And that could involve using some of the digital and mobile strategies seen in countries like Singapore and South Korea where removal has been more effective, they suggest with warnings.
All of this is under review by various public health agencies, but an expert at York University in infectious disease modeling warns that delayed action may allow the virus to continue its rapid spread and force enforcement action. even more intense physical distancing.
This may be the painful lesson that Canada must learn, said Jianhong Wu, an experienced model maker who has led several national projects on SARS, pandemic influenza and immunization assessment.
“Every country had to go through this first before they knew how serious it was,” said Wu, a prominent research professor whose work includes analyzing epidemic data in Wuhan, China, where the virus has first detected at the end of last year.
The argument for more stringent contact tracing was set out this week in a directive from the Chief Medical Officer of Health for Ontario. Dr. David Williams has asked provincial public health units to use their authority to isolate cases of COVID-19 and anyone with whom these infected people have come into close contact.
Williams reiterated that at a press conference, noting the social contacts of those infected must also be traced and contained if we are ever to put the virus on its heels.
“Even if we have succeeded in flattening the curve, the real work of grumbling in public health then takes on even more speed,” explained Williams, referring to the famous line graph which illustrates the sharp increase in cases that would result without intervention.
” [With] in all of these cases, you will need to make many more contacts, more phone calls, more surveys. ”
Williams said his office is considering how to add more staff, volunteers and the use of technology to this effort.
This work will need to continue throughout the spring and summer to ensure that infections do not trigger “flares”.
“We are quickly considering how to accelerate this – not only for today, but tomorrow and in the future, as it will be very important in the days and weeks to come,” said Williams.
It’s “very intensive” work, says Williams
It is “very intensive” work, he added, and this is where technology can help. Whether this includes using mobile tracking tools to keep an eye on infected people is an open question, and he is not ready to rule it out.
“We have many proposals to come, and nothing is downright rejected,” said Williams.
Canada’s biggest obstacle to technology-assisted tracking is public and policy aversion to measures that threaten individuals’ privacy, said Wu, but argued that public safety concerns should prevail on these concerns here.
For now, Ontario Health Minister Christine Elliott has hinted that the emphasis is still on people’s power. She said Thursday that she hoped medical students could help carry the load.
Such a strategy is already in use in Alberta, where approximately 300 medical students at the University of Calgary have strengthened the province’s ability to contact infected people and ensure that they and their contacts isolate themselves.
Dr. Richelle Schindler, medical resident at U of C specializing in public health and preventive medicine, said by email that nursing students could be added to the monumental task, in which trackers chase individuals over the phone but can send paramedics to check on those they cannot reach.
Albertans violating segregation orders face $ 1,000 fine, but courts have been empowered to administer fines of up to $ 100,000 for first offense and up to 500,000 $ for more serious subsequent offenses.
Student trackers must have clinical experience but also follow two days of training before touching the phone. They also get program credits for their time.
Although the importance of contact tracing has received less attention than testing in Canada, Wu stressed that this is a crucial step in suppressing an epidemic.
He noted that the test results provide a snapshot of infections that are several days or even weeks old. But tracking contacts can tell where the virus is when it passes from person to person.
“The public needs to know that if you want to get back to normal, you need to know who’s exposed,” said Wu, pointing to areas of Asia where mobile data usage is supposed to enable schools and busy markets. to stay open.
Contact tracing usually involves notifying infected people and their close contacts, but really effective tracing would also notify contacts of these close contacts, said Wu.
By the time you have identified people with the virus, their close contacts may already be infected and spread it to others.
“Then you can say the community is safe – we know who is affected or exposed, who is infected, so you can start resuming some social activities again,” said Wu.
Intensification of tracing efforts
Toronto’s assistant public health officer of health said Thursday that his unit was “strengthening” tracing efforts by developing a web-based system that would allow more front-line staff to join the effort from home.
The rapid case and contact management system for coronaviruses would allow trackers to capture essential case information that could be shared with the province.
Dr. Michael Finkelstein said Toronto currently has more than 100 staff working with infected people and their contacts, and acknowledged that keeping pace with the cases is becoming more and more difficult.
But right now, mobile citizen tracking is not part of Toronto’s strategy.
“TPH is aware that some jurisdictions have used this technology and is investigating its use,” said Finkelstein by email.
Wu described a synergistic relationship between three pillars of disease suppression: screening, tracing, and social distancing. Where one wobbles, the others have to compensate, he said.
Even if contact tracing becomes less effective as the spread in the community increases, people still need to know the level of infections and the level of exposure.
“It is never too late, so you can never give up,” said Wu.
“But I think we are at a stage where we really need to integrate technologies and you really need to have public participation. “