Since the start of the pandemic, Public Health nurse Heather Dickson has spoken to hundreds of people that either have, or know someone with, COVID-19. She is one of Kingston Frontenac Lennox & Addington (KFL&A) Public Health’s team of contact tracers.
Making daily calls to active COVID-19 cases in self-isolation, she said she has witnessed how truly unpredictable the illness can be.
“The people who I maybe think ‘Uh oh, they’ve got all these underlying health issues,’ don’t necessarily get a worse case. And someone who is otherwise healthy does not always get off easy. Completely, it’s an unpredictable illness. You absolutely don’t know what you’re going to get,” she said. “You have no idea, which makes it scary.”
Investigating a new case of COVID-19
The KFL&A Public Health team performs contact tracing locally, and also in a supportive capacity for York Public Health. Dickson explained that a nurse’s work starts when she is assigned a positive lab result of COVID-19 to contact and investigate.
“The nurse calls the person and does a big, in-depth interview with them on symptoms and risk factors,” Dickson said. “We’re also really looking into: who have they been around in the 48 hours before their symptoms started? Who could they have transmitted it to?”
“We’re also going back two weeks to look at where they could have acquired the virus from, and investigating that way,” she said.
“Sometimes it takes a lot of thinking. Two weeks ago, I couldn’t necessarily tell you every place I stopped. Did I stop for coffee? Which fast food place did I eat at? So we have ways of suggesting people do it — maybe looking through their credit card record or their phone, pictures they may have taken. It’s a little bit of detective work.”
She said the number of close contacts per case ranges from person to person, with no noticeable trends based on age or city.
“Some people are staying in their very small social networks, and still getting it from that one fluke occurrence… Like the hug to the friend you haven’t seen in a long time,” she said. “You think, ‘Oh it’s one person, I haven’t seen them in so long and they’re healthy!’ Unfortunately, that can be all it takes.”
Others have larger groups and are maybe not paying as close attention, she said. “We’re getting a real mixture right now, real mixed bag.”
Breaking the news to close contacts
Volunteer contact tracers then call the people identified as contacts from the 48 hour period prior to a person’s COVID-19 symptom onset. They’re informed that they’ve been exposed to COVID-19, and told to isolate.
“It’s a real challenge in some instances because we have to protect the case’s private information. So we may be saying: ‘You’ve been identified as a close contact of someone with COVID. We can tell you a date, but we can’t tell you who. We can’t tell you where.’ That’s hard to take. Someone saying suddenly: You’ve got to stop your life but I can’t tell you exactly why,” she said.
Others are more prepared. “If it’s a friend that has tested positive and they’re waiting for the call, in those instances, they’re relieved to hear from us. Finally, someone they can ask all their questions to, get some reassurance.”
She said she has not seen much evidence of uptake on the Canadian government’s COVID Alert App.
“We don’t have any way of knowing unless someone tells us ‘Oh I saw the alert on there.’ But I don’t think it’s a huge number,” she said.
The app also has limitations. “It does not replace contact tracing at all because it doesn’t give you the specifics of where, when, what the nature of the contact was. So we need to still do our job, too,” she added.
Overall Dickson said the experience and her interactions with people have been positive.
“I’ve been surprised in a warm way of the thanks that we’re getting from people. We really are impacting their lives, we’re shutting them down for two weeks. Isolation is hard,” she said.
Dr Moore: Contact tracing team has ‘tremendous capacity’
At the monthly meeting of KFL&A Public Health’s Board on Wednesday, Nov. 25, 2020, Medical Officer of Health Dr. Kieran Moore explained that supporting contact tracing in the York Public Health region has sharpened the Kingston team.
“We have built tremendous case management capacity in KFL&A,” he said, noting that processing York cases has given the local nurses and volunteers practice to handle higher volumes.
“We are ready if our case numbers go up. We’re ready if we have to respond to 30, 40, 50 cases a day. We’ve exercised this capacity, we’ve tested it.”
This week, Ontario’s Auditor General praised KFL&A Public Health’s team of contact tracers for their speed and efficacy in her report on the province’s response to COVID-19.