Health officials in Ontario regions with the highest number of active COVID-19 cases are taking days to track down many of those who may have been exposed to the illness, a problematic delay that infectious disease experts say jeopardizes the province’s ability to reduce spread of the disease.
The problem is only expected to worsen as Ontario ramps up the number of COVID-19 tests done each day, as it could increase the number of positive cases that need contact tracing.
Experts say Ontario’s current contact tracing targets are inadequate and that the province needs to revamp the system to ensure contacts of new positive cases are notified quickly.
"It's taking days and days for people to even be contacted about contact tracing," said Isaac Bogoch, an infectious diseases physician at Toronto General Hospital, referring to his experience with patients who have tested positive and discussions with colleagues about their patients. "We can clearly make short-term Band-Aid solutions that are going to be effective in contacting patients with their positive test results in real time."
Under the current system, Ontario health officials say they want health units to contact 90 per cent of new cases within 24 hours of receiving a positive test to initiate the contact tracing process. Many medical experts say this goal isn’t good enough, as contact tracing must be done much faster to alert people exposed to COVID-19 so they isolate themselves and avoid spreading the disease to others.
The current approach means it often takes days from the time a person first gets tested until the contact tracing process is complete, particularly in parts of the province with a high caseload, such as the Greater Toronto Area.
When asked by The Globe and Mail, many public-health units in Ontario said they are able to start and, in some cases, complete the contact tracing process within 24 to 48 hours of receiving a patient’s positive test result.
But two hard-hit regions that make up two-thirds of Ontario’s active COVID-19 cases are facing challenges meeting the goal.
In Toronto, which has about 45 per cent of the province’s active COVID-19 cases, health officials say they’re only able to reach 80 per cent of confirmed new cases to start the contact tracing process within 24 hours.
In Peel, which has about 20 per cent of Ontario’s active cases, health officials say they’re able to reach about 92 per cent of new cases to initiate contact tracing process within 24 hours of a positive test result, which meets the provincial target. But in a statement, Peel Public Health said its ability to meet the target “will be put under pressure” as testing increases and more positive cases are found.
"We will continue to follow up with all cases as soon as possible, however our ability to get to them in 24 hours will be impacted," the statement said.
Abhishek Narayan, a physician in the GTA who tested positive for COVID-19 early last month, said it took two days for Peel health officials to reach him after his positive result came back. And when they did call, he said the contact tracer didn’t take any detailed information about his contacts.
“[The questions] were superficial at best and it wasn’t really focused on too much contact tracing,” Dr. Narayan said.
In a statement, Peel Public Health said nearly all of newly identified COVID-19 cases are contacted within 24 hours and they are asked a series of questions.
Michael Warner, medical director of critical care at Toronto’s Michael Garron Hospital, said he’s increasingly frustrated by the lengthy delays it’s taking health officials to reach contacts of confirmed new cases. Dr. Warner said since it’s possible to diagnose patients with COVID-19 at the hospital, before their tests come back, local health officials should leverage that information to do contact tracing even further.
Dr. Warner said he recently diagnosed a patient with COVID-19 and contacted Toronto Public Health shortly after to start contact tracing. Despite this, it took officials nearly two days to finally reach the family, he said.
In a statement, Vinita Dubey, Toronto Public Health’s associate medical officer of health, said more than 550 staff are working on case investigations and contact tracing and that more are added each day. It’s a complex process, she said, and they are looking at ways to expedite the contact tracing process.
“Unfortunately, the path from patient testing to the notification of public health is not always smooth. This can result in delays in the case and contact management process,” Dr. Dubey said.
Dr. Warner said Ontario must rethink how contact tracing is done to ensure faster turnaround times.
“When you set mediocre targets and don’t achieve them, it means you’re performing poorly overall,” he said.
In an e-mail, Hayley Chazan, a spokesperson for Ontario Health Minister Christine Elliott, said the government is planning on releasing “a renewed strategy” to help local health units with contact tracing. The new plan will include an exposure notification app that can alert Ontarians when they may have been exposed to COVID-19. She did not provide a specific timeline for the new strategy.
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