SPEAKER: Now, let's talk about the natural history 

of SARS-coronavirus-2. 
And by natural history, I mean, what 
happens to someone when they get a SARS-coronavirus-2 infection. 
So what does happen to someone after they're infected 
with SARS-coronavirus-2? 
Well, many people get an illness that we call COVID-19. 
COVID-19 is short for coronavirus disease that 
emerged in 2019, and for short we say, COVID-19. 
So not everyone who gets infected 
with SARS-coronavirus-2 gets sick. 
So not everyone develop signs and symptoms. 
However, if they do get sick, we're 
going to talk about what their signs and symptoms are. 
We would want to know how long they're sick. 
We'll talk about that as well. 
Importantly, we're going to talk about how long 
they can infect people and spread the virus, 
and where and how people shed the virus. 
So these are all the different components 
of what happens to someone when they're infected 
with SARS-coronavirus-2. 
Let's talk, next, about signs and symptoms of disease. 
So you may have heard these words before, 
but it's important to define them so the difference 
between signs and symptoms. 
Signs of disease are objective measurements 
to characterize an illness or disease that can be observed 
during a physical exam. 
So, for example, temperature is a sign of disease, 
because it can be measured by taking your temperature. 
Breathing faster than usual is also a sign, 
because someone can count the number of times 
that you're breathing per minute and determine 
whether it's faster than usual. 
Symptoms are not something that can be objectively measured, 
but how the patient says they're feeling. 
So, for example, fatigue is a symptom, 
because it's how someone is feeling. 
They're feeling very tired. 
Nausea is a symptom, because it can't be measured. 
It's how someone is feeling. 
A loss of taste or smell is also something that someone reports. 
It's something that they're observing themselves, 
not something that can be observed 
during a physical exam. 
Muscle ache is the same. 
Fever can be both a sign and a symptom, 
because it can be measured by someone else 
and you can also feel when you have a fever. 
So it's important to keep these general definitions in mind. 
Now, let's talk about the signs and symptoms of COVID-19. 
And this disease is unusual, because it 
can cause such a wide variety of signs and symptoms. 
It makes it difficult to classify. 
So as we just mentioned, some people have no symptoms at all. 
This is called being asymptomatic. 
So this means that someone can be 
infected with SARS-coronavirus-2, 
and they will never know. 
They feel just fine. 
They're perfectly healthy. 
Other people will have some disease, but it will be mild. 
They may not need to seek care at all. 
It may feel like just a head cold, or a very mild fever, 
or respiratory illness. 
Other people will have very serious disease. 
They'll feel very sick, and it can lead to death 
in some people who develop severe disease. 
So, again, it's a wide range of signs and symptoms 
with this infection. 
Among people who do develop signs and symptoms, 
there are some common signs and symptoms of COVID-19. 
Many people will develop a fever. 
Many people will feel very tired, 
or have what we call fatigue. 
People may have chills. 
That often goes along with the fever. 
Some people will experience muscle pain. 
Some will develop a cough. 
Many people think about COVID-19 as a respiratory disease, 
and think about coughing, but not all people with COVID-19 
will have a cough. 
Many people who have COVID-19 say 
that they recently lost their ability to taste or smell. 
Some will have difficulty breathing 
and feel like they're short of breath. 
That's a more serious symptom of COVID-19. 
Some people with COVID-19 could also 
have a headache and a sore throat. 
It's important to keep in mind that people who have COVID-19 
may have only one of these signs or symptoms. 
They may have just a few of these signs or symptoms. 
Some people may have all of these signs or symptoms. 
So there's not one right way to define COVID-19. 
But you should be aware of all the possible signs and symptoms 
that people may have. 
And many signs and symptoms of COVID-19 
are what we call non-specific. 
It means they're common to other infections as well. 
So fever, cough, myalgia or muscle pain, 
are common to many different types of infections. 
So people with these signs and symptoms may have COVID-19, 
but it's hard to tell without a test. 
Some signs and symptoms are more specific for COVID-19. 
I mentioned one previously, and that's 
the recent loss of the ability to taste or smell. 
About 1/3 of patients report this loss of taste or smell, 
and this is something that's a bit more specific for COVID-19, 
because it's very rare in other types of infections. 
There are some signs and symptoms 
that mean the disease is becoming more severe 
or progressing, and these are important to know, 
because when people have these signs and symptoms, 
they may need to seek immediate care. 
The most common signs of progression of the infection 
are increased or more severe fevers, an increased difficulty 
breathing. 
Anyone who is experiencing these signs and symptoms 
should contact a doctor. 
Patients should immediately seek emergency care 
if they develop any of these warning signs or symptoms, 
including, bluish lips or face. 
That could mean that they're not getting enough oxygen. If they 
have an increased rate of breathing, 
which means they're breathing much faster than normal. 
If they're feeling shortness of breath, which means 
they feel like they're not getting enough air in, 
even though they're breathing quickly. 
If someone is experiencing chest pain when breathing, 
this is a serious symptom and they 
should seek immediate care. 
If someone is waking up from sleep feeling 
like they're short of breath, and they're not 
able to get enough air in, they should seek care right of way. 
Anyone who develops new confusion, 
so they're confused about events, or people, 
or what's happening, or they're difficult to wake up, 
should also seek immediate emergency care. 
All of these are signs that the patient is not 
getting enough oxygen, and that's 
a very serious condition. 
And they should seek care right away.
Play video starting at 7 minutes 59 seconds and follow transcript7:59
One of the ways that COVID-19 causes severe disease 
and death, is through congesting in the lungs. 
So our lungs are how we get oxygen into our body. 
And if the lungs don't function properly, 
we can't get enough oxygen. 
So on the left side here, you can see healthy lungs and what 
healthy lung tissue looks like. 
You can see here that the field is dark. 
This shows you that the tissue is healthy.
Play video starting at 8 minutes 32 seconds and follow transcript8:32
On the right side, however, are the lungs of someone 
who has severe COVID-19. 
So in red here, you can see the same lung area 
that's pictured on the left, except you can see that it's 
white instead of dark. 
That shows that the tissue is severely damaged by the virus, 
and this shows that this person is having a very difficult time 
breathing and getting enough oxygen into their body. 
This shows you what the virus can do, 
and how it causes severe disease and death.
Play video starting at 9 minutes 6 seconds and follow transcript9:06
Now, let's talk about the incubation 
period for SARS-coronavirus-2. 
It's important for you to learn the term incubation period, 
because you're going to hear it throughout this course. 
So the incubation period is the time 
from when someone is infected until they develop symptoms. 
So usually this takes a number of days. 
So the incubation period for SARS-coronavirus 
ranges from 2 to 14 days. 
So most people infected with this virus 
will develop signs and symptoms between 2 to 14 days 
after they're infected. 
You can see here on your screen the proportion 
of people who develop symptoms by each day 
after they are infected. 
So 5% of all people infected with this virus 
will develop signs or symptoms within two days. 
So it can be very quick. 
And 1/2 of people infected, will develop signs and symptoms 
within five days. 
So just five days after infection, 
1/2 of everyone infected will develop signs and symptoms. 
By 14 days, 95% of all people who are infected 
will have developed signs or symptoms.
Play video starting at 10 minutes 30 seconds and follow transcript10:30
OK, now let's define the infectious period. 
This is an important term that you'll 
need to know for the rest of the course. 
The infectious period is the time 
at which someone infected with SARS-CoV-2 
can transmit the virus to other people. 
So for people who have COVID-19 disease, 
their infectious period starts two days 
before the start of their signs and symptoms. 
And they could infect other people 
throughout the end of their illness. 
So we define the end of their infectious period 
as being at least 10 days after the onset of their illness. 
And as long as their symptoms are improving, 
and they haven't had fever within the past three days, 
we could assume that they're no longer infectious. 
So it's a bit tricky to identify exactly when 
the end of the infectious period is, but these 
are some of the markers we use to identify when someone 
may no longer be infectious. 
As you know, some people who are infected with SARS-CoV-2 
may never develop any kind of symptoms. 
They are asymptomatic. 
But they can still be infectious. 
They could still infect someone else. 
For these people, it's more difficult to define 
their infectious period. 
It's more difficult to define when 
they could infect someone else. 
But, typically, we assume this period 
to be about 10 to 14 days, and we 
should assume that it started before they had a test that 
showed that they had the infection, 
and to last for at least 10 days after the test. 
So now, let's think about the timeline 
of infection using these new terms that we've learned, 
the incubation period and the period of infectiousness. 
So here, first, we see that someone 
is infected by someone else. 
And then, they enter their incubation period. 
So the person is infected, but they haven't developed 
signs or symptoms yet. 
They may not know that they're infected. 
Remember, this incubation period can range from 2 to 14 days, 
but on average is about five days. 
The incubation period here is represented in the orange line. 
At the end of their incubation period, 
again, which will be an average of five days, 
but can be up to 14 days, they will develop signs and symptoms 
of disease. 
So for people who have mild illness, 
that illness is going to last about ten days. 
For people who have more severe illness, 
that can last two weeks or more. 
Now, let's think about when that person is infectious, 
or when could they possibly transmit the virus 
to someone else. 
So you can see here in yellow, that this person who developed 
signs and symptoms here on day 14 
was infectious starting from day 12, 
and they are going to be most infectious on the first day 
of onset of symptoms, which will be around day 14. 
So on the day that they first notice 
that they are sick, the day they first start feeling badly, 
is the day that they are most infectious, 
or probably most likely to infect someone else. 
They can continue to be infectious 
throughout their signs and symptoms. 
This will be at least ten days, possibly longer. 
Particularly for people who have severe disease, 
they're going to be infectious for much 
longer and through the duration of their illness. 
So it's important to remember here a few key things. 
People can infect others before they become sick, 
before they know they're sick, and particularly on the day 
that they're sick. 
And they can continue to be infectious and transmit 
to others through out their illness period, 
as long as that illness period lasts. 
So that's going to vary from person to person, 
but we'll be at a very minimum ten days. 

