Washing hands, testing and social distancing get most of the attention when it comes to strategies to fight the spread of coronavirus. But contact tracing is the essential behind-the-scenes work needed to stop transmission.
Contact tracing is the labour-intensive investigation by public-health officials to identify people who might have been exposed to coronavirus. The process is about getting people assessed, tracking down their contacts, and potentially isolating those who have been exposed to the virus – even before they start to show symptoms.
It’s seen as a critical component in the battle to flatten the curve so hospitals aren’t overwhelmed by a rush of critically ill patients. Taking these steps will also be key to enabling societies and economies to begin the process of restarting, at some golden point in the months ahead.
Provinces are now boosting their efforts, following Alberta’s lead of enlisting medical students, nurses and other non-traditional contact tracers to help public-health officials.
“All they need is the clinical training, a phone and an internet connection, and we can train them to do this work,” says Dr. Richelle Schindler, a University of Calgary medical resident currently training to become a medical officer of health. In recent weeks, she has been the driving force behind increasing the number of individuals aiding in the province’s contact tracing work.
“Being able to scale up contact tracing is so critical for our ability to contain the virus.”
The contact tracing process has long been the bread-and-butter of public health for diseases such as measles, Hepatitis A or sexually transmitted infections. But COVID-19 has made breaking the chain of disease transmission all the more important.
In the Asian countries where the disease first spread, governments have used technology to contact trace those infected with or exposed to coronavirus. Strict surveillance measures in Singapore and Taiwan have been lauded, even as individual privacy concerns have been sidelined in the name of public health. Western countries are now also rushing to create apps that can alert individuals and health authorities when someone with COVID-19 has been in contact with others.
But in this country, until now, contact tracing is still being done the old-fashioned way – mostly by using the phone, calling again if need be or even showing up to somebody’s home for a “wellness check,” as a very last resort.
Dr. Schindler says three weeks ago, as the number of COVID-19 cases in Alberta began to rise, “it became abundantly clear” that the 30 or so public-health staff who normally do contact tracing would need more help.
The province started enlisting a new work force – beginning with medical students. Since then, Alberta has built a team of more than 400 medical students from the University of Calgary and the University of Alberta, along with nurses and some medical residents. More workers could be added to the ranks.
“Under normal circumstances, this program would have been in development for months,” Dr. Schindler says. “We mobilized this project in days, because waiting to make a perfect system was not an option.”
The country’s most populous province is also moving in this direction. Ontario’s Chief Medical Officer of Health, Dr. David Williams, gave an order this week for public-health units to implement more aggressive contact tracing. The move came in response to an increase of community transmission of coronavirus. That emergency order has given public-health units the ability to make staffing decisions, despite collective agreements, and to enlist retired nurses and medical students in the effort.
Saskatchewan and Newfoundland and Labrador are also launching comparable responses, Dr. Schindler says. “I’ve had conversations with people in just about every province, to help them set up something similar."
Alberta has been aided by its provincewide, fully integrated health system. Contact tracers working for Alberta Health Services are not bound by geographical constraints as much as officials might be in other provinces, and can shift resources and calls to whatever part of the province is seeing a flare-up of cases.
A more robust system of contact tracing could help Canada and other countries at some point transition out of self-isolation measures, and the accompanying economic shutdown. If public-health organizations get better at tracking down and isolating individuals who have been sickened by COVID-19 or exposed to coronavirus, society might more quickly be able to return to a degree of normalcy again.
Dr. David Strong, a Medical Officer of Health for the Calgary zone, says Alberta will see a growth in cases, as other jurisdictions have. After a peak, the number of cases will drop, but the virus won’t completely disappear. With a vaccine for COVID-19 likely 18 months away, a second wave of infections is possible.
That will make contact tracing all the more indispensable, Dr. Strong says.
“This is going to continue for quite some time to come," he says of the pandemic. Contact tracing will “allow us to get on with our lives, with some degree of security."
Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters.