Jordan: I say this knowing you’ve probably already heard it many times, but if Canada is going to keep COVID-19 under control through the summer and the fall, it will be because contact tracing and tracking play a huge role in containing the virus. In fact, you hear about this in every in depth interview, in every in depth article about Canada strategy.
News Clip- Trudeau: We need to accelerate our ability to do contact tracing.
News Clips (montage): Contact tracing, contact tracing, to ramp up contact tracing.
Jordan: We need contact tracing. That’s how we stop outbreaks. But how does that process actually work? What do contact tracers do during every shift? Who are the people tasked with this difficult job? How do they deal with people who pick up the phone and are too scared or too angry to work with them? How many cases can be missed from one initial case before we’re risking an outbreak? And as we prepare for a second wave this fall, do we have enough contact tracing and tracking people, apps systems to make this work? I’m Jordan Heath-Rawlings. And this is The Big Story. Aaron Hutchins is a writer at Maclean’s. He is a frequent and favourite guest of ours, though not so frequent recently. Hi, Aaron.
Aaron: Hey, you’ve been avoiding me.
Jordan: You’ve been busy. You’ve been real busy. Why don’t we start by sort of defining contact tracing? Cause this is something that we’ve mentioned dozens of times over the past few months on the show without ever actually getting into the nuts and bolts of it. So, who do they work for? What do they do?
Aaron: Well, I went down to London, Ontario, which is just between Toronto and Windsor, Detroit, kind of near the border. And they work for their health unit. So Toronto has a public health unit, London, Middlesex, has a health unit. Alberta has a health unit on its own. Um, so it really depends on, you know, I guess the size of the jurisdiction. And the folks in London, they go by– they’re not contact tracers per se, they’re called case and contact management, which basically means you’re calling up people who have tested positive for COVID-19, and then just learning about them, about their living scenario, who they’re around, who they’ve been around, where they’ve been, if they can quarantine safely, if they need more medical assistance. And then once you establish that they don’t, they aren’t in need of dire medical attention, you try and find out who they’ve been around. And that’s where the contact tracing is, is finding out who they’ve been around, has been family, has it been friends? And then calling those folks to say that they’ve been exposed, and probably best to stay at home for the next little while.
Jordan: What kinds of responses do they get when they make that call? I imagine it’s a piece of news that affects people very differently.
Aaron: There definitely are different types of reactions. I’ll break it into two sections. One, if you are a person who got tested for COVID-19, there’s the expectation that it could come back positive. So some people take that in stride, other folks, they– when the contact tracer breaks the news, if they are the ones to break the news, oftentimes those folks will cry because they’re worried. Are they going to feel okay? Are they going to die? They live with folks, they’ve been around elderly folks, are those people are gonna be affected? Are they gonna die? So what I was told was the most common reaction to folks finding out that they have tested positive for COVID-19 is, you know, just sadness. Whereas if you are someone who, say you’ve been hanging out with your friends at, you know, a backyard barbecue, and one of them test positive for COVID-19, they tell the contact tracer, Hey, I was around my friend, Jordan at a barbecue. They’ll give you a call to say you’ve been exposed. But because of privacy reasons, they can’t actually say that it was your friend Jeff, or your friend Sally, who was around you that tested positive. So for those reactions, some folks, if they don’t know who it was, there’s a lot of anger involved. Because you can imagine, as you’re living your regular life, you’re going to the grocery, you’re, you know, seeing friends from a distance, you’re planning your life. And then you get a phone call out of the blue, from someone from your public health unit saying, hi, we’ve been told that we’ve been informed that you’ve been in contact with someone from– who tested positive. So we’re going to need you to stay at home and self isolate for the next, you know, upwards of two weeks. Those people aren’t often too happy to hear the news. And sometimes, you know, they’ll be asking these contracts tracers, well, who was it? Who’s the one that was in touch with you that tested positive? And they can’t say who it was. And that just creates a lot of serious anger. Now for good friends, some people, I mean, if I tested positive and I was hanging around you, I would probably give you a heads up, saying, Hey, by the way this happened. But some folks they’re, for whatever reason, they don’t want to tell other folks that they tested positive, which is, you know, within their right to do so. So when the contract tracers, you know, tell them, it comes as a complete mystery.
Jordan: What do those contact tracers do? Actually, let’s make it more specific. You spent some time with someone named Tracey Ashby. Just tell me about her. What kind of training does she have? What kind of people do this job? What’s required?
Aaron: Yeah, so Tracey, I met her– I went down to their operations down in London, Ontario, and I got to listen to her end on, you know, a bunch of phone calls to see what she does. Now Tracey, she actually sits on a reproductive health team where she coordinates a prenatal program. Basically she helps women who are at risk of food insecurity. So that’s her regular day-to-day job, is helping out women who are, you know, maybe don’t have the financial means to, with food and they’re expecting children. And because of COVID-19, they had to be redeployed to do this tracing call. So it’s people from all over. Public health nurses, sometimes it’s students, like medical students who get involved in this. Anyone who can help really that, from the health community, who they can call upon. She’s a very friendly, very straightforward woman, but her job is really being a bearer of bad news. And that can take its toll on anyone. When you’re– you can imagine whenever Tracey’s starting a phone call, the baseline is not good news. It is hi, you have, you know, the coronavirus, or hi, you’ve been in touch with someone. So she is someone who has, you know, a certain amount of patience, very good phone interview skills, and also a baseline knowledge from being a nurse. Basically, she just works out of her home with her, you know, her husband in one room, her kids in another room, and her– trying to keep her dog out of the dining room where she works. She is at the frontline of our hopes of preventing the spread of this pandemic even further.
Jordan: Where does tracking and tracing kind of fit in to the overall fight against the virus? Again, I feel like it’s a phrase that we include in a lot of lists of what we need to do without understanding its role.
Aaron: Most definitely. It’s absolutely vital. And when you think about, at the very beginning, folks were trying to, you know, get all the personal protective equipment, we’re trying to make sure that emergency rooms weren’t overrun, that we had enough ventilators for folks if things happened, that we had enough doctors and nurses that were healthy, that could see these patients. By now that it seems that we have at least passed that test, these folks really are the next line. And, you know, there’s still nurses who are in the front line seeing these patients, there’s still doctors in the front lines, you know, trying to help people who have COVID-19, but in terms of this hidden front line, they’re the ones who are making phone calls, and in an ideal world, they are going to prevent the spread from going any further. So if someone gets COVID-19, if these contact tracers can get the message out fast enough and communicate the urgency of it enough that folks stay at home, it will prevent us from getting into a scenario of where we were in April, where we were panicked and wondering if emergency rooms are going to be overrun.
Jordan: How do they deal with people who are reluctant? And how often does that happen? Because, you know, certainly on social media, there’s a little bit of a backlash about, you know, giving out your private information to people calling you up to do contact tracing.
Aaron: Yeah. That’s one of the toughest part of the jobs is just, one, getting people to answer the phone, I guess, from a random number that they don’t know, and then being told they’re public health unit. So one thing that’s clear, that they don’t ask for any personal information from you. In some cases they don’t know much about you except for your name, if you are someone who’s just been, you know, in contact with someone. There are people who are very, you know, they’re angry and they have good reasons to be angry, I suppose. If you live in a room full of, you know, with all five of your friends, and instead you have to sit in your own room for the entire time. She was telling me there was a one person she was talking to that basically was yelling at her saying, this isn’t fair, what you’re telling me is I can’t go into the room and watch TV anymore because I can’t be in the other room. And Tracey had to tell her that this isn’t about fairness. This is about a global pandemic. So I think the tricky scenario for these contact tracers, and it’s not just Tracey, it’s every single one of them, is trying to establish a certain baseline of trust with these folks, that we’re here to help, this is the reason why they’re doing this to help, the urgency behind it, the rationale behind it. Basically checking in every few days to make sure that they’re okay, that, you know, tracers will call to make sure that they need– to see if they are okay for food, if they’re okay for groceries, if their symptoms are getting worse or better. It’s one of those jobs that an app can’t do per se. If you have an app that just says you’ve been in contact with someone, time to self-isolate, some people could just dismiss that and say, well, I can’t do that. I got to, you know, I’ve got a party to go to, or I got this thing I’m going to, I’m so not going to follow that. Whereas a phone call from a tracer can really help add a human element to it, establishing just how important it is. And if people aren’t willing to abide by the instructions, say someone has COVID-19 and they say, well, I’m going out anyway. Then there’s other steps that local health units can do to kind of enforce that. Fortunately, I’ve been told that that hasn’t happened in London yet, but that is a scenario where they have to learn how to be an ally and not someone who just preaches. Cause there’s– one tracer told me once you start preaching to these people, you lose them.
Jordan: Where do the apps that you mentioned fit into this? Do they work in concert with contact tracers? Are they backups? How does it work?
Aaron: I think most contact tracers, the human ones would say that this is– the apps could be kind of something that would be an accompanying help. There’s no way that apps could replace the rule that contact tracers just have, whether it’s from helping people through their emotions, through the many questions that they might have. Where apps really come into play is the speed. Every minute counts in this scenario. And you can imagine if someone has been exposed to COVID-19, you don’t want them going to a grocery or to a friend’s house or visiting a relative or anyone else who might be in their bubble, if they’ve been exposed. So what apps can do is they can actually really help in terms of getting the speed to the folks early enough. And those who abide by the recommendations of an app saying by the way, you’ve been in contact with someone who tested positive, that would really do well to making sure that people maybe stop their routine as it was right now, call their local health unit and ask what steps to take place next. So I think it could be very good at accompanying it, especially in terms of getting the speed of the message out faster. As you can imagine with the contact tracer, if you’ve got a list of 20 names to call and you’re calling them one by one, and you talk to each one of them for 15, 20 minutes, it could be hours, it could be over a day before you finally reach every single one of the contacts. And if it’s an extra day before one person who, you know, has been exposed, who might actually have the virus, who might be spreading it further is going on, passing along the virus further, you can imagine where an app could really help stop someone from passing on the virus earlier.
Jordan: Now that most places in Canada are really opening up, on the one hand, that means way fewer cases, which is great, but it also means, you know, people are much more mobile. Like I went to a patio for the first time in months this weekend.
Aaron: How was that?
Jordan: Oh my God. It was lovely. And it was very safe. Like, I think it was very safe. On the other hand, if a contact tracer needed to get in touch with me, you know, a month ago, I would give them two names. And now I wouldn’t even know where to begin. So is their job getting harder or easier, because there’s just fewer cases?
Aaron: It kind of goes in tangent. When you have lots of cases, the workload can become quite overwhelming. And I know that teams in Toronto and Alberta, especially, are looking to learn how to ramp up, expecting more cases as the economy and stores reopened again. And there’s no doubt, it’s really, really difficult to track everyone down. And I know contact tracers, they can’t– there’s a certain amount of time that you can’t say, well, I was at this restaurant and then they will call that restaurant and say, well, who was sitting next to Jordan in the restaurant? And can you check your receipts? It’s– there’s things that are within their control, then things that are not within their control. What’s really helpful for them is, you know, getting in touch with all known contacts, which really is important, because hopefully if people are going to patios, they are distancing well. And hopefully the app can catch that person who might’ve been too close at a grocery store, on a patio, on the subway. Hopefully they can catch those people who have fallen through the cracks of the contact, you know, the verbal contract tracing system.
Jordan: As we prepare for the fall, and the second wave that kind of most experts say is coming, how is the government preparing their tracing programs? Are they ready to scale them? How do we find more people with the right kind of backgrounds? What are we going to need?