 So among people who get COVID-19 , 

some are at much higher risk for having severe disease. 
Let's talk about what some of those risks are. 
Some people are much more likely to have severe disease 
if they get infected. 
In particular, older adults who are over the age of 65 
are much more likely to have severe COVID-19 
disease than others. 
And those risks increase with age. 
So the older you are, the more likely 
you are to have severe disease. 
People who are obese also have an increased risk 
of severe disease. 
I want to point out that some people who 
are severely ill with COVID-19 are 
young and perfectly healthy. 
So I don't want you to get the impression that all people who 
have severe disease are older or have 
other chronic medical conditions. 
Sometimes young, perfectly healthy people 
can also become severely ill. 
That's rare. 
It's a small proportion of infections. 
And children are very unlikely to be severely ill. 
But it does happen sometimes. 
Other existing medical conditions 
that increase the risk of severe disease in COVID-19 
include diabetes, hypertension, any kind 
of lung disease such as asthma or emphysema or COPD, 
which is chronic obstructive pulmonary disorder. 
People who have heart disease, liver disease, 
any kind of kidney disease are also 
at increased risk for severe COVID-19 disease. 
People who have weakened immune systems 
are also at increased risk. 
And some people have weakened immune systems 
because they're taking certain medications like steroids 
or others that affect their immune function. 
If someone has HIV and they're on medication 
and their HIV infection is controlled, 
they're not at substantial increased risk 
for COVID-19 severe disease. 
Let's talk about death from COVID-19. 
So how does this disease kill? 
First, if the lungs aren't able to recover-- 
if the virus damages the lungs too much 
and the patient is unable to breathe on their own, 
then that's one way that someone can die from COVID-19. 
Another way is through lack of oxygen. 
So if the lungs aren't functioning properly, 
then you can't get enough oxygen in your body 
and that can damage many of your other organ systems. 
And you need all of those to function in order to survive. 
So damage to those organs can put you at increased risk 
for a heart attack or kidney failure, 
strokes or other blood clotting disorders that can all cause 
death from COVID-19 . 
Some people are at higher risk for death than others. 
It depends generally on your health before you get 
sick and also access to care. 
So if someone gets sick with COVID-19 
but is unable to seek care early in the illness, 
then they're at higher risk for death. 
It's important for people who develop severe disease 
to be able to get the supportive care they need quickly. 
Death from COVID-19 is rare among young and healthy people, 
but it can happen. 
Death among older adults who have COVID-19 
is much more common and it increases with age. 
2% to 5% of people aged 65 to 75 years 
will likely die from COVID-19 in the United States. 
That risk increases to 4 to 10% among those aged 75 to 85, 
and is over 10% in people aged more than 85 years old. 
This is why it's so important to help keep people 
in these higher age groups safe from infection. 
It's very important that we do everything 
we can to try to limit transmission 
to people who are in these high risk age categories. 
Right now, we don't have any specific treatment 
to cure COVID-19. 
Although scientists are working very, very hard 
and as quickly as possible to find treatments. 
The best treatment we have now is 
to support the body's functions until the body's immune system 
can fight off the infection. 
Many patients with lung disease and severe lung disease 
require mechanical ventilation. 
That's a breathing machine. 
We also call it a ventilator. 
And it helps patients breathe while their body is 
fighting off this infection. 
People who need it will receive this kind 
of mechanical ventilation support 
to keep their lungs working so that their body can continue 
to get the oxygen it needs while it's working hard 
to fight the virus. 
Currently, these are the best treatments 
we have for people who have severe COVID-19 disease. 
[OUTRO MUSIC]

 So how does someone know if they have COVID-19? 

Now, we're going to talk about some laboratory tests that 
can be used to diagnose this disease.
Play video starting at 21 seconds and follow transcript0:21
There are two kinds of laboratory tests 
you might hear about for COVID-19. 
One is a diagnostic test, and that test 
identifies virus that's in the body. 
It's called a PCR test, which stands for polymerase chain 
reaction. 
That's the chemical reaction that's done in the lab 
to look for the virus. 
It's also called a molecular test, 
and it gives us a sign that the virus 
is reproducing in your cells. 
Another kind of test is an antibody test. 
This test can identify antibodies 
to the virus usually in your blood. 
Antibodies are made by your immune system 
to fight off viruses or bacteria. 
We can identify antibodies that are 
specific to this virus in your blood. 
Some antibodies called IgG antibodies begin 
to develop when you're sick, but they're identified mostly 
after you recover. 
Remember that no tests are perfect. 
This means that sometimes, despite our best 
efforts, the results from the test could be wrong. 
When we're looking for active infection, 
usually, we do PCR tests on people 
who have current signs and symptoms of the disease. 
The PCR test detects the RNA of the virus, 
which means the genetic material of the virus. 
So this tells us, essentially, if the virus is in the body 
and replicating in the body. 
We usually take a swab from the nose, the throat, 
or the mouth somewhere in our respiratory tract. 
Saliva can also be tested for the virus, 
but it's not commonly used. 
The reason we take samples from the respiratory tract 
is because that's where the virus likes 
to replicate in the body. 
If someone has a positive PCR test, 
that shows that there are particles 
of that virus in the sample that was taken. 
This means there is an active infection there. 
Sometimes, there are false results, 
and that means that someone actually 
is infected with the virus, but their sample 
doesn't show that the virus is there. 
So not all people with the infection 
will have the viral RNA in their sample. 
This is important to keep in mind that just 
because someone has a negative PCR 
test that doesn't necessarily mean that they definitely 
don't have the infection. 
However, if someone does have a positive PCR test, then 
we can be very confident that they do have COVID-19. 
Sometimes, we want to know if someone has 
had the infection in the past. 
An IgG antibody test is the most common antibody test 
used for this purpose. 
Our bodies usually start to produce IgG antibodies 
10 to 14 days after we're infected. 
So they'll start to develop when we're sick, 
but we'll be better able to identify them 
after we've recovered. 
So these antibody tests can be performed 
after someone has already recovered from the infection 
or in people who've never had signs and symptoms 
but want to know if they have been infected. 
Remember that some people are infected but never 
have signs and symptoms. 
A positive IgG antibody test means 
that you were infected with the virus in the past, 
but it doesn't tell us when you were infected. 
So if you have IgG antibodies in your blood, 
that could mean that you have some protection 
from future SARS coronavirus to infections. 
However, we don't know how long that protection will last, 
and we don't really know how good that protection is yet. 
So this is something that we're actively 
trying to learn more about. 
So to summarize again, there are two types 
of tests, a diagnostic test and a test 
to see if you had a past infection. 
The diagnostic test takes a sample 
from your respiratory tract. 
This figure shows a swab being collected 
from the back of the throat going in through the nose. 
That will tell us whether or not there's viral RNA detectable 
in your respiratory tract, suggesting that you 
have an active infection. 
By the time you recover, you'll develop IgG antibodies, 
and if we take a sample of your blood, we can detect those 
and we can determine if you were infected in the past. 
Neither of these tests are perfect, 
but they're very useful tools for identifying 
people who have had disease and who are currently infected. 
[MUSIC PLAYING]

PEAKER: Now let's talk about how SARS-CoV-2 

is transmitted between people. 
There are two main ways that SARS-CoV-2 
is transmitted between people that you need to remember. 
So as you know, infected people have the virus 
in their respiratory tract, in their mouths, noses, 
and throats. 
And there are droplets that come out of our nose and mouth 
when we're talking, laughing, coughing, sneezing, 
singing even. 
Sometimes you can see them, but sometimes they're 
so small that you don't really notice them. 
But they're there anyway. 
If someone is infected with SARS-CoV-2, 
then those droplets that come out can have the virus in them. 
And then those droplets, if they land on someone else's face, 
in their mouth, nose, or eyes, can infect someone else. 
So if you are sitting close with someone, 
you're talking with them. 
You sneeze. 
You get a cough in the face. 
If you're sitting nearby someone, 
those droplets can travel far enough to infect you. 
The second way the virus is transmitted 
that you need to know about is through contact 
with surfaces that have viruses on them. 
So we just talked about how the virus 
is in respiratory droplets of people who are infected. 
So if those droplets get on surfaces, 
or they're on the infected person's hands 
and that person touches a surface 
like a table or a doorknob, they can leave the virus 
on that surface. 
And then the virus can survive or stay on those surfaces, 
and it contaminates the hands of other people. 
Now if you touch a surface that has the virus on it, 
and then your hands touch your mouth, nose, or eyes, 
the virus can infect you that way. 
That's why hand washing and cleaning 
are so important for preventing transmission, 
because many people can get infected through their hands. 
In hospitals, patients have procedures done 
that may increase transmission. 
But that's a specific setting, and we're really focused here 
in this lecture on transmission out 
in the communities, so outside of the hospital setting.
Play video starting at 2 minutes 53 seconds and follow transcript2:53
So as you already know, people who 
are infected with this virus will have infectious virus 
in their respiratory droplets. 
When you sneeze, cough, talk, or sing, those viruses 
and those droplets can travel up to six feet, 
which is a pretty long way. 
And those viruses could land in eyes, noses, 
or mouths of other people and infect them that way. 
Or, as we already mentioned, they could land on surfaces. 
That's why mask use can be one way to reduce transmission. 
This is primarily to keep infectious droplets 
from contaminating the environment. 
So if someone who is infected is wearing a mask, 
then there are fewer infectious droplets 
that will come out from their mouth and nose. 
Wearing masks is a great way to prevent people 
from infecting others.
Play video starting at 3 minutes 53 seconds and follow transcript3:53
Something to keep in mind is that SARS-CoV-2 is 
transmitted very efficiently. 
So this virus transmits between people 
in ways that make it very difficult to detect and stop. 
People are infectious before they have symptoms, 
so they may be infecting others and not even know it. 
Some people never develop symptoms, 
and so they could also infect other people 
without knowing that they, themselves, are infected. 
So it's important for us to test symptomatic people 
and identify who they've had contact with quickly 
to try to limit the spread. 
This is done through contact tracing, 
and you'll hear more about this. 
So knowing how the disease is transmitted, 
it makes sense that transmission is more likely to occur 
the closer the contact you have with someone else. 
So people who have physical contact with a patient 
or have close contact are more likely to be infected. 
By close contact, we mean people who 
are within six feet of the patient for 15 minutes or more. 
Now why six feet? 
Well, that's the distance that we 
know that those infectious respiratory droplets can 
travel. 
And 15 minutes means that you've been around them long enough 
so that you may have come into contact with some 
of those infectious droplets. 
So that's what we call a close contact. 
And close contacts may have never 
had actual physical contact with the patient, 
but they're close enough so that they could 
be at risk for transmission. 
People who share an environment with someone who's infected 
are at some risk for infection themselves. 
And an example of a shared environment 
is an office or even a restaurant, 
if you're close enough to the person. 
Sharing food and bathrooms is another example 
of a shared environment where infection could be transmitted. 
And sharing a bed is another way that transmission could occur. 
Again, because you're in close contact or physical contact 
with someone who has the disease. 
For all of these reasons, transmission 
is much more likely between people who live together, 
because they're often having physical contact as well 
as sharing spaces.
Play video starting at 6 minutes 27 seconds and follow transcript6:27
There are some living conditions that dramatically increase 
the risk for transmission. 
Sometimes we call these congregate housing settings, 
and it means essentially when there are many people living 
in very close quarters. 
Prisons and jails are examples of congregate housing, 
as are group homes, dormitories as like at schools, 
or shelters. 
These places are all high risk for very quick spread 
of the infection, because people are living close together 
and sharing spaces.
Play video starting at 7 minutes 9 seconds and follow transcript7:09
When we think about risk for transmission, 
nursing homes really represent a worst case scenario 
for COVID-19. 
This is because you have, of course, 
people living in close quarters together 
who may have frequent contact with each other. 
But they also represent a group of people 
who are at very high risk for severe disease 
because of older age, multiple underlying health 
conditions that put them at increased 
risk for severe disease. 
They may need multiple interventions, such as feeding 
and toileting, so they're having very close contact 
with caregivers. 
Staff are at increased risk because of this, 
because they're having such close contact with patients. 
And importantly, nursing homes aren't hospitals, 
so they're not well equipped to take 
care of people who develop severe infections 
from COVID-19. 
So nursing homes are a place where 
transmission can happen very quickly, 
and people will be at high risk for infection. 
And if they are infected, the health consequences are severe. 
So these really are worst case scenarios 
for outbreaks of COVID-19. 
[MUSIC PLAYING]

