Why contact tracing remains a hurdle for Quebec in containing COVID-19

Quebec has ramped up its ability to track down members of the public who may have been exposed to COVID-19.

But challenges remain in ensuring those who may have contracted the virus are aware.

Among the biggest hurdles? Getting people to pick up the phone.

Health Minister Christian Dubé said Friday that up to 30 percent of people contacted due to potential exposure to a COVID-19 case do not answer the call.

"It's problematic," he told reporters. "I have to appeal to the idea of public responsibility."

Following the discovery of a case, public health tries to reach a list of people who may have been in contact with the infected person.

Experts say quick and effective contact tracing, coupled with access to rapid testing, is essential in containing the spread of COVID-19.

Carl-Étienne Juneau, a PhD in public health, recently completed a study with colleagues at Université de Montréal on contact tracing. 

His research concluded that contact tracers need to be able to reach at least 80 per cent of people who may have been exposed to curtail the pandemic.

Under the current situation in Quebec, he said, if only 70 per cent of people are being reached, "we're just slowing it down. We're not stopping it."

Personal responsibility and government action necessary

Juneau said both the government and the public have the responsibility to help stop the pandemic.

He said there are four steps in testing and tracing, and ideally the process takes at most three days.

A sick person gets tested, gets the result, people who may have been exposed are contacted and all those required go into isolation.

"I think it's a team effort," he said.

Marie-Pascale Pomey, a professor at Université de Montréal's School of Public Health, says people may be getting their positive results quickly but there are delays in getting a call from public health to provide the information necessary to do contact tracing.

"This delay can be quite long. It can take between three to five days," Pomey said.

She also says the government offers no incentive to people who need to get tested.

"At the moment, we don't have any stick or any carrot," she said, referring to the idea that the government reward those who respond to calls and punish those who don't.

Last month, Quebec opted not to use a smartphone application to notify the public about potential exposure to COVID-19, arguing its own testing and contact-tracing capability are sufficient at this stage of the pandemic.

More contact means more tracing

In contrast with the spring, when Quebec was under lockdown and contact between people was limited, public health can often now be faced with the challenge of tracking down dozens of people in connection with a positive case.

Earlier this week, Dubé cited a gathering of 17 people at a restaurant in Montérégie that resulted in 31 confirmed cases. Hundreds more, he said, will have to be monitored. 

In a statement, Marjorie Larouche, a spokesperson for the Ministry of Health, said its teams "are faced with investigations that are heavier and more complex to carry out." 

"The complexity of the investigations puts enormous pressure on the teams who must reach a very large number of people and find their contact details," she said.

A nurse practitioner who works part-time as a caller for testing centres outlined some of those challenges in more detail.

"It's really surprising how often we're getting results and we're not able to get in touch," she said. She didn't want to be publicly identified because she's not authorized to speak on the matter.

People often don't pick up the phone because the caller ID is blocked, the nurse practitioner said.

They are only allowed to leave a message if it's clear that it is a private voicemail for the individual who got tested.

Often, the mailbox is full so that's not possible. Other times, a person's phone number or email address isn't written out clearly.

The nurse practitioner advised those waiting for a call to make sure to watch their phone.

Under the current directives, a health professional is required to speak with anyone who tests positive, as well as those who are negative but have symptoms, she said.

She suggested that before taking part in a large event with family or friends, consider this: how many people would need to be contacted if I tested positive the next day?