COVID-19: It worked in Asia. The WHO says it’s crucial. But is Canada still using contact tracing?

By | March 25, 2020

The message from Dr. Jeremy Jones, a cardiologist in the Eastern Ontario town of Lindsay, was an urgent call for people to observe social distancing. But it also contained some startling information.

The Haliburton, Kawartha, Pine Ridge District Health Unit had just announced that three people at the Pinecrest Nursing Home in Bobcaygeon, Ont., had tested positive for COVID-19. What the public-health officials didn’t mention, said Jones in a note disseminated over social media last weekend, was that 20 other residents and eight staff members were suffering from similar symptoms, but had yet to be tested.

“This additional 28 people undoubtedly are further cases of COVID-19,” Jones wrote. “This means that there could be hundreds of cases in the community that have gone undetected.”

Neither Jones, the health unit nor Pinecrest administrators could be reached for comment. But there’s little evidence government officials have issued any warnings about the risk of community spread from the facility, or tried to contact those who might be affected.

Orders to stay at home and practice social distancing on a mass scale are in effect across the country. It’s unclear, however, to what extent public-health authorities are still doing the traditional forms of epidemic detective work: strictly quarantining those infected and tracking down people who might have encountered them while they were contagious — what’s called contact tracing.

Such methods have been pursued aggressively by countries like Taiwan, Singapore and South Korea, allowing them to get the virus somewhat under control, while avoiding large-scale lockdowns like Canada’s.

Asking everyone to stay home is important but only a “defensive measure,” Tedros Adhanom Ghebreyesus, head of the World Health Organization, said Monday.

“To win, we need to attack the virus with aggressive and targeted tactics —  testing every suspected case, isolating and caring for every confirmed case, and tracing and quarantining every close contact.”

Canadian officials insist that’s what’s being done here.

“Case identification and very rigorous contact tracing is still being carried out in every province and local municipality,” Dr. Theresa Tam, Canada’s chief public health officer, said Monday. “That is still Canada’s strategy … We’re still containing the virus as much as possible.”

Canada’s Chief Public Health Officer Dr. Theresa Tam speaks at a news conference on the coronavirus disease (COVID-19) outbreak on Parliament Hill in Ottawa, Ontario, Canada March 19, 2020. REUTERS/Blair Gable

But with an estimated one million Canadians returning to the country from overseas in recent days, there’s evidence public-health officials are struggling to keep up. The case of one P.E.I. woman who had symptoms of what turned out to be COVID-19, stayed overnight in Toronto and then flew to Moncton last week has received little attention. Close to 80 Canadian passengers from a cruise ship rife with the virus say they faced minimal screening when they returned on commercial flights this past weekend.

Dr. Jeff Kwong, a family physician and public-health professor at the University of Toronto, says continued contact tracing is “absolutely” necessary to identify where outbreaks are occurring and halt the chain of transmission.

He admits he has no inside knowledge of what’s happening in the local public-health offices that run the ground war against any epidemic, but senses it is becoming increasingly difficult for them to stay on top of the situation.

Part of the problem, Kwong said, is chronic under-funding.

But COVID-19 poses unique challenges. Patients tend to first develop mild symptoms they may not pay heed to, and there’s some evidence even asymptomatic people can be contagious. Then there can also be a delay in getting a test, and test results. So once someone is confirmed as COVID-19 positive, public-health tracers have to look back several days for possible contacts, said Kwong. Meanwhile, those contacts may already have the disease — which has a relatively short incubation period of five days — and be spreading it themselves.

You’re just constantly trying to play catch-up

“This might be contributing to why they are so over-stretched,” he said. “You’re just constantly trying to play catch-up.”

When the novel coronavirus first reached Canada in late January, the public-health response seemed more stringent.

Authorities said at the time they were contacting passengers on a flight that this country’s first recorded case took from China to Toronto. Canadians repatriated from Wuhan — where the pandemic started — and later from contaminated cruise ships, were held in a quarantine facility at Canadian Forces Base Trenton.

But things were dramatically different for Martha Turner Bradbury and her husband Al this past weekend when the Winnipegers came back from Marseilles, France after being let off the Costa Luminosa. Several passengers on the cruise ship have tested positive for COVID-19. About 75 Canadians and 230 Americans were flown to Atlanta, Ga., on a crowded plane, where Bradbury estimates one in 10 passengers had visible respiratory symptoms – fever, coughs, looking generally unwell.

Passengers aboard the Costa Luminosa cruise ship, that was hit by the coronavirus disease (COVID-19), wave from a balcony, at the port of Savona, near Genoa, in Italy, March 21, 2020. REUTERS/Massimo Pinca

But anyone who didn’t have symptoms was allowed to move freely into the Atlanta terminal and then board commercial flights. The Bradburys took one to Minneapolis, and another from there to Winnipeg.

A Canadian Borders Services Agency officer had them don masks and gloves when they disclosed their recent contact with COVID-19 patients, asked about their arrangements for self-isolation, then let them go. Bradbury says a couple they travelled with were not even questioned about possible virus contact. Now in isolation, Winnipeg public health officials have told them they won’t be tested unless they develop symptoms.

“Honestly, we expected there to be far more strict guidelines when you admit you were heavily exposed in a pretty confined area,” said Bradbury. “To go from complete isolation in your cabin on the ship to all of a sudden to just be out in the general population … There needs to be some kind of tracking system.”

P.E.I. reported last week that a woman who had been on another cruise ship flew to Toronto and stayed at a hotel there before flying on to Moncton March 9, on WestJet Flight 3440. New Brunswick’s chief medical officer of health warned anyone on the flight to stay in isolation and monitor their symptoms. But there is no indication public health proactively contacted the passengers. Nor has there been any official notice to Toronto residents who may have encountered the woman.

Our staff would counsel the person, try to understand the barriers to isolation and mitigate the barriers

Toronto public health will follow up on contacts with an infected person if notified of any by counterparts in another province, spokeswoman Dr. Lisa Berger said by email. Her office did not respond when asked if it had received such notification.

Toronto was the first and is one of the hardest-hit cities in Canada. Contact tracing is still an important part of the public health department’s response to COVID-19, Berger said.

But while places like Singapore and Taiwan have recruited police officers and are using cell-phone technology and even new cell-phone apps to trace contacts, the effort in Canada seems more constrained.

Toronto’s department prioritizes notifying close household contacts and those in health-care settings and places with vulnerable people, “followed by other close contacts and all other contacts,” said Berger.

And while Singapore, for instance, sends text messages several times a day and makes random phone calls and visits to check up on quarantined patients, Toronto acts only if it becomes aware someone with COVID-19 is not isolating.

“Our staff would counsel the person, try to understand the barriers to isolation and mitigate the barriers,” Berger said. If that didn’t work, it would resort to legal means, she said.

Kwong said he has no doubt public-health officials Canada-wide are “pulling max overtime” to fight the pandemic. But with a million Canadians recently arriving from other countries and possibly importing the virus, the earlier, tough measures — like securing people at the Trenton base — may simply not be possible.

“It’s one thing if it’s a flight or two,” he said. “How can you put a million people into bases?”

Health – National Post