SPEAKER: Let's summarize now the main points that we've 

learned in this lecture.
Play video starting at 17 seconds and follow transcript0:17
SARS-coronavirus-2 is a new virus infecting people 
and causing COVID-19 disease. 
The disease is causing a worldwide pandemic. 
Although some people never develop any signs or symptoms 
of disease when they're infected, 
other people are at very high risk 
for severe disease and death. 
People are at higher risk for severe disease and death 
if they are, older adults, or they have some other kind 
of pre-existing medical condition, 
such as diabetes or high blood pressure.
Play video starting at 58 seconds and follow transcript0:58
There are laboratory tests that can 
be used to identify if someone has an active infection, 
or if someone has been infected in the past. 
And, importantly, for this disease, 
people are infectious before they become ill, 
as well as during their illness. 
People who never develop signs and symptoms 
can still infect other people. 
This infection occurs primarily through contact 
with the respiratory droplets of someone who is infected. 
Without any intervention, each person 
can infect two to three other people, 
which means that the outbreaks can grow in size very quickly. 
However, if we're able to intervene 
to prevent even some transmission, 
we can dramatically reduce the number of cases. 
And this is the public health goal for controlling COVID-19. 
[MUSIC PLAYING]

EMILY GURLEY: Hello, my name is Emily Gurley, 

and I'm an Infectious Disease epidemiologist 
at Johns Hopkins Bloomberg School of Public Health. 
Today, I'm going to talk to you about the basics of contact 
tracing for COVID-19. 
Once you finish this lecture, you 
should be able to do a number of things, including describe 
what contact tracing is and how it 
can be used to stop transmission of SARS coronavirus 2. 
You should be able to define what 
we mean by a case of COVID-19, and also 
be able to define what a contact means. 
You should be able to explain the meaning and purpose 
of isolation and quarantine. 
You should be able to calculate how long a case should isolate 
and how long a contact should quarantine 
based on what we know about the infectious period. 
You should be able to describe the connection 
between the infectious period and isolation and quarantine, 
and importantly, you should also be 
able to identify high risk settings for transmission that 
might require extra action beyond regular contact tracing 
efforts. 
So let's talk now about contact tracing 
and how it's used for COVID-19 prevention. 
Every case of COVID-19 that's diagnosed requires action. 
We have to act, and there are a number 
of ways that we have to act. 
First, we need to support the person who is infected. 
It's important that we act to ensure that they have access 
to medical care and any social services they may need. 
They need to be able to access treatment. 
Right now, we only have basic supportive treatments 
available, but one day if we have other treatments 
or curative treatments, they would 
need to be identified so they can be offered 
those curative treatments. 
We also need to act to be sure that those cases are limiting 
their contact with other people. 
This is important, because someone who is infected 
can infect others. 
And part of our goal as public health practitioners 
is to prevent the spread of COVID-19. 
So when we diagnose a case, we need 
to find them, offer them medical support, 
and also make sure they're changing their behavior 
to limit their contact with other people 
to reduce the risk of transmission. 
Next, we have to also identify all the people 
that they may have infected. 
We have to notify them about their exposure 
and offer them some social services that they may need. 
If they develop signs and symptoms, 
we also need to make sure they have access to medical care 
and offer them treatment. 
And importantly, we need to limit their contact 
with other people. 
So once we find people who've been exposed, 
those people could become infectious and then infect 
other people. 
So if we can get them to change their behavior, 
we can limit transmission onward. 
So the basic idea behind contact tracing 
is that if we can limit contact between people who are infected 
and others, then we can limit opportunities for this virus 
to be transmitted, and this is vitally important for COVID-19. 
This is one of the best ways that we can limit 
the spread of this disease. 
Let's also recall the timeline of infection 
and infectiousness. 
So here we can see that someone has been infected. 
You can see in the orange line their incubation period, 
and that's the time between when they become infected 
and when they develop signs and symptoms. 
Then you can see in the blue line, 
after they develop signs and symptoms, how long they'll 
have the disease. 
And then in yellow, you can see, again, the time period 
that this person is infectious. 
And that means the time period when 
they can infect other people. 
This timeline shows that people can infect others up 
to two days before they themselves feel ill, 
particularly on the day of illness 
and throughout their illness period. 
Now, if we assume that someone was infected or exposed 
to this person and infected on the day 
that person became sick, if we assume they have a five day 
incubation period, they're going to become ill five days later. 
We can also think about their infectious period, which 
would begin two days before they became sick 
and would last throughout their illness period. 
So the point of contact tracing is to find those contacts 
and ask them to stay home so that they 
don't infect anybody else. 
And as you may recall, that window 
of opportunity to find them before they themselves 
become infectious and could infect someone else 
is pretty quick. 
And so this is important to keep in mind when you are finding 
contacts and tracing contacts. 
This whole system of finding cases and contacts 
has to happen on a very short timeline 
to be optimally effective. 
Isolation and quarantine, which we'll define shortly, 
can have a big impact on reducing transmission, 
because they serve to limit contact between people 
who are infectious and others. 
And as we know, stopping just one transmission chain 
can prevent many future cases. 
As you can see here, if each infected person infects 
two other people, an outbreak can grow very quickly. 
However, if we can stop just one of those people 
from being infected at each step, 
we can really have a big impact on the total size 
of the outbreak and reduce transmission. 
[MUSIC PLAYING]
SPEAKER: So now, let's be very clear 
and define what we mean by case, contact, isolation, 
and quarantine. 
Those are important concepts that you'll 
have to really understand well throughout the rest 
of the course. 
So let's define what a case is, and what a contact is. 
A case is someone who has COVID-19, someone 
who could infect others, usually this 
is defined by a positive laboratory test, a PCR test 
usually, and we've already discussed that. 
Sometimes we may refer to cases that 
are suspect or probable cases, which means they may not 
have had a test yet, but we think 
they probably have the disease. 
So that could be someone that you 
know was exposed to another infectious patient, 
so you think they probably have it, 
but they just haven't had their test yet, 
but sometimes we refer to them as cases as well. 
So a contact is someone who had contact with a case 
while they were infectious. 
So basically, this is someone who's 
been exposed to someone who was infectious. 
And we care about contacts, because they 
could have been infected. 
And because of that, they need to take special precautions. 
So if you'll recall, a case is infectious 
during their illness, and the two days before their illness 
began. 
So you'll want to identify people 
who had some kind of contact with them 
during their infectious period. 
I mean, we talk about contacts, there 
are really three different kinds of contacts 
that you could think about. 
The first is direct physical contact. 
So anyone that had physical contact with someone 
who is infectious is at risk for infection. 
They are definitely a contact. 
We also talk about close contacts. 
And I want to define what a close contact means. 
So this means someone who may not 
have had any physical contact at all, 
but was close to the person who's infectious. 
They were within 6 feet of this person for at least 15 minutes 
or more. 
Now, 15 minutes is just a guideline. 
In some places, they'll ask about close contacts 
who were nearby the case for 10 minutes or more, 
or maybe 30 minutes or more. 
So there's some flexibility there. 
You'll need to talk with your jurisdiction, where you're 
working, to figure out exactly how they're 
defining those contacts. 
But this is the basic idea that you're nearby 
the person who's infectious for at least some period of time, 
and you're within 6 feet, which if you'll recall, 
is the distance that respiratory droplets can travel. 
There's a third type of contact that you may also 
want to think about, and those are 
people who have been in the same room for an extended period, 
maybe an hour or more with the infectious person, 
but they were more than six feet away. 
So sometimes these people could also be at risk. 
They may have had contact with the same surfaces, 
for example, of someone who is infectious. 
These are called proximate contacts, 
and sometimes you'll also be looking 
for these types of contacts when you're doing contact tracing. 
Now, let's define what we mean by isolation versus quarantine. 
Both of these terms mean that someone 
is going to distance themselves from other people. 
Someone is going to stop having contact with other people. 
But they mean slightly different things, 
so let's be clear about these. 
Isolation means keeping sick people separate from others, 
from healthy people, or any other person. 
This can be done with in home, so you can restrict yourself 
to your home. 
If you live with other people, you 
would also need to keep from having 
contact with other people even within the home. 
If you're unable to do that within your home, 
then you may need to go somewhere else to isolate 
yourself from other people. 
In some places, people may go to a hotel, 
or find another place where they can be separate from others. 
In hospitals, patients will have to have a separate space 
and have very limited contact with anyone else except health 
care workers who are wearing the appropriate masks, gloves, 
and gowns to keep them safe. 
How long should someone isolate from other people? 
Well, it should be for the duration 
of their infectiousness. 
And as we've already discussed, that 
will start two days before the onset of their illness, 
and it will last through the duration of their illness. 
Some people are sick longer than others, 
so their infectious period will be longer than others too. 
But in general, we would say that someone 
can stop isolating themselves from others 
safely if it's been at least 10 days after the onset 
of their illness, all of their symptoms are improving, 
and they haven't had any fever within the past three days, 
and this means that they haven't had fever in the past three 
days, and they also have not been taking medicines 
to suppress their fever for the past three days. 
So it's important to check that. 
So quarantine means restricting the movement and contact 
of healthy people who've been exposed with other people. 
So we isolate a case, but we quarantine contacts, 
because they've been exposed, and they 
could become infectious. 
Contacts should be quarantined for 14 days 
since the last contact they had with the infectious patient, 
the person who may have infected them. 
So it's important to know when their contact was 
to be able to figure out how long they need to quarantine. 
[MUSIC PLAYING]

