Last week Coun. Gary Zalepa contacted regional Public Health to question the timing of contact tracing, which is considered key to stemming the rising cases of the novel coronavirus.
He had received a call from a local winery, explaining they got “courtesy” call from Public Health, informing the winery that two weeks earlier, someone with a confirmed case of COVID-19 had visited them.
Zalepa had also just read an article in the Globe and Mail on the importance of contact tracing, and the need for “robust and timely” testing in place for it to be effective. He was concerned about the reason for the delay. By the time winery staff learned of the case, it was too late for precautionary measures to be effective.
The answer came from Dr. Mustafa Hirji, acting medical officer of health for the Niagara Region. In the specific case of the winery, Hirji says, the reason for the delay is that his department only learned about the visit by someone with a positive test result two weeks later, from another area outside the region where the testing had occurred.
In Niagara, he said, despite a six-fold increase in COVID cases, his department has been meeting the provincial standard of reaching contacts in 90 to 100 per cent of cases within 24 hours.
To accomplish that, he says, they’ve pulled people away from other departments, scaling back services in those areas out of necessity to handle contact tracing.
The majority of new cases come from contact with family or household members, he says.
His impression is people are noting the rise in cases and are respecting the guidelines that call for fewer contacts, he added.
He suggests there was an increase two weeks after the September long weekend, likely due to the number of visitors to Niagara, and if there is to be another rise stemming from the Thanksgiving holiday, we may see “a bump in cases later this week.”
But the big driver of the region’s increase in cases is that people with symptoms of infection are not isolating and getting tested, continuing to go about their life and spreading infection as a result.
“Many are not getting tested until a week or 10 days later, when their illness isn’t going away. So by the time we learn about a case, the infection has spread farther, and it’s too late for us to do much useful follow-up,” he says.
Another challenge for contact tracing is that people are not forthcoming about where they have been or who they might have been in contact with, he says.
“We speak with cases daily, and often several days later, we catch them telling stories inconsistent with what they originally told us, and learn they have had additional contacts. Or in interviewing new cases, we learn they are linked to a previous case, but that previous case had not mentioned them as a contact of theirs.”
People misleading the public about COVID-19, or not wanting to share personal details with public institutions, “is harming the effectiveness of contact tracing across Canada,” Hirji says.
“Public Health is not an enforcement agency that will get people in trouble. We prioritize privacy of our clients and will protect their personal information. We just want to find where infection may be spreading and stop it.”
Another of his concerns is the number of unnecessary tests, which are “of low value,” such as routinely testing long-term care home staff, or employers requiring staff to be tested before reporting to work.
“This testing has been shown to do virtually no good. However, it is clogging up the provincial lab system, resulting in slower turn-around time for tests of symptomatic people.”
Delays in test results slow Public Health’s response with contact tracing, he says. The message from Public Health, Hirji adds, is to isolate immediately even with mild symptoms, and get tested.
What he couldn’t address was the delay in appointments for testing, a question he referred to Niagara Health.
A call to the Niagara Health department that makes appointments suggests the caller leave a message, and expect a response within three to four days, and that a test will be scheduled the same day.
A statement regarding the testing backup from Niagara Health says, “Over the past month, our assessment centres experienced a surge in the numbers of people requesting testing, and moving to an appointment-only model and prioritizing testing for those most at risk has allowed our teams to provide more efficient service to patients.”
In September, the statement says, more than 16,600 tests were completed, about 6,300 more than in August, and from Oct. 11 to 18, more than 9,600 tests have been completed.
“Teams are working diligently to return calls in a timely manner, and we appreciate the community’s patience and understanding.”
Calls are being returned within 48 hours, the statement says, “and we are scheduling patients for appointments within 24 hours of their call back.” Testing is prioritized for those most at risk.
For more information on testing, visit https://www.niagarahealth.on.ca/site/assessmentcentres.
Anecdotal comments from the community suggest the wait time for call-backs and appointments could be longer, but Zalepa says, following a period of long delays, his sense is the wait time is lessening, thanks to the messaging that is getting out about unnecessary testing. The up-to-date response time now “may be better than what we’re hearing,” he says. He also reinforces the message of Public Health, to call a physician for advice before assuming a test is necessary.
The news from the Public Health about contact tracing is “a really good piece of information,” says Zalepa, that should give people confidence “that things are being done right” in Niagara, and that there are ways the public can be helpful by providing the correct information to Public Health.
Niagara Region is one of several that have partnered with other regions to share resources when their local systems are overwhelmed, he adds. “This creativity allows one area that starts to get ahead to help other areas that require help.”
As other regions see COVID cases increase, that impacts on NOTL businesses, such as wineries, especially on the weekends. “It’s a challenge,” says Zalepa. “We’re encouraging local businesses to be vigilant and not get too complacent. We all have a role to play in getting that message out,” he says.
“We’re at a point where we can end up with the type of closures seen elsewhere in the province. Dr. Hirji made some good points of what we can do, and the messages we need to get out.”
To bring down the number of cases across the region, Hirji encourages workplaces to follow the provincial regulation to screen their staff for symptoms, so they are prompted to isolate and get tested.
Local municipalities should proactively enforce this provincial regulation, he says. “There seems to be very little enforcement of this, and we find many businesses daily who are not following this rule, often leading to spread of infection in their workplaces.”
At the same time, asymptomatic testing, such as businesses requiring testing of their employees, should be discouraged, he says. “Testing should be done because of symptoms, or because a health care provider or Public Health has instructed it. This will let labs get results out faster, and speed the turn-around on contact tracing.”