Contact tracing delay and a failure to reveal all threatens to spark Covid outbreak in regional Victoria
A delay in contact tracing Melbourne’s largest current Covid-19 cluster and the failure of a positive case to adhere to the conditions of his worker’s permit and speak honestly with health officials threatens to spark a significant outbreak in regional Victoria.
But Victoria’s premier, Daniel Andrews, and chief health officer, Prof Brett Sutton, have cautioned against taking a tougher approach to contact tracing, appealing instead for people to tell the truth about their movements and circumstances.
The tracing system, which has been overhauled but is still seen as a significant impediment to Victoria emerging from Australia’s strictest lockdown, is about to undergo a significant test: scrambling to deal with an outbreak in Shepparton that started two weeks ago.
Within hours of the Department of Health and Human Services revealing that several sites in the town 200km north of Melbourne had been identified as high-risk, local testing stations were overwhelmed, with some residents reportedly told by police to come back on Thursday or endure a six-hour delay.
A lag in testing will delay contact tracing, potentially resulting in further cases.
“Most important is getting tested early, whether you have symptoms or have been at a known exposure site, do it and do it fast,” the chair of epidemiology at Deakin University, Prof Catherine Bennett, wrote.
“This is how we limit the risk of spread, and reduce the risk families and immediate close contacts will even need to be isolated, much less deal with being infected.”
The spread of cases from Chadstone shopping centre to Kilmore and Shepparton started in late September after a cleaner at the Butcher Club in Chadstone tested positive.
Another staff member positive on 28 September, and reportedly provided full details to DHHS the following day about all close contacts, including work colleagues.
On 30 September, a truck driver who lived with a worker at the butcher left Melbourne to travel through regional Victoria.
On Wednesday Sutton said he did not believe the driver had been told to isolate, despite living with a close contact of the butcher. The department publicly identified the shop as a highrisk location the day before he left Melbourne.
The driver, who worked as a tyre salesman, was a permitted worker. This meant he could travel outside Melbourne but otherwise had to adhere to the same restrictions as those in the city, such as not dining in cafes or visiting non-essential businesses, while visiting regional Victoria.
But he ate breakfast at the Oddfellows cafe in Kilmore before stopping at a tyre shop in Benalla and at another tyre shop and a Bunnings warehouse in Shepparton.
It is not clear when tracers assigned to the Chadstone case first spoke with close contacts of the butcher but on 2 October they spoke to the truck driver.
He admitted the Kilmore and Benalla travel but did not mention he had been to Shepparton.
Contact tracers linked the driver to Shepparton after a worker at the tyre centre tested positive on Tuesday afternoon. Two other workers at the centre have also tested positive.
There are now more than 40 cases linked to the Butcher Club outbreak, spread across Melbourne suburbs bordering Chadstone, suburbs in the outer south-east, suburbs in the outer north, and in regional Victoria. .
On Wednesday Andrews said he believed the new method of logging tracing data electronically was being used concurrently with the old system, which was seen as inefficient because it was largely paper-based.
The department confirmed to Guardian Australia that in the past month local public health units – or regional hubs – have been rolled out across Melbourne “to enhance the speed, efficiency and accuracy of our contact tracing processes”.
The sites are in Melbourne’s west, north-east and south-east, and more are expected to be established in coming weeks.
Bennett, who has worked in contact tracing in New South Wales, praised the department for its handling of the Kilmore outbreak, saying it was similar to the model favoured by NSW Health.
Updates to Victorian IT systems and the establishment of local health units would increase this capacity, she told Guardian Australia.
“In New South Wales you have local area health services managing the contact tracing and they have built up relationships with local community leaders and businesses,” Bennett said.
“This allows efficiency. When they’re talking to people about the pubs they’ve visited and the suburbs they’ve been to, they know exactly where they are talking about which also makes a difference.”
Guardian Australia has been told that during the peak of Victoria’s second wave in August, private operators involved in the testing process became so concerned about the state’s contact tracing capacity that they introduced measures to limit the possibility that positive cases were infecting others.
The procedure once a person tests positive in Victoria is relatively straightforward : the clinician who tested the patient informs them of the positive result, the pathology company that completed the test informs the department, and the department contacts the patient to begin tracing.
But as the number of positive cases climbed into the hundreds, it became clear that the department would be unable to trace them all quickly.
One provider of clinical services, who did not wish to be identified, said he had instructed his workers to contact all positive cases a second time several days after they were informed of their diagnosis to ensure tracing of the patients had started and they were aware of how to properly isolate.
“The problem up until five or six weeks ago was that it was all being done by fax and phone call and list creation,” he said. “That in itself was a slow process; can you imagine if you were a pathology company with 60 positives how long that would take? It was abysmal.”
Andrews said on Wednesday that the truck driver had been referred to police but he and Sutton agreed that little would be gained by taking a more punitive approach to tracing.
Sutton suggested that, in some cases, the residency or work status of a person could result in them holding back on information given to tracers.
“I recognise that there are issues that sometimes relate to a person wilfully hiding stuff and others who are genuinely fearful of consequences with respect to visa status. A lot of people have fears about what it might mean for their work.
“They should all be reassured that no employer has a right to sack you, to stop giving you hours because you become infected with coronavirus and subsequently recover.”