 As a contact tracer, 

you'll need to be able to calculate 
how long a case should isolate and how long a contact should 
quarantine themselves. 
It'll be based on your understanding 
of their infectious period, and it 
will be an important component of working 
with cases and contacts to limit the spread of disease. 
So let's go through some examples, very 
practical examples, using a calendar 
to see how this might work. 
So how long should a case be isolated from others? 
Well, the short answer is ideally as long 
as they are infectious. 
But there is a longer answer. 
We know that by the time they're diagnosed, they may already 
be sick, so by the time you're investigating this case, 
their infectious period has already started, 
probably at least a few days before. 
So you'll need to talk to them about isolating themselves 
for the duration of their infectious period. 
They'll have to monitor their symptoms each day 
to help you determine if they're still infectious 
and if they've recovered. 
And remember, they'll need to isolate themselves 
at least 10 days after symptom onset, 
and you'll have to know that their other symptoms are 
improving and they haven't had fever for three days. 
So let's see practically what this will look like. 
Let's assume that you identify a case, 
and you call them on May 10th. 
During the conversation with them, 
they tell you that they became ill on May 9th. 
So now you know that they were infectious for two days 
before they became ill, and they will 
be infectious for at least 10 days after their onset. 
So that means May 9th plus 10 days 
equals May 19th, so you can see here 
in blue their total infectious period, which 
started two days before their onset of disease 
and went all the way through May 19th, which 
is 10 days after the onset. 
So we know that the case will be infectious at least through May 
19th in this example, but you'll need 
to have continuing follow up to see when they can stop 
isolating from others, because you'll 
need to know when their symptoms resolve 
without use of medication. 
So the 19th is the earliest time that they can stop isolating, 
but just a reminder that you'll need to be following up 
with them to see if they can really stop 
isolating on the 19th or not. 
So on this slide, the days of their infectious period 
are shown in blue, and we assume that we 
call the case on May 10th, and you're 
going to ask them about the contacts they 
had since May 7th. 
Those are shown here also in yellow. 
We assume that after you call them, 
so from May 10th through May 19th, 
they're isolating themselves, so they're not 
going to have any additional contacts. 
So in your discussion with them on May 10th, 
you'll need to list out everyone they had contact 
with since May 7th. 
Now that you've identified the contacts, 
you'll need to help them calculate how long they 
should quarantine. 
So how long should a contact stay in quarantine 
or distance themselves from others? 
The short answer is ideally as long 
as they could be infectious, which 
means the 14 days since their last contact with someone 
who is infectious. 
So there's a longer answer though. 
Again, it's 14 days since their last contact, 
because we know almost everyone who is infected 
will develop illness within 14 days. 
However, by the time that you are 
having a conversation with the contact, 
their contact with the case may have been days ago, 
so you'll need to figure out how much time they 
should quarantine from the time you talk to them. 
And in other examples, the contact may be ongoing. 
So for example, if they live with the case, 
they lived with someone who is infectious. 
So that will require some additional calculations. 
It's important to note also that when you're 
having a conversation with a contact, 
if they've developed symptoms, they should probably 
be considered a case, and so then you 
would talk to them about isolating 
rather than quarantine. 
Now, let's think through a specific example. 
Remember the case we already talked about? 
Well, let's assume that you're going 
to call one of their contacts, and you're 
able to have a conversation with this contact on May 13th. 
And on the call with this contact, 
you understand that their last interaction, their last contact 
with the case was on May 10th. 
If you'll recall, that's the second day 
of illness for the case, so they should receive instructions 
to quarantine for 14 days since their last exposure 
to their case. 
If their last exposure was on May 10th, 
you would add 14 days, and so that 
would mean that they should quarantine through May 24th. 
So we already mentioned that if a contact lives with a case, 
then figuring out their quarantine period 
could be a bit more difficult, because 
their quarantine periods going to be longer. 
So the contact should quarantine themselves immediately and then 
also for 14 days following recovery of the case, 
because that would be the last time they had contact 
with an infectious case. 
So for some contacts quarantine is going 
to be longer than 14 days. 
Let's just see what that would look like on the calendar. 
Let's assume, same scenario, we call the contact 
on the 13th of May, and it's the same case, 
but they live with the case this time. 
So the person that they live with became ill on the 9th. 
This is the case we talked about before. 
Let's also assume that the case will be fully recovered 
by the 19th. 
This would be 10 days since their onset of illness. 
Therefore, if the contact has to quarantine themselves 
for 14 days after their last infectious contact, 
then they would need to quarantine through June 2nd, 
because that would be two weeks after the full recovery 
of the case that they lived with. 
So you can see in this example where the contact lives 
with the case, their quarantine period is going 
to be almost three weeks long, because they'll 
have to quarantine themselves while they're still 
having contact with the case and for two weeks after. 
[MUSIC PLAYING]

