Is city’s contact tracing good enough?
Associate medical officer explains the bottlenecks and what can be done
What’s going on with contact tracing? This has been a running — and increasingly urgent — question throughout Ontario’s COVID-19 epidemic. But this piece of the public health response has remained a black box to outsiders, including doctors who are sounding the alarm over what they describe as unacceptable delays.
On Tuesday, the Toronto Star spoke with Dr. Vinita Dubey, associate medical officer with Toronto Public Health, to ask her the question directly: What
is going on with contact tracing in this city — and is it good enough?
This interview has been edited for length and clarity.
There’s been a lot of criticism of contact tracing delays, including from doctors who treat COVID patients. Do you think Toronto Public Health is doing a good enough job of contact tracing?
I think we have to understand the system. What I would first say is some of the contact tracing, the delays, are beyond the control of Toronto Public Health. Maybe even just last week, when we looked at the data, it was taking on average five days from when a person had symptoms to when they were going to get tested. So that plays (into) the individuals who go to get tested. And the way to deal with that is to open up testing and encourage people.
Based on our most current data, it looks like it’s taking 2 1⁄2 days from when the test is done to when Toronto Public Health receives that result. So during those two and a half days, we can’t start contact tracing because we rely on laboratory confirmation to begin contact tracing … so that’s a delay we don’t have any control over.
Once the result’s reported to us, then our clock starts ticking. The provincial goal is to reach 90 per cent of cases within 24 hours of it having been reported to TPH, and right now we’re at about 80 per cent. So we’re getting there … and once (we talk to the person and) have a list of contacts, we have 24 hours to get in touch with those contacts. And 97 per cent of the time, we’re getting in touch with them within 24 hours. Do you think that 2 1⁄2- day delay is too long? Would you like to see it shorter?
Who wouldn’t want to see it shorter? Absolutely, right? In this recovery phase, testing and case and contact tracing are two key public health system measures … that will help us to stop the spread.
So let’s talk about that 2 1⁄2- half-day delay. I see that your medical officer, Eileen de Villa, has a May 29 report to the Board of Health where she is calling for the Ministry of Health to create a more efficient system of transferring lab results to public health units. In some cases, test results are being sent to TPH in one large fax, sometimes containing hundreds of individual test results.
Under the legislation, labs are required to report results to us, but the ways in which they’re required to report is up to them. And so we get reports electronically, but we also get reports by fax, by mail and sometimes we get called.
The other piece is that we get duplicates. So for someone who’s tested positive for COVID — 40 per cent of the results that come in are actually repeats. It’s a pseudo-manual process … even if it comes in electronically, it doesn’t automatically go into a computer system that links all of these records together.
The public health data management person has to take the report, put it in, do a search for the person, find them if they’re not in there, create the person (as a file), and link it to their record.
Sometimes we’re getting lab reports from labs that don’t have all the identifying information and so then, we’re stuck. Either we have to spend time finding that contact information or waiting, contacting the lab.
So who can fix this systemic problem?
It all plays into a provincial system … We’ve been working with the province on it. I don’t in any way want to say the province hasn’t been attentive to these issues.
Part of it is dealing with technology systems that may not have been made for a pandemic — doing 20,000, let alone 80,000, lab results a day, or linking to other health records.
So some of it is technologybased and as we know, some of those solutions can be more difficult. You say we don’t have a data system set up for this pandemic, but isn’t that what iPHIS (the integrated Public Health Information System) was supposed to be? A data system to help respond to a possible pandemic like COVID — or like SARS, which led to the creation of iPHIS?
Yeah, but I’m not just talking about iPHIS. The labs have their own data system, called OLIS; so do iPHIS and OLIS speak to each other? That’s a good question, right? And not all of the labs use OLIS so how do you get all labs on board? OLIS then connects with another system called ConnectingOntario (which provides access to digital health records); ConnectingOntario doesn’t connect with iPHIS.
So it’s not just about iPHIS. And iPHIS is almost 20 years old. How are you measuring success when it comes to contact tracing? What are you looking at to tell how well TPH is doing?
Our staff is very well trained. When they have a case before them, they do a very good investigation.
We do have a quality assurance system to make sure the data being collected is good data. But we also have a system in place where each case that is investigated is actually reviewed by a manager. The straightforward ones can be dealt with through that pairing system but then if there are complexities … it can go to someone like me, an associate medical officer of health.
So there are a number of levels in place to review the cases, so that’s how I can say confidently that our basic public health work that’s getting done is getting done properly. I’ve spoken with health workers who’ve tried to volunteer as contact tracers but were told there wasn’t enough office space. In a time when TPH needs as many contact tracers as possible, why can’t you onboard volunteers who are already medical professionals?
Yeah. It sounds as simple as that, doesn’t it? But you know, volunteers have to be on site. Right now, we’re working through logistics of whether they can work remotely, but we have to be clear that this is sensitive personal health information. And so we can’t just take everyone who says they want to volunteer and allow them to do this work without making sure that we’re also mindful of the sensitivity of the data … while also making sure that our physical space is safe.
As the province continues to relax restrictions, and some of your staff will need to return to their former roles, how will you ensure enough capacity for contact tracing?
It’s not just TPH that’s in that situation. For example, opening up of restaurants; a lot of our inspectors are doing COVID work and once we start opening up restaurants, we’re going to have to start doing regular restaurant inspections, so we’re going to pull those inspectors back. So these are the kinds of things that we’re actively thinking about; that’s why we’ve created partnerships with the (Registered Nurses Association of Ontario) to get some nurses on board, and continue to train up staff.
(But we are) also looking at recovery and ... what public health services we’re going to go back to providing.