Update on Toronto Public Health’s Case and Contact Management Work
Case and contact management is the work that public health units do to contain virus spread and keep people safe. This means contacting anyone who tests positive for COVID-19 and tracing all their contacts, to see who may have been exposed, and get them tested and self-isolating. It’s a key element of our ongoing response to the COVID-19 pandemic.
When a patient tests positive for COVID-19, they are informed of the result directly by their own doctor or medical professional. These results are then sent to the area’s local public health unit – Toronto Public Health for residents of Toronto – by the doctor and/or testing lab. Public Health staff are responsible for following up with the patient to make sure they are self-isolating, and to begin the case and contact tracing process.
Staff at the local public health unit ask a series of detailed questions in order to establish a list of the patient’s contacts over the past two weeks. They then notify those people that they may have been exposed to COVID-19, and provide instructions on testing and self-isolation. Staff continue to engage with anyone who has tested positive through daily phone calls and checkups over a two-week period.
Today, our Medical Officer of Health gave an update on where we are with this important work. Right now, TPH staff are contacting over 88% of people who test positive for COVID-19 within 24 hours, and scaling up to reach a target of 90%.
As the province’s testing capacity continues to increase, case and contact tracing work will only grow. At the same time, as we begin to restore more normal activities and more people go back to work, each patient’s individual contacts are likely to increase significantly.
It is important to note that our provincial public health systems were not designed for a global pandemic. These systems were intended for isolated outbreaks that impact a small number of people. As a result, there are frequently delays from the time a person is tested to when public health units receive results and can begin the case and contact management process.
Toronto Public Health has worked overtime to rapidly adapt and scale up to meet this challenge. TPH has increased the number of staff working on case and contact management from 50 staff to over 550 staff and volunteers – a team larger than the total number of employees at many local health departments.
TPH has also partnered with the University of Toronto and Registered Nurses’ Association of Ontario, who have connected TPH to 170 nurses for this work, and other local public health units. And rather than rely on the Province’s outdated, 15-year-old data management system, the City of Toronto built our own data management program CORES in just eight weeks, to better and more quickly track local test results, hospitalizations, and deaths. We are also conducting area-based data and analysis to track the impact of COVID-19 on different communities in our city.
We are still learning about this virus. Toronto Public Health is committed to continuing to adapt our systems to meet new challenges. But we also need province-wide changes. Right now, TPH staff often get incomplete or delayed results from testing labs. This means it takes longer for staff to contact patients, and trace and inform people. We need the Province to create a standardized template for lab reports, which will ensure that public health units have complete information in a timely manner, for case and contact management.