SPEAKER: So as a contact tracer, you're 

going to investigate cases and identify contacts. 
Sometimes you'll encounter some more risky situations 
for transmission and you'll have to handle them 
in a bit of a different way. 
So now let's talk about what some of those situations 
might be and how you can identify them. 
So as you know, when someone who's infectious 
has more and closer contacts with more people, 
that can be a really risky scenario for transmission. 
So there are a couple of important terms 
to keep in mind here. 
One is congregate housing settings. 
And this is any kind of shared living environment where 
an individual or a family has private living quarters, 
but shares common dining, recreational, 
or other facilities with others. 
These can be risky places for transmission. 
Also think about high-risk sub populations. 
And this is a segment of the population that 
may have characteristics that increase 
their risk for infection or increase 
their risk for severe disease. 
We already know what some of these groups are. 
Older adults, for example, are at much higher risk 
for severe disease. 
So when you are investigating cases and investigating 
contacts, talking to them, it's important to be 
on the lookout for anyone who is a member of one 
of these special populations that are at increased risk. 
So if you're talking to a case, for example, 
and they mention that they are in a very dense contact 
environment where they live closely with other people 
or have many shared spaces, then this 
is something you'll want to take note 
of because you may need to report it to your supervisor. 
You may need a different approach 
for contacting the people that they've had contact with. 
There are other situations where it 
may be difficult to contact trace and identify exposures. 
We'll go through some examples of this, as well. 
But in some cases, people may not even 
know who they've had contact with, 
so you may need an institutional approach 
to identify who their contacts are. 
Let's say, for example, they were in a movie theater. 
You may need to work with the movie theater 
to see who else was in that theater. 
The case themselves may not know. 
Let's think of another population, 
people who may find it difficult to isolate 
themselves or quarantine themselves within their living 
environment. 
We're going to talk about some examples of that, as well. 
And then finally, there are groups 
of people who are at higher risk for severe disease or death. 
And they may need some additional special 
considerations. 
So now let's define these four groups 
and unpack them a little bit more 
so you understand what you're looking for 
and when you might need to report to your supervisor 
that there may be a high-risk event. 
So the first scenario are dense contact environments. 
This is where there are large crowds of people. 
So if a case has recently been at a conference 
and had many contacts with others, 
you're going to want to note that and take 
some special action. 
If the case frequently has close contact or interactions 
with others, including physical contact or being 
within six feet for prolonged periods of time-- 
these kinds of contacts can lead to what we 
call a super-spreading event. 
And that means an unusually high reproductive number. 
So on average, you know that someone 
who is infectious who has COVID-19 
could infect two to three other people. 
But if they have contact with dozens of people 
while they're infectious, then it's 
possible that they can infect many, many more than two 
to three people. 
And so again, this is a risky situation 
that you'd need to identify because you 
may need to take more than just the usual contact tracing steps 
to address this kind of exposure. 
Some examples of what those dense contact environments 
might include conferences, as I mentioned, 
people who've spent a lot of time on mass transit. 
So maybe they took a flight or they were on a train 
together for a long time. 
Religious services or demonstrations 
are another place where people often have close contact 
with many other people. 
The workplace environment could be another example, bars, gyms. 
Schools with people sitting together 
in a classroom for a long period of time 
is another dense contact environment, sporting events 
and concerts or other places where 
people are often in very close contact with each other. 
So anytime you identify a case who's 
had one of these exposures during their infectious period, 
you're going to need to report to your supervisor. 
There may be more than you need to do than the typical contact 
tracing. 
So let's talk about the next group, those 
where it's complex or hard to contact trace and identify 
exposures. 
So these are examples where the close contacts 
may be unknown to the case. 
So let's say you were at a concert. 
You may have had very close contact 
with someone next to you, but you may not know them. 
You may not know how to contact them. 
Another example is where the recall of close contacts 
may not be reliable. 
So let's say that you're talking to the case 
and they just may not remember who they've had contact 
with for various reasons. 
Another example is where there may be so many contacts 
that they had, it's difficult to determine who's really at risk 
and who the possible contacts are that you need to find. 
So some examples of where tracing contacts 
can be difficult are in a homeless shelter, for example. 
So the case themselves may not recall all of their contacts. 
They may have had contact with multiple people 
and they can't remember who they were. 
The contacts may be spread out through multiple jurisdictions. 
So let's say, for example, the person 
was in two different shelters in two different counties 
during their infectious period. 
So that would make the contact tracing much more complex. 
You may also have difficulty locating or testing 
contacts who were exposed to this person. 
So that's another added layer of difficulty 
in this kind of setting. 
In some places, it may just be very difficult for cases 
to isolate themselves from others or for contacts 
to quarantine themselves from other people. 
They may just be unable to distance themselves 
from others because of either the design of the house 
or the facility or maybe because they 
have developmental disabilities and aren't able to distance 
themselves from others. 
They need someone for their everyday care. 
It also may be that where they live, 
there aren't enough resources like masks, gloves, or staff 
so that you can adequately keep people 
separated from each other. 
So let's say one person is caring for two people. 
You don't have enough staff so that those people 
can be cared for independently. 
There could also be social pressures where they live, 
which makes it very difficult for them 
to keep a distance from others. 
Sometimes people may also be unwilling to cooperate. 
And that's another difficulty that you 
would want to notify your supervisor about. 
So one example of where it may be 
difficult to isolate or quarantine 
could be an intermediate care facility. 
And these are homes with people who have special needs. 
So the residents may be unable to cooperate or isolate 
or quarantine themselves because they may not understand 
basic concepts of hygiene and social distancing, 
so they may not be able to carry out the instructions themselves 
and it may be difficult to remove them 
from other people who are infected within the home 
because they all need care and there's nowhere else 
for them to go. 
It's also harder to maintain resources 
for effective prevention in those scenarios 
because they may not be used to using masks and gowns 
and they just may not have them on hand. 
So this would be another example of where 
you'd need to talk to your supervisor right away. 
So we've talked about the three examples 
where risk of transmission may be higher. 
But remember there's a fourth group as well, 
where the risk of transmission may be higher, 
but there's also a higher risk of severe disease or death. 
These are people who are more likely to get infected 
because they have many frequent close contexts similar to some 
of these other scenarios. 
But they also may have underlying medical conditions 
that put them at risk for severe disease. 
And they may get exposed to the virus 
multiple times because of others who 
they're having contact with. 
One example of this kind of scenario 
is an assisted living facility. 
So it's a congregate living situation 
where people may have their own rooms, 
but they share resources like kitchens 
or other social spaces, so they're 
at high risk for infection. 
Most residents in assisted living 
are over 60 years of age. 
So they're at higher risk for severe disease and death, 
as well. 
And these facilities may have multiple levels of care, 
including skilled nursing facilities which 
care for individuals with illness or injury. 
So they may have some of the same limitations 
on isolating themselves or quarantining themselves 
from others. 
So this is going to be an especially risky situation 
where people are at high risk for infection, 
but also severe disease or death. 
So again, as a contact tracer, you're 
going to have to help identify these high-risk situations when 
you're talking to cases or to contacts. 
It'll be really important for you 
to collect the necessary information 
to accurately assess this risk. 
So this will include making sure you know where people live 
and where they are, the type of interactions 
they have every day. 
If they're in one of these settings 
or have been in settings where they could have had contact 
with many people, you'll need the contact information 
for the venue. 
You'll need the name of that venue, where is it located. 
You'll need details. 
You'll need the names of their close contacts 
as best they can remember, but perhaps 
even details about contacts that they're not able to remember. 
You'll need specifics about where they've been, 
so if they were on a flight or a train. 
If they went to a movie theater, which movie did they see 
and what time was it? 
If they were at a conference, what's the name? 
If they were in a class, who's the teacher 
and where's the school? 
You'll need facility names. 
And this will all help you with helping to control transmission 
in this scenario. 
Your identification of this high-risk situation 
may also depend on noticing a pattern between multiple calls. 
So maybe, let's say for example, you 
talk to a few cases in a day and they all 
may work in the same facility. 
Well, then that could be a clue to you 
that there is transmission going on at that facility. 
And you'll need to escalate this issue. 
You'll need to report it to your supervisor 
immediately because it could be some indication that there 
is a high risk of transmission at that facility. 
When you're speaking with someone 
who may be in this high-risk scenario, 
you'll need to note for them that there may be 
additional follow-up required. 
And again, you should immediately escalate and report 
any kind of high-risk case or contact to your supervisor. 
Typically, these high-risk scenarios 
are going to be handled by specific teams that 
are trained to work with facilities, 
to work with organizations, to work with these cases 
and contacts to come up with a comprehensive plan on how 
to address risk and how to provide the services required 
to really stop transmission in these scenarios. 
So it's important, again, to immediately contact 
your supervisor if you identify high-risk cases or contacts. 
[MUSIC PLAYING]

