVERE symptoms:
1. Severe symptoms = symptoms that need hospitalisation (e.g. severe shortness of breath, chest pain)
2. Isolate for 10 days after you’ve recovered
3. Always wear a mask, also @ home 2 avoid infecting others

17. What if you’re a #HealthWorker?

Isolation rules = same but there’s 1 difference:
- When you return to work you need to wear an N95 mask (also called a respirator) that works better than surgical/cloth masks + makes it harder to infect others/4 yourself 2 get infected

18. If you were infected, how do you know you can return to work?
1. Mild symptoms: You isolate for 8 days and return to work, no need to test
2. Severe symptoms: Isolate for 10 days after your symptoms have ended, no need to test.

19. Why don’t you need to test to confirm that you no longer have #COVID?

1. Because the tests can’t always tell.
2. PCR tests look 4 the virus's genetic material, not necessarily LIVE virus (see next tweet for rest of explanation)

20. So u can test + for weeks if there’s still dead virus left in your body (it often happens), but you’re not infectious (as there's no live virus).

Most people’s bodies clear the virus within 7-10 days (the milder your symptoms, the quicker you’re likely to clear the virus)