Already battling a pandemic for nearly two and a half years now, surveillance teams in Delhi are embarking on a new challenge: tracing the contacts of the city’s first monkeypox patient.
The 34-year-old, who was diagnosed with the infection on Sunday, has no foreign travel history but visited Himachal Pradesh for three days on June 26.
The main challenge, Delhi surveillance officers said, is the nearly month-long gap between his return from the hills, the first set of symptoms on July 5, his hospitalization on July 22 and finally his diagnosis two days later. He is likely to have interacted with countless people during that time, officials said, leaving tracking teams with a mountain to climb, apart from the possibility that multiple contacts could fly under their radars.
“The longer the gap between contracting infection, onset of symptoms and confirmation of infection, the trickier the contact tracing process becomes. In the case of the patient from West Delhi, the incubation time was around 10 days and it took another 10 days for the infection to be diagnosed. In the first two days, we managed to isolate the immediate contacts of the patient, which does not require much effort. It’s the tracking of other links that takes time,” the manager said.
Officials explained that patient contact tracing works in “concentric circles.” This means that the patient’s immediate contacts – family, friends, medical professionals who treated them – are contacted and isolated first. Then the next line of contacts, where they met during the incubation period but for a relatively limited period or in a configuration where contacts are limited. This progress is maintained.
Isolation is advised for these contacts and their symptoms are observed for a period of seven days.
Another barrier to exercise, the official said, is that a patient is likely to forget a significant number of people they have interacted with if there is a prolonged gap between acquiring an infection and the appearance of symptoms.
Fourteen people who came into contact with the patient from West Delhi have so far been traced and isolated. Others are pending. Authorities have yet to identify the source of the infection.
The West Delhi patient started developing skin lesions about eight days after he first had a fever.
On July 21, Dr. Richa Chaudhary, a dermatologist, diagnosed the patient with monkeypox and reported the case to health authorities.
Senior officials from the Delhi government’s health department said surveillance teams in Himachal Pradesh were also helping the administration track the patient’s chain of contacts. Authorities in the neighboring state have been told to isolate and observe any confirmed contacts for possible symptoms.
Health department officials said the Delhi government’s familiarity with the contact tracing exercise, thanks to the pandemic, is likely to help their efforts, with several established surveillance systems now in place.
For example, the department has a dedicated control room to track Covid-19 infections. The district teams also support the department in this exercise.
“We currently do not have a dedicated monkeypox control room as there is only one confirmed case in Delhi. nor is the number of Covid patients too high,” a health official said.