Toronto Public Health halts contact tracing outside of COVID-19 outbreaks in facilities

Toronto Public Health says it has halted contact tracing outside of outbreaks in what are called congregate settings because of a rapid rise in COVID-19 infections.

The "strategic shift" means TPH will no longer notify close contacts of people infected with COVID-19 outside of outbreaks in such facilities as hospitals, long-term care homes, retirement homes, homeless shelters, schools and child care centres for now, according to a report by The Globe and Mail.

TPH said on Saturday it will be now up to the infected person, if not connected to these settings, to call their close contacts. 

• Toronto suspends contact tracing outside outbreak settings to focus on isolating confirmed cases

The public health unit added there is no change in policy and procedures for congregate settings​​​ and TPH will continue to notify close contacts of infected people in these facilities.

Lenore Bromley, spokesperson for TPH, said in an email on Saturday that the change in policy is due to the dramatic rise in the number of COVID-19 infections in Toronto in the past month and the need for the public health unit to focus its efforts on calling and isolating people confirmed to have the virus. 

"As part of the usual course of outbreak management, when cases reach a high level, public health must make a strategic shift and temporarily re-prioritize case and contact management to focus on the highest risk scenarios," she said.

"At Toronto Public Health, we're implementing this prioritization now."  

Bromley said TPH will continue to contact people diagnosed with COVID-19. Staff will do the following, she said:

• Confirm a positive COVID-19 lab test result.
• Assess signs and symptoms and determine when symptoms first presented themselves.
• Assess and confirm the person's ability to go into isolation safely and make a referral to the Toronto Voluntary Isolation Centre if the person cannot isolate safely at home.
• Provide instructions to the person to notify his or her high risk contacts.

Move is 'temporary response,' medical officer says

Dr. Eileen de Villa, the city's medical officer of health, alluded to the new policy on Friday, saying TPH has nearly 700 staff people dedicated to case and contact management and has worked with Toronto hospitals to improve its response. But she said case counts are rising dramatically and consistently and TPH must focus its resources.

"This is a temporary measure in response to very high case counts," she told reporters at a city hall news briefing.

"The reason I am asking the Province to undertake additional public health measures is to drive overall case counts down. When this happens, we will return to the previous case and contact management strategies."

Coun. Joe Cressy, who represents Ward 10 Spadina-Fort York and is chair of the Toronto Board of Health, said the volume of cases in Toronto has forced TPH to make adjustments so that full contact tracing is now being done only for people in high risk congregate settings.

"For individuals in the broader community, TPH is still following up to check on them and to provide support to positive cases, but it is not doing full case and contact management after the fact," Cressy said on Saturday.

Cressy said the public health system is close to becoming overwhelmed at the moment because of the sheer number of cases and additional measures are needed now to slow the spread of the virus.

"This is an indication that the system is reaching its breaking point," Cressy said.

In the absence of stronger public health measures, hospitals and public health systems are at risk, he added.

Colin Furness, infection control epidemiologist and assistant professor in the faculty of information at the University of Toronto, said not doing contact tracing with certain people means the city will not be limiting spread as much as it would otherwise. The more contact tracing that can be done, the better, he said.

"This is certainly not what one wants to hear. Contact tracing is a really, really important tool in public health to make epidemics go away or at least to constrain them," Furness said.

There is a danger of losing control over the pandemic, he added. Contact tracing explains how spread is happening and provides important data, he said. He noted the amount of work to be done with contact tracing is greater now because people are moving around more than they were in the spring.

But Dr. David Fisman, an epidemiologist and a professor at the Dalla Lana School of Public Health at the University of Toronto, said TPH is making the right move, given the growth in cases. 

"It's absolutely the right thing to do. In the first place, you could hire 5,000 people and they wouldn't be able to keep with the numbers and do this meaningfully," he said.

"For contact tracing to be meaningful, it has to be rapid and we can't do that right now."

Public unit calling on province to take stronger action

On Friday, de Villa called on the province to implement stronger public health measures to slow the spread of the virus. She suggested that the province ban indoor restaurant dining, close gyms and ask people to only leave their homes for essential trips.

De Villa said while she has some authority to make such changes under existing public health regulations, she received legal advice that it would be "unprecedented" for a local medical officer of health to enact such broad changes.

"I am therefore urging you to act in collaboration with the City of Toronto to implement these measures in as timely a fashion as possible," she said in a letter on Friday to the province.

On its website, which lists daily status of COVID-19 cases, Toronto reported 335 new COVID-19 infections as of Friday. The number brings the city's cumulative total to 20,473. A total of 16,842 are said to have recovered from the virus. A total of 1,299 people have died of COVID-19. There are 85 people currently in hospital with COVID-19.