 Hello. 
My name is Emily Gurley, and I'm an infectious disease 
epidemiologist at the Johns Hopkins Bloomberg School 
of Public Health. 
I want to talk to you now about the steps 
to investigate cases and trace their contacts. 
By the end of this lecture, you should 
be able to identify all of the basic steps 
to investigate cases and trace their contacts. 
You should be able to provide examples 
of the kinds of questions that you 
might ask of cases and contacts during each step. 
And you should be able to describe 
the kinds of social support that cases and contacts 
may need to carry out isolation and quarantine. 
After all, asking people to isolate and quarantine 
is difficult, and they may need some additional support. 
And finally, we're going to present 
an example of a simple case investigation 
and contact tracing call so that you can hear what 
this sounds like in practice. 
Next, let's go through the basic steps-- 
naming them, understanding what they mean, 
and how they come in the sequence. 
On this slide, you can see the six steps of case investigation 
and contact tracing. 
Please know that this is a major simplification of what's 
actually happening, but hopefully it can provide you 
with a framework to think through the different 
components of what you'll do while you're investigating 
cases and tracing contacts. 
So let's go through these briefly first. 
First, when you call a case, you'll introduce yourself, 
and you'll get their basic information. 
We'll talk more about that in just a minute. 
Next, you would inquire and find out 
about their infectious period. 
So you need to ask them questions 
to be able to determine that. 
Once you define their infectious period, 
you would move on to step 3, which 
is identifying the contacts they had 
during their infectious period. 
Then you would move on to step 4 of that call 
with the case, where you're providing them 
with instructions on isolation and helping 
them to identify challenges to their ability to do that. 
You would also provide them with any support 
that you could to allow them to isolate. 
So then we move on to number 5, which is about the contacts. 
You'll initiate contact tracing, which 
means calling or contacting the contacts in some way, 
informing them about their exposure, 
asking about symptoms, and giving them 
instructions about quarantine. 
Finally, in step 6, you're going to implement regular check-ins. 
And this refers to the contacts as well as the cases, 
and you're going to follow up with them 
throughout their isolation or quarantine period. 
On this slide, you can see how the steps fit together 
in a sequence, one after the other. 
So steps 1 through 4, again, are about calling the case 
and having a number of conversations 
with that case on introducing yourself, 
inquiring about the infectious period, 
identifying their contacts, and giving them 
instructions on how to isolate. 
After that first call, where you've done all four steps, 
you move on to step 5 where you call their contacts. 
And that step-- step 5, where you're calling the contacts-- 
could be repeated many times. 
It would be repeated for all the different contacts 
that they had. 
And on those calls, you're asking about symptoms 
and instructing them on quarantine. 
Finally, step 6 is an ongoing step as well. 
So you're going to be implementing regular check-ins, 
being in constant contact with the case and their contacts 
to follow up on symptoms and how things 
are going with their isolation and quarantine. 
So you can refer back to this to see how each of the steps 
are going to link together. 
Now that we've defined each of the steps, 
let's talk about what happens in each step and talk about some 
of the questions that you might use in each of the steps. 
So on this slide, please note that the words in italics 
are the questions that you may use during each of these steps, 
or something similar, just to give you an idea of how 
these conversations flow. 
First, you might want to identify your organization. 
To do this, you may say something like, "Hi. 
This is Julie from the health department." 
Next, you want to be able to confirm their identity 
and their residence. 
Because you're going to be talking 
with them about personal information, 
you want to make sure that you have the right person. 
So when you say, "Is this Swetha," 
they confirm that it is them. 
And you say, "Nice to meet you. 
I need to discuss some sensitive information with you. 
Before we keep talking, can you please tell me 
your birthday and address?" 
And then if they can confirm that, 
then you can feel confident going on. 
Next, in this step, you want to discuss the positive test 
with them, because that's really the reason why you're calling. 
So you might say, "I'm calling about your coronavirus test. 
Have you talked with your provider yet?" 
It's possible that they've already heard about their test 
from their health care provider. 
You also want to describe the importance and the benefits 
of the call to the case. 
You want to say something like, "I'm calling to see how you are 
and to help keep you, your family, 
and your community safe." 
You want to provide them some assurances 
and confirm that the call is confidential. 
So you might say something like, "What we talk about 
is between you and me." 
You want to check in about the length 
and the safety of the call before you continue. 
So you may say something like, "This call 
should take about 20 minutes. 
Is now a good time to talk? 
Are you in a safe place to talk?" 
While you're on the call, it's important to pause and ask 
and assess about the need for medical care. 
If you notice that the person you're talking to 
has trouble breathing, or is having chest pain that 
doesn't go away, if they seem confused 
or is having trouble talking, those 
could be some indicators that the person is very severely 
ill. 
And if that's true, you would need 
to help get them medical care right away. 
You wouldn't finish the call. 
You would just turn from the questions 
you're asking to helping them get medical care. 
As you remember, step 2 is also part of the call with the case. 
In step 2, you want to inquire about their infectious period. 
So there are a few questions you're 
going to have to ask to determine 
when their infectious period started. 
If they had symptoms, you're going 
to ask questions like, "What date did your symptoms start," 
or, "Did you feel like you had a fever? 
How has your fever improved without medication? 
How are you feeling now?" 
And if they didn't have any symptoms-- 
maybe it's someone who's been diagnosed with an infection, 
but they never had signs and symptoms-- remember, 
we call this an asymptomatic case-- 
you may ask them, what date did they get tested? 
So depending on the answers that they provide, 
you can calculate the period of time 
that the case may have spread SARS-CoV-2 to others 
