Based on epidemiologic data from the World Health Organization (WHO), the initial perception of COVID-19 risk in Zambia was high among international travelers entering the country.
Monitoring of persons traveling from countries reporting COVID-19 cases was a priority before cases were recorded in the country. This was one area in which the Zambia Field Epidemiology Training Program (FETP) quickly identified FETP alumni and residents to offer their service. Ten Cohort 5 Frontline residents were identified and trained in monitoring and contact tracing. During February 2020, the Ministry of Health, through the Zambia National Public Health Institute and with support from the U.S. Centers for Disease Prevention and Control (CDC), implemented monitoring and contact tracing (MCT); this involved identifying persons who may have been exposed to COVID-19 and following them up daily for 14 days from the last point of exposure. The MCT model was initiated in the capital city, Lusaka, which has the highest number of travelers in the country. Persons with a history of travel to an area with local transmission or who worked in, or attended, a healthcare facility treating COVID-19 infections or who were admitted to a facility for severe pneumonia of unknown etiology were registered for monitoring upon arrival.
MCT of international travelers was systematically applied with the motive of breaking the chains of transmission, assuming the persons are exposed; the FETP acknowledges this as an essential public health tool for controlling COVID-19. The FETP monitors made, on average, 800 phone calls to persons listed on the monitoring form; travelers who had not developed symptoms (fever and at least one sign or symptom of respiratory disease, e.g., cough or shortness of breath) were dropped after 14 days of monitoring and quarantine. This intervention was able to identify the first two cases of COVID-19 in Zambia, confirmed on March 18, 2020.
Following the declaration of COVID-19 as a pandemic as well as a steady increase in the number of positive cases in Zambia, the MCT team escalated efforts by extending their roles and began monitoring persons in transit, contacts to positives cases, and alerts from various sources as well as swabbing and taking specimens to the laboratory. As of June 28, 2020, the national MCT team had successfully managed to follow up 29,894 persons from 31,280 travelers (or 87 percent of the travelers) through phones.
As Zambia continued to record a steady increase in the number of COVID-19 cases, with local transmission, the Ministry of Health intensified response efforts at all levels of the health system. The FETP residents were then strategically assigned to support critical activities including early identification and isolation of positive COVID-19 cases, early contact tracing, early investigation, ensuring adherence to self-quarantine, early response to rumours, and risk communication. This required additional FETP alumni or residents. Therefore, 30 more field epidemiologists (both graduates and current residents of the FETP) were deployed in high-risk districts of Zambia for a period of one month during May 2020.
In the capital city, four alumni were assigned to ensure that data collected during COVID-19 response were of high quality.
FETP alumni were also deployed to five major points of entry to support rapid response teams (RRTs) in the screening of high-risk persons such as truck drivers in transit and individual travelers, both in-land and international.
All the intensive activities continued over a period of one month through support from AFENET, U.S. CDC and ZNPHI. After a month of deployment, a smaller team comprised of 10 FETP alumni was deployed through support from Africa CDC.
All current FETPs have taken up or are supporting research topics to support policy decision-making in the COVID-19 response. These topics include: Knowledge, attitudes and practices towards COVID-19; risk factors for COVID-19 transmission; descriptive and analytical studies of the first few cases; risk factors for health worker infections; and risk factors for COVID-19 infection among truck drivers.
The story for Zambia FETP involvement has some challenges as well; all aspects of the response had challenges. One challenge during the initial surveillance was daily monitoring of travelers. Monitoring all the travelers for 14 days was not easy as some of them gave incorrect contact details, and some of them were lost to follow up during the quarantine period. Finding all of the contacts of positive COVID-19 cases was also a challenge complicated by recall bias and occasional long turn-around times for laboratory results; commodity security for laboratory reagents was unstable in the initial response as reagents were not readily available in the country. For deployment of FETP alumni or residents outside their work stations, a lot of funds are required, but this was more reliable to ensure the residents do not multitask and are fully dedicated to the COVID-19 response.
The Zambia FETP continues to support the COVID-19 response in the country.