Second wave could require more contact tracers
Worst-case scenario sees up to 10 times the current number of COVID-19 cases
For two days in a row, the number of new COVID -19 cases in Montreal has dropped to the low hundreds — a sign that the coronavirus crisis is being brought under control in what has long been dubbed the epicentre of the pandemic in Canada.
But behind the scenes at the Montreal public health department, officials are preparing for the prospect of a second wave of infections.
Under the worst-case scenario, authorities envisage having to deal with as many as 10 times the current number of COVID-19 cases.
To date, the city has encountered that situation on only one date, May 3, when authorities declared 1,652 cases as a result of a lag in reporting.
If a big second wave hits — and it’s now occurring in Iran — the health department will need to augment its contact-tracing team. Those are the investigators whose goal is to stop community transmission of the highly contagious coronavirus.
“I’m not going to predict if and when there’s going to be a second wave,” Dr. Noémie Savard, in charge of the contact-tracing team, said in an interview Tuesday.
“In terms of contact tracing, what’s important is to have to plan for surge capacity, to know that right now there’s this number of cases but to have scenarios if we need to, to investigate five times more, 10 times more. That’s what’s important to know and plan for.”
Premier François Legault has often boasted of how Quebec conducts many more COVID-19 tests than other jurisdictions. But testing is one part of the public-health equation. The other part, which doesn’t get nearly the attention it deserves, is contact tracing.
It involves phoning people who have tested positive and asking where they’ve been in the past 14 days and with whom they’ve been in contact.
If an infected individual has spent at least 15 minutes with someone — and has been physically closer to that person than the recommended distance of two metres — investigators will reach out to that contact.
That person will then be tested. Even if the result is negative, he or she will have to self-isolate for 14 days, on the presumption that they might still develop symptoms after they were swabbed. The contact-tracing team has observed that on average, an infected person generates three contacts.
In extremely rare cases, the health department has called the Montreal police to intervene if they discover a contact does not self-isolate.
During the pandemic, the team has conducted at least 18,000 contact-tracing investigations. It’s been a Herculean effort, given the team has only 150 investigators. Le Devoir reported on Tuesday that Laval and the Montérégie employ more contact tracers than Montreal, even though they’ve reported far fewer cases.
The one country that has been widely praised for its contact tracing is Germany. In hard-hit North Rhine-westphalia state, authorities hired at least 3,385 contact tracers. That works out to one tracer per 5,310 residents.
In contrast, the rate in Montreal is one tracer per 13,331 residents. It would be unfair to suggest the coronavirus spread like wildfire throughout Montreal because of a lack of contact tracers, but certainly the city could have benefited from more investigators.
Montreal is now at a surreal stage: the number of new cases is in sharp decline, and the city has recorded COVID-19 deaths in the daily range of 20 to 40 in the past week. Many Montreal stores have reopened, as have dental clinics. Public gatherings of up to 10 people have been allowed for nearly two weeks, and people are holding picnics on Mount Royal.
But on Tuesday, Legault also spoke of a possible second wave, arguing it’s urgent to train and hire as many as 10,000 orderlies to work in the province’s network of long-term care centres.
What worries Savard is that as the government loosens confinement measures, some Montrealers might stop practising physical distancing and her team will suddenly find itself with a lot more cases to investigate.
“If everyone is able to limit their contacts for the next month, it’s certainly going to make contact tracing easier,” she explained. “The message is keep your distance. I think it’s in everyone’s interests.”
The other thing the health department can do is start systematically testing everyone in the community, even if they don’t have symptoms. Alberta started doing that last week after running a successful pilot project in Calgary.
Unofficially, staff at some COVID -19 screening clinics have tested asymptomatic individuals who have not been in contact with someone who has had a positive result. But it would be the prudent thing for the health department to make this official policy.