‘We’re like detectives’: How a group of contact tracers follow COVID-19’s every step in Hamilton — and keep you safe
Test. Identify. Trace. Follow up. Repeat.
That has been the M.O. of some 60 Hamilton public health workers who over the past two months have taken the form of what they call a Florence Nightingale and Sherlock Homes hybrid in their around-the-clock quest to thwart COVID-19 from spreading into the community.
Case management and contact tracing have come to the forefront of public discussion in recent weeks as reopening economies underscore a pressing need to understand exactly where cases of novel coronavirus pop up - and pinpoint exactly where they might go.
As the number of people everybody interacts with on average increases, the potential for a new infection to become a large outbreak and grow exponentially is very real," said Susan Bondy, an associate professor at the University of Toronto's Dalla Lana School of Public Health.
Bondy said the importance of contact tracing is twofold: Compiling a list of a case's contacts not only helps public health units establish a trail of where the virus might have been and spread, it also gives them a framework of who needs to self-isolate and which places need sanitizing.
Hamilton, for the most part, seems to be faring well.
The city's medical officer of health commended what she considered a rapid contact tracing strategy when citing our relatively low rate of community transmission on Tuesday, May 26.
In large part, that's thanks to the aforementioned public health workers who were plucked from different departments in March and redeployed to form a team of quick-thinking case managers and contact tracers.
We're like detectives," said Carol Fedoryshyn, one of dozens of public health nurses who have taken on a new role within the unit to help curb the spread of COVID-19.
The team has been divvied up each week to alternate between case managers and contact tracers, a way Michelle Baird, director of Hamilton's disease control division, said helps workers cross-train" and become familiar with a virus that's tested the global understanding of infectious phenomena.
While public health has conducted some form of contact tracing in the past - like sexual health nurses who track sexually transmitted disease - the novel coronavirus virus presents different challenges.
The content about the virus, how it presents, incubation periods, when you can be most infectious," Fedoryshyn said, that's part of what we had to learn that's different."
The arduous process - which Baird said has a teamwide target to identify and trace cases and contacts within 24 hours - starts with case managers, who cold-call cases to inform them they've tested positive for COVID-19.
Managers first ask cases about acquisition: Where do you think you could have contracted the virus? Then they ask about symptoms: What did you have, when did the symptoms start, and which ones have resolved?
Asking about symptoms serves two purposes. First, once we know when the symptoms started, we can determine the time frame for their self-isolation; and second, we can determine what they were doing in the period they were most infectious," Fedoryshyn said.
The latter is key because it helps give sense to when contacts were exposed to cases at the stage for which they were potentially most at-risk for infection.
A recent study conducted by a group of evolutionary biologists at the University of Arizona that looked at the rate of spread, and specifically when and why countries enter epicentre status, underpins the importance of that.
The study found that the earliest known infections in the U.S. and Europe - the Patient Zeroes" of January - weren't the igniters of the epidemics that followed. Instead, as those initial cases petered out in isolation, outbreaks were sparked by a small, concentrated number of super-spreaders," cases who were already infected - but went undetected - and ultimately set the stage for an explosion of infections.
The implications of that spread, the study suggests, highlights a critical need to test and trace cases - and early, before they become a problem.
It's important for our epidemiologists at public health to be able to link one positive case to another," Fedoryshyn said.
On average, cases in Hamilton have six contacts, which range from family and household members, colleagues, and congregate settings such as grocery and drug stores.
Case managers compile that list and forward them over to contact tracers, who inform contacts they've been potentially exposed and offer them information about self-isolation and infection control measures. From there, a monitoring team checks-in daily with potential cases to track their physical and mental well-being up until they're symptom-free or past 14 days of quarantine.
But what about contacts who aren't people and rather congregate settings, like grocers? Do they, too, shut down and close to customers for two weeks? Not exactly. Public health discerns from a case what time and where exactly they shopped before contacting a store manager, who they ask to inform their staff, check for symptoms and sanitize the potentially exposed area.
For Fedoryshyn, effective tracing is the difference between a handful of isolated cases and managing a full-blown outbreak. That's been the standard since Hamilton reported its first coronavirus patient on March 12 - and the reopening of provinces or curves flattening won't change that.
It's no different," Fedoryshyn said when asked whether tracers feel more pressure as people venture outside again. Public health is about population health and that's why contact tracing is so important, so we can contain the spread of the virus."
Sebastian Bron is a Hamilton-based reporter at The Spectator. Reach him via email: sbron@thespec.com