or when they were infectious. 
You can also find out who was close to the case 
during that period of time. 
Please note that there may be differences 
in how the infectious period is calculated, depending 
on whether there were symptoms or fever. 
While you're talking with the case, 
you'll move on then to step 3. 
Now that you've identified their infectious period, 
you'll need to identify who they had contact 
with during that period. 
So anyone considered a contact of the case 
during their infectious period will be quarantined, 
which includes but isn't limited to people 
who live with the case, were face-to-face 
within six feet of the case for 15 minutes or more, 
or had other types of direct contact with the case, 
like kissing, or had contact with secretions of the case. 
So someone taking care of them may 
have cleaned up their used tissues, for example. 
Some helpful questions you may want to use 
are, "Do you have any caretakers or housemates? 
Would you be willing to look at your calendar, or phone, 
or social media to help jog your memory about what 
you did this past week? 
Where have you traveled?" 
All of those questions will help you 
to help the case remember the things that they 
may have been doing during their infectious period. 
So in step 4, you're still on the call with the case, 
and you're going to issue isolation instructions 
for them. 
There are four components of issuing the isolation 
instructions. 
First, you'll explain isolation to them in simple terms. 
So what does isolation mean? 
What are you asking them to do? 
Then in number 2, you'll ask questions 
to check that they understood completely 
about what isolation means and help them make a plan. 
Isolating yourself isn't easy, so they'll need a plan. 
Third, you should identify the challenges 
that may stop them from following your isolation 
instructions. 
And then, finally, offer them resources 
to improve the chances of following the isolation 
instructions and being able to carry it out. 
Let's break these four components of the isolation 
instructions out a little bit more 
and think about some things you may do. 
So to explain isolation simply, you 
could say something like this. 
"Isolation means that you should try 
to eliminate your contact with other people, 
except if you need to see a doctor. 
If you live with others, you might 
try to find a different place to stay, 
or you might use your own bedroom and bathroom. 
If you need to be around other people, 
you should wear a mask." 
Next, you'll need to check their understanding 
and help them make a plan. 
To do that, you'll need to ask them some questions. 
So you may ask questions like, "Do you 
have a safe place to stay? 
Will you need food soon? 
If so, how could you get it? 
Do you take any medications, and will you need a refill soon? 
And do you have a mask?" 
So they'll need plans. 
Next, you'll want to help them identify challenges. 
Again, this could be done through asking them 
some more questions, like, "What concerns 
do you have about your responsibilities 
and mental health?" 
Some examples of concerns they may have 
are taking care of their parents or kids, 
or they're the only employed person in their home. 
It's also possible they're in a domestic violence situation 
and may need help finding a safe place to stay. 
Finally, based on the challenges that they've 
identified with you, you would want 
to be able to offer them some resources. 
It's important to keep in mind that the resources 
available to people are going to be different 
depending on where you are. 
Some examples of resources you may have to offer them 
include the 211 number. 
This is not available in all parts of the United States, 
but it is in some. 
And it's a place where people can access some immediate needs 
they may have. 
You could put them in touch with food banks, 
other local services, organizations, or neighborhood 
and community support groups that can support people 
during this time. 
At the end of the call with the case, 
you're going to wrap up that call. 
You're going to make sure that you answer their questions 
and have a plan for follow-up. 
So you'll say something like, "Thank you for your time. 
We've talked a lot today, and I've 
given you tons to think about. 
You'll probably have more questions 
over the next few days. 
If you think of something, here's our phone number. 
But either way, I'll be calling back soon to check on you. 
Bye." 
After you're done with the call with the case, 
you're going to move on to step 5, which is contact tracing. 
When you call a contact, first you're 
going to inform them that they were in close contact 
with someone who has coronavirus, or COVID-19. 
Next, you're going to check to see if they have 
any symptoms, such as a fever. 
You're going to provide them instructions to quarantine. 
You're going to help them identify challenges and offer 
resources to overcome those challenges. 
You're going to answer their questions 
and then make a plan to follow up. 
So you should recognize many of these, 
because it's very similar to some of the things 
you're going to do on the call with a case. 
Checking if they have symptoms, identifying challenges 
to quarantine, offering resources, answering questions, 
and following up are very similar to what 
you do with a case. 
Some frequently asked questions from the contacts 
include things like, "What happens if I get sick? 
How do I get tested? 
Do I need a mask? 
Can you give me a letter for my job or landlord?" 
And those are questions that you should anticipate 
and have some answers for when you 
are ready to talk to contacts. 
Finally, we've come to step 6, which is implementing 
regular check-ins. 
So at this stage, you've established a relationship 
with the case and with all their contacts, 
and you're going to make sure that you keep following up 
with them to check in on their isolation and quarantine 
and, of course, their symptoms. 
It's important to check in on symptoms, 
because that can determine when they can end their isolation 
or quarantine. 
So on these regular check-in calls, 
you're going to ask cases about their symptoms. 
If they're getting worse, they may need medical care. 
If they're getting better, then they 
may be able to end their isolation soon. 
You're going to ask them, importantly, 
if they've had new contacts, because then you would need 
to find those people as well. 
You're going to offer continued support for isolation. 
For follow-up calls with contacts, 
you want to track and see if they've had any symptoms. 
If so, they may need to get a test 
and then may also need medical care. 
And you'll also continue to offer support for quarantine. 
As a contact tracer, you're going 
to be providing important support 
to members of your community to help 
stop the spread of COVID-19. 
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