Posted by Steve Lettau on Nov 05, 2020

Contact tracing has been a cornerstone of public health for much of the past century, even before the novel coronavirus.

By Diana Schoberg, Illustrations by Gwen Keraval in The Rotarian Magazine - October 2020

In 20 July 2014, a Liberian-American man collapsed in an airport in Lagos, Nigeria, a city of more than 10 million people. Three days later, he was diagnosed with Ebola, the country’s first case. The arrival of the Ebola virus in one of the world’s largest cities was a scenario that, as one U.S. official noted at the time, generated worries of an “apocalyptic urban outbreak.” 

But what could have been a ghastly epidemic was averted; only 19 additional people in Nigeria contracted the disease, and seven died. The World Health Organization (WHO) declared the country free of Ebola on 20 October, three months after that first case was diagnosed.

To achieve that, the work of the Rotary-supported polio eradication program — the strong partnerships that had been built between the Nigerian government and other organizations, as well as the infrastructure that had been put in place — proved to be key. The Nigerian health ministry swiftly declared Ebola an emergency and created a command center, modeled after those used by the polio program, to coordinate its response. A team of 40 doctors trained in epidemiology who assisted in the country’s polio eradication campaign were reassigned to tackle Ebola. Technical experts from the polio program trained health workers on contact tracing, case management, and more.  

From that first patient, called the “index case,” health workers generated a list of nearly 900 contacts, diligently tracked down by a team of 150 contact tracers who conducted 18,500 face-to-face visits to check for symptoms of Ebola. Only one contact was lost to follow-up. Shoe-leather public health detective work had stopped the outbreak.