When will COVID-19 force public health to give up on widespread contact tracing?
The answer is today for our neighbours to the east. Effective Friday, Nov. 6, Alberta Health Services announced it would be abandoning widespread contact tracing, outsourcing the job to residents as it struggled under the burden of surging daily caseloads that rose to roughly 800 cases yesterday.
“Hi – this is ___ (name of positive case). I am calling to inform you that I have tested positive for COVID-19,” begins the script the health agency released Friday to help Albertans navigate that “scary” conversation.
The health agency said it would be limiting its contact tracing to “three priority groups only”: health care workers, minors and people living in congregate or communal facilities.
The rest of the population — including event organizers, workplaces and individuals — you're on your own, signalled health officials.
On Thursday, B.C.’s record-breaking daily caseload reached 425 cases, little over half Alberta’s total. But in Fraser Health, home of 63% of Thursday’s cases, COVID-19 transmission rates have made the region the epicentre of the province’s pandemic, with provincial health officer Dr. Bonnie Henry suggesting further regional restrictions may be on the horizon.
In several cases, including a recent “super-spreader” event at a dance studio in Chilliwack and a cluster at a yoga studio in Port Coquitlam, claims of long delays in contact tracing have raised concerns over how close public health has come to a breaking point.
As Alberta’s health officials find themselves overwhelmed and abandon widespread contact tracing, it also begs the question, could Fraser Health be next?
A COMPLICATED PROCESS
In a call with reporters Wednesday, Fraser Health CEO and president Dr. Victoria Lee addressed rising concerns over just how fast contact tracers were following up on cases.
In what she described as a “detailed and vigorous process,” Lee said tracing transmission chains from a single exposure can face a number of hurdles and can be complicated by language barriers, inaccurate phone numbers or fear of stigma.
“Some people just don’t want to be found,” she said. “So the timelines do actually vary quite significantly and can be several days.”
Tracing is triaged, and while the highest risk exposures are targeted first, Lee said every case, “even low-risk” is followed up.
The first one or two days are crucial, said Lee, and contact tracers aim to reach everyone involved in that period. At the same time, Lee said it usually takes five to nine days after an exposure for a person to become infectious.
“The virus dictates the timelines and guides how we issue notifications and confirmations, and if necessary, declare an outbreak,” she said.
And while the health authority has not downloaded contact tracing onto residents in the same way Alberta has in recent days, Fraser Health does ask anyone who tests positive and who is waiting for a call from public health to limit contact with anyone else in the two days before symptom onset.
BENT BUT NOT BROKEN
On Thursday, as B.C. announced a record-breaking 425 new cases of COVID-19, health minister Adrian Dix said 580 contact tracers have been hired across the province to date. The province hopes to hire 800 new contact tracers in total, a figure that has crept up from 500 announced in August in preparation for a second wave of the virus.
While Dix said contact tracing is “going well” and that 47 contact tracers have been redeployed to Fraser Health to meet demand, Dr. Brodkin said that so far, the health authority has not reached a breaking point.
An Alberta scenario, it appears, has not yet arrived.
“We have had a significant increase in our caseload. Fraser Health is constantly evaluating our processes and adjusting in order to ensure that we have the workforce that is needed to do that work,” said Dr. Brodkin.
“For the most part, we are continuing to meet our timelines.”