Aaron: Well, the first thing you need is lots of testing. And I don’t want folks to think that, you know, all of a sudden, once we have contact tracing, we can stop doing testing. Cause the first step of a contact tracer is having someone with a positive test. So it’s absolutely vital that testing stays up, that testing is high, that we’re testing lots of people. The next step is trying to find the right amount of folks who can come in out of the job based on need. If there’s a surge in one province or one city, how can we get employees into there, contact tracers into that role on a kind of a fluid level? I know that Statistics Canada identified, I think, upwards of 1700 people that they have that do field survey interviews. And the federal government estimated that they could conduct 600,000 contact tracing calls per month. I can tell you from seeing what contact tracers do, that that would be more than a dozen calls per employee per day, which is pretty unrealistic considering that, you know, initial case reviews can last half hour easily, sometimes an hour. Check-ins can last, you know, 15 minutes. I don’t think the amount of phone calls the federal government is saying its Stats Can employees can do, is nearly as high as they’re saying. However, every extra tracer helps. I know that their teams have their folks who are in the regular public health jobs, and they can be transferred in and out based on, based on need. And I know there’s– I think the federal government had like a massive amount of volunteers they’ve had through some sort of database. I don’t know where they’re being deployed to, but ideally if any jurisdiction or province is really struggling with an outbreak, we would hope that those people could be deployed to those areas.
Jordan: And finally, is there a target that we’re trying to hit? Because I know you can’t possibly trace every single contact with every single case, but like, you know, the same way we kind of talk about herd immunity. Is there a level at which if we can trace this many people, then we can head off this outbreak before it starts?
Aaron: It all really depends on how fast you get to them. And I was talking with an epidemiologist and math modeller at the University of Toronto, Ashleigh Tuite, and she was telling me that right now a lot of our impact we’re having is our physical distance. That’s where we’re doing really, really well right now. And doing the testing is also really important. If we were in, like, kind of our regular world circumstances where people were just living their normal lives and hanging out, there was a study that was published in the Lancet that found that about 75% of infected contacts would have to go into quarantine within 12 hours if we want to contain a potential outbreak. The problem with that is you can’t get to three quarters of the contacts in 12 hours, because that is just unrealistic, based on if the numbers go up, that is. So you have one person or two people you’re hanging out with, then if testing goes fast enough, if people get themselves tested fast enough, it helps. The problem with that is, one, people forget who they’ve been around or on the patio. The second thing is some people, they wait days before they actually get tested after they show symptoms. So I know in Toronto people were taking, I think it was upwards of like five days from seeing symptoms before they actually got tested. And you can imagine it takes another day or two before the test results come in, and then it goes to the contact tracer who takes other day to find folks. So you’re looking at, you know, maybe like upwards a week of when someone actually is potentially spreading COVID, to when another person might know that they’ve potentially been infected. So it’s really, really vital, as important as contributions are, that folks are getting tested as early as possible for their symptoms, people still keep their masks on and do their physical distancing so that the numbers stay low, so that the testing labs don’t get overwhelmed with the number of tests to do, and then the contact tracers don’t have to call, you know, 50 people. I think in Vancouver, they told me that the most cases they had to trace for one call was 54, maybe, which is an obscene amount of phone calls to make. So if, when it’s one or two, then these things are a lot more manageable. So try and keep those distancing measures up because that makes the life of contact tracers a lot easier. And hopefully helps us squash the curve.
Jordan: I will do that. Aaron, it’s great to talk to you again. Thanks for joining us.
Jordan: Aaron Hutchins of Maclean’s. That was The Big Story. You can find more of them, we’ve done hundreds and hundreds by now, thebigstorypodcast.ca. You can even search by topics, scroll down to the bottom, there’s a little query bar. You can also talk to us on Twitter at @thebigstoryFPN. You can email us, that address is email@example.com. And of course we’re a podcast, so we we’re in all the players, Apple, Google, Stitcher, Spotify, Podcatcher, Podfather, you pick one. We’ll be there. Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.
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