Toronto Public Health is so far behind in reaching patients with newly confirmed coronavirus infections that it has decided to suspend contact tracing outside of outbreaks in congregate settings, abandoning a crucial weapon in the fight against COVID-19 in the city.
The Globe and Mail has obtained a copy of a Toronto Public Health e-mail, sent just before 2 p.m. on Friday, advising the city’s disease detectives to stop calling the close contacts of people who test positive, and to pause the collection of data on where people were exposed to the virus.
“Effective [Friday,] due to the increasing number of cases of COVID-19 in the city, Toronto Public Health is no longer able to follow up with contacts. This means that TPH will only call confirmed cases. We will not call close contacts. Confirmed cases will be asked to notify their high risk/close contacts to self-isolate,” the e-mail reads.
The goal of the new approach is to rapidly call and isolate cases, the email adds.
“Acquisition (exposure) data will also temporarily be suspended. Note TPH is also in back log of cases, of approximately 800 cases (please do not share this information with others outside this email.)”
Toronto Medical Officer of Health Eileen de Villa hinted at the new strategy during a news conference on Friday, saying that soaring case counts had forced the health unit to “temporarily reprioritize case and contact management to focus on the highest risk scenarios.” She did not spell out that contact tracing had been suspended.
However, she said that if case counts drop, the unit will, “return to the previous case and contact management strategies.”
Councillor Joe Cressy, chair of the city’s board of health, said that even though Toronto’s 700-member case and contact management team is the largest in the country, it simply cannot cope with the number of new cases and potential exposures pouring in every day now.
“At a certain point in the outbreak, if you have cases and outbreaks at the levels we’re seeing in Toronto, prioritization becomes essential, which is exactly why we’re calling on the provincial government to implement an immediate 28-day pause,” Mr. Cressy said in an interview Saturday. “The system is overwhelmed. If we do not see an immediate pause as we’ve requested from the provincial government, this will get worse.”
On Friday, Dr. de Villa called on the province to shut down indoor dining and indoor fitness and team sport facilities in the city for a period of four weeks – a call Premier Doug Ford’s government has so far rejected. She also urged Torontonians not to leave their homes except for work, school or exercise.
Mr. Ford announced on Friday a further tightening of rules for the hospitality sector in the province’s coronavirus hotspots, and a new province-wide mask mandate.
In response to questions about the e-mail, Lenore Bromley, a spokeswoman for Toronto Public Health, said the decision to stop calling close contacts was made in response to the surge in new infections.
In a written statement, she said that TPH staff will continue to call patients to confirm their positive COVID-19 lab results, assess their signs and symptoms and determine when their symptoms began, make referrals to Toronto’s voluntary isolation centre if necessary and “provide instructions to the person to notify their high risk contacts.”
Ms. Bromley said that TPH will continue to report daily cases, recoveries and deaths. “We will also continue to investigate and respond to outbreaks in hospital, long-term care, retirement home, shelter, school, and child care settings and there are no changes to the policies and procedures for these settings,” she said.
Toronto’s decision to suspend contact tracing came on the same day that Ottawa Medical Officer of Health Vera Etches declared the coronavirus outbreak in her city “a crisis,” that threatened to overwhelm hospitals and public-health resources.
“It’s the right word for the moment,” said Anthony Dale, president of the Ontario Hospital Association. “The large hospitals in Ottawa are full. They’re at 100 per cent or higher occupancy because they have a particularly difficult situation with alternate-level-of-care patients in that community,” he said, referring mainly to elderly patients who are waiting in hospitals for nursing-home beds.
Mr. Dale said hospitals in Ottawa and Toronto are approaching a breaking point. The pressure isn’t just coming from a rising number of COVID-19 patients – there are still far fewer in hospital now than at the height of the spring wave – but from all the ways hospital staff are being asked to fight the virus. Hospitals are operating assessment centres, processing COVID-19 tests in their labs, assuming management of long-term care homes with outbreaks and struggling to catch up on postponed surgeries, Mr. Dale said.
“They’re serving as the anchor of the pandemic response,” he said on Friday.
Ontario reported 653 new cases of COVID-19 on Saturday, 284 of them in Toronto. The province processed 46,254 tests the day before. More than 91,000 samples are now in the queue, raising the likelihood that it will be days before some patients learn they’ve been infected.
Saturday’s province-wide tally is down from 732 new confirmed infections reported Friday, but it is in keeping with the recent trend toward higher case counts.
“We are looking down the barrel of a severe lockdown in our city if measures aren’t taken now,” Mr. Cressy said. “There’s no sugar-coating this. If we do not see provincial action today, schools are at-risk of closing in the future, just as our health-care system is at risk of being overwhelmed.”
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