Public health staff in Canada’s largest city are struggling to keep up with the vital work known as contact tracing, or alerting those associated with people who test positive for COVID-19 in a bid to curb its spread, some Toronto doctors say.
Doctors say that individuals who test positive can wait for days without a follow-up call from Toronto Public Health’s contact tracers, who perform the detective-like task of tracking a patient’s steps. In some cases, this means that friends or co-workers of a positive case are not being promptly instructed to self-isolate for the mandated 14 days.
The city has seen the number of confirmed COVID-19 cases surge from 270 in mid-March to more than 2,800 a month later. Plus, Toronto Public Health has itself been hit by the virus. After eight employees tested positive, the agency on March 30 had to tell most staff at its downtown headquarters – including contact tracers – to work from home.
Toronto Public Health has moved staff from its other departments to do contact tracing, and says it now has about 200 dedicated to the job.
Toronto’s Medical Officer of Health, Eileen de Villa, said her agency is prioritizing high-risk cases, directing its resources where they are needed most. Medical students are being brought in to help as well, she said, but the work requires training.
“We can’t be everyplace simultaneously," Dr. de Villa said. "It’s just a challenge with respect to managing resources. But we do want to make sure that we focus our efforts on those cases and on those contacts that are highest risk in terms of continuing spread of COVID-19.”
In the face of public health’s slow pace, one hospital with a COVID-19 assessment centre, Michael Garron Hospital in Toronto’s east end, has decided to take on some of the work itself.
Janine McCready, an infectious diseases doctor at Michael Garron Hospital, said her hospital’s staff are following up with those who test positive, finding out where they work and what their other contacts are, and urging patients to tell their contacts to isolate as well.
“We are doing our own kind of mini Toronto Public Health job here, because there seems to be a pretty big delay between when the tests are positive and when they hear from anyone,” Dr. McCready said.
This week, about a dozen volunteer medical students in offices at the North York Civic Centre started helping with Toronto Public Health’s efforts. One of the doctors supervising them, Jeff Kwong, said another 10 students were to start their training next week and that he hopes to add at least 10 more each week.
A family doctor who trained as a public health physician, Dr. Kwong raised concerns with Toronto Public Health about contact tracing delays and ended up volunteering to help.
“I just heard anecdotally, these cases are saying [at COVID-19 assessment centres], ‘Oh yeah, we tell them they are COVID-positive and Toronto Public Health didn’t call me for so many days’,” Dr. Kwong said.
He said some cases take a whole day to trace, if there are many contacts to track down. Others can be done in as little as an hour. Until this week, the intensive work was being documented on paper forms and entered by hand into a database.
To fix that, Toronto Public Health launched a new system on Thursday that will allow contact tracing to be done more quickly, said Joe Cressy, the city councillor who chairs Toronto’s board of health. He said public health officials have told him they have the staff they need.
Doris Grinspun, chief executive officer of the Registered Nurses’ Association of Ontario, said Toronto Public Health has not drawn on the association’s network of thousands of nursing students, part-time nurses and retired nurses to help with contact tracing. But she said Ottawa’s public health unit has brought in 100 extra nurses to help.
“We have numerous, probably over 1,000 nurses they could bring in,” Dr. Grinspun said. “If they are not doing more robust case-contact-tracing because of resources, then we have a problem.”
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