Field Notes from FETPs Fighting COVID-19: February 2021
Since the beginning of the coronavirus pandemic, staff, trainees, and alumni of Field Epidemiology Training Programs (FETPs) have been applying their expertise in outbreak detection and response to mitigate the spread of COVID-19 in more than 100 countries.
On January 27, TEPHINET held its eleventh global COVID-19 teleconference for FETPs to share their experiences, challenges, and lessons learned in the field during their COVID-19 response activities. The FETPs in Bangladesh, Jordan, South Africa, and Zambia shared their experiences on this call.
Bangladesh Field Epidemiology Training Program
Currently, 30 alumni and 12 fellows of the advanced, two-year level of the Bangladesh FETP are involved in the COVID-19 response, and 79 alumni and fellows of the FETP’s newer Frontline level training are also involved.
FETP alumni and fellows have applied their skills towards developing a national COVID-19 database, investigating cases and contacts, training contact tracers, and manning COVID-19 hotlines. They have also developed guidelines and reports (including guidelines on COVID-19 vaccine implementation), conducted research (including active pharmacovigilance), managed quarantine centers, and followed up with travelers.
Throughout the response, the FETP encountered several challenges and developed solutions to address them. To address difficulties in conducting field investigations, including closed institutions and lack of transportation, they arranged for temporary vehicles and conducted mobile-based contact tracing and teleworking.
Due to the possibility of fellows being exposed to COVID-19, the FETP initially did not have opportunities to access isolation and quarantine facilities. To address this, the program reserved a hotel to use as an isolation and quarantine facility and secured a new office space. They also purchased personal protective equipment and arranged COVID-19 testing sites.
The FETP also had difficulty conducting academic sessions and recruiting their new cohort and was able to address this through online teaching and training sessions, changing training schedules, and modifying fellows’ projects and expected deliverables.
This experience has helped the program identify and address gaps in Bangladesh’s preparedness and improve the functioning of the FETP. Ongoing challenges including the demanding workload, a need for more training materials on pandemic response, and adapting to the frequent changes in protocols for quarantine, isolation, and contact tracing.
Jordan Field Epidemiology Training Program
Prior to its first reported case of COVID-19, the Jordan FETP worked to increase the country’s preparedness for responding to the coronavirus by conducting workshops on COVID-19 for trainees and alumni, developing definitions for suspected and confirmed cases, creating epidemiological investigation forms, and establishing guidelines for handling suspected and confirmed cases. In cooperation with the Ministry of Health and EMPHNET, the FETP also held workshops for health workers at the national and sub-national levels.
Jordan registered its first case of COVID-19 on March 2, 2020. FETP trainees and alumni became directly engaged in responding to the outbreak. Four FETP teams were established to 1) follow up on new cases, 2) follow up with contacts, 3) investigate random outbreaks, and 4) collect, analyze, and disseminate data by writing reports for Ministry of Health stakeholders. FETP trainees and alumni conducted a seroprevalence survey for COVID-19 virus infection.
Twelve FETP trainees and alumni worked in a 24/7 call center which was established to help coordinate efforts among multiple health sectors. The center was a key dashboard for the number of beds for COVID-19 cases in isolation wards and intensive care units throughout Jordan. These call center workers were responsible for coordinating with paramedical staff to secure the transfer of COVID-19 patients, updating occupancy rates for COVID-19 patients around the clock in all accredited hospitals, and helping to ensure medical care for COVID-19 patients.
The FETP also engaged in activities to raise public awareness of COVID-19, including developing and disseminating brochures, responding to hotline calls, and spreading information through traditional and social media channels.
South Africa Field Epidemiology Training Program
As of January 2021, South Africa had the highest number of confirmed COVID-19 cases in Africa and the fifteenth highest number of infections worldwide. More than one month before the country reported its first case of the disease, the National Institute for Communicable Diseases (or NICD, which houses the South Africa Field Epidemiology Training Program) activated the Emergency Operations Center (EOC). FETP residents and alumni have been working within the EOC, conducting event-based surveillance, preparing inputs for daily situation reports, and monitoring health facilities’ preparedness for handling cases of COVID-19.
In the area of surveillance, the FETP has been managing the national data team and liaising with national contact tracing and clinical management teams. Other activities include managing the national COVID-19 master database, cleaning national and provincial datasets, analyzing data and compiling reports, and capturing data via Persons Under Investigation (PUI) forms.
FETP residents and alumni have also been participating as members of rapid response teams and conducting case investigations, tracing and monitoring contacts and alerting provincial epidemiologists about contacts who need to be monitored and/or swabbed.
In addition, the FETP has been assisting with country-level coordination, planning, and monitoring, including training healthcare workers and military personnel, monitoring and evaluating the readiness of healthcare facilities, and developing response plans and standard operating procedures. The FETP has also engaged in risk communication activities. For example, the FETP answered frequently asked questions about COVID-19 in several languages. These videos were distributed to the public via the NICD’s social media accounts.
Zambia Field Epidemiology Training Program
Zambia is currently experiencing a second wave of COVID-19. Residents and alumni of the Zambia FETP have been supporting the public health response to the pandemic since early 2020.
The FETP has been engaged in following up with high-risk travelers, training health workers in infection prevention and control, contact tracing, geospatial mapping and analysis, and outbreak investigation. FETP residents and alumni participate in rapid response teams and the Incident Management System.
Residents and alumni have been conducting research to better understand COVID-19 in Zambia, including conducting a cohort study of long-term symptoms among persons with COVID-19; case control studies among healthcare workers; a knowledge, attitudes, and practices study among truck drivers at points of entry; an assessment of whether malaria indicators can be used to track COVID-19; mortality surveillance at a large urban hospital; a pilot of wastewater surveillance for SARS-CoV-2, and more.
The FETP is using this pandemic as an opportunity for residents to complete certain required deliverables for graduation, including outbreak investigations, data analyses, abstracts, and scientific communications. While the pandemic has severely impacted normal life in Zambia, this is a unique time to train as a field epidemiologist and show the value of FETP.