Why contact tracing is ‘a skill and an art’ in the fight against COVID-19

SASKATOON — Tracing the contacts and movements of someone exposed to COVID-19 is key to containing the disease. Dr. Johnmark Opondo, medical health officer in Saskatoon, spoke with CTV Saskatoon’s Jonathan Charlton about how contact tracing works – and how much it has increased during the pandemic. This interview has been edited for length and clarity.

When COVID-19 hit, was there contact tracing capacity already or did you have to start from scratch?

This is really interesting. The pandemic is a public health emergency, it’s a new infectious disease. But contact tracing is something that we do all the time. It’s just maybe some of the best hidden secrets of the work we do as the Saskatchewan Health Authority.

Any communicable disease … we do contact investigations and that’s one big contribution to quickly controlling any infectious disease outbreak. The main thing is to get quickly to people who have been exposed, notify them and ask them to isolate themselves or get tested.

For COVID we’ve just used the same practice. We had smaller teams – but as the SHA we ramped up, we scaled up as the need has grown because COVID came in and we quickly needed a lot of capacity to do a lot of work in a short period of time.

How many people doing tracing do you have now compared to before?

In Saskatoon, at a stable state we probably have something between six to seven nurses doing contact tracing across our communicable disease front. We have approximately, on average, including our casuals, maybe a nice round number would be 10.

During COVID, at the peak, in March, April when we were seeing a lot of cases, I think we had something like 30 people helping us in contact tracing. The majority were public health nurses but we’ve had other disciplines of employees like our health inspectors and some of our exercise therapists. It became all of us contributing when this was critical.

Can you describe how the process works?

Contact tracing is a skill and an art and I think it’s really good to be able to describe this to your audience and the people of Saskatchewan. Usually the way we do contact tracing is when we have a new case, we do an initial interview and many times it’s on the phone. We have a set of interview questions and it’s very friendly – because we’re nurses. Nurses are really patient advocates so it’s very patient centred.

We want to know how you are, if you need any medical support that referral is made then. We really want to know two main things – are you isolated at home, that’s really important for public safety, and then if you can tell us your list of people you’ve had contact with in the last 14 days and maybe the places you’ve been.

In this day and age of social distancing, a good check is, you should know who you’ve encountered in the last 14 days. If it’s a longer list than you can recall, you need to check whether you’re truly social distancing, because you should be unless you’re in an essential service field. And if you are in an essential service field we want to know where you’ve been.

And really, the aim of contact investigations is gentle. It’s about protection so that we can quickly get to people who you may have been in contact with. When we do get to the people when we’ve collected information from you, we’re very careful that we don’t disclose or we don’t breach your confidentiality.

How many contact traces have been done so far for COVID-19?

In the Saskatoon area it’s in the thousands. Each case on average in Saskatoon we have called at least seven other people.

Has there been any thought to using contact tracing apps or technology like that?

We know about them, we know how they’ve been used in other settings and we’re kind of trying to view them and understand them in the Canadian context. But this is an area that’ll be very new and innovative and we really have to get public support and buy-in.

I understand there are apps that are really very good and they’re not intrusive and they don’t take a lot of your data – but for the apps to work, a high proportion of the public has to have those apps on their phone. Just doing contact tracing based on cell phone numbers is something that can be very sensitive and maybe I’ll just leave it at that.

But I think the apps we’ve heard about, there are some that look particularly interesting. We’ll see. For us in Saskatchewan the way we’re doing it with the outbreak, it’s been quite efficient. And I think it’s been quite effective. It’s worked for us quite well.

In general, how should people be feeling about the state of the pandemic in Saskatchewan and the risk it poses?

I think the Saskatchewan people have really done an excellent job in collaborating and cooperating at great inconvenience to themselves. They socially distance, people didn’t have their Easter, religious ceremonies the same way, we’ve cancelled a lot of mass gatherings and concerts. So we’ve made a huge sacrifice. And I think our numbers show that, that things have stabilized, things are going in the right direction. Generally speaking, things look good.

But you can’t be overly optimistic. Because you asked me that question and I have to touch wood. I don’t want to jinx our trend, but our trends are generally going in the right direction, even in the places where we are experiencing outbreaks.

Pandemics come in geographic waves so in Saskatchewan we’re not an island. We have to make sure that we’re helping our neighbours, both Manitoba and Alberta. We are in one big epidemic zone in the Prairies so if we can all help each other and move towards a stable situation at least for the Prairies … if things calm down, which is the trend I’m seeing, then I think we’ll be good. But it may only be for a while. This new virus is around so really we have to proceed with caution.

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