Alberta put its contact-tracing system on life support. Can it be resuscitated?
At its height, Alberta had 2,500 contact tracers. Now it has fewer than 1,500 — many added in recent weeks
Charlotte says when she started work as a contact tracer in 2020, she was excited.
She was eager to help with the pandemic effort and she felt by investigating COVID-19 cases she could make a difference — identifying and tracking the spread of the virus, while supporting those who tested positive.
A second contact tracer, Linda, called the early work fulfilling.
"It was busy, but, you know, we really felt like we were playing a vital role," she said.
"At the beginning, it was a decent work environment. We had support, we had the numbers, we had the organization," Charlotte said.
"And then, since about August, that has not been the case."
August was when Alberta planned to drop isolation requirements and start treating the COVID-19 not as a pandemic, but an endemic disease like the flu. Hundreds of contact tracers were laid off or had their contracts not renewed, as they would no longer be needed to notify close contacts and would only continue to investigate "high-risk settings."
Those plans didn't last, as cases doubled and doubled again, but contact tracers who spoke to CBC News said even with new staff added by Alberta Health Services (AHS) during the fourth wave, the system isn't working to stop people spreading the virus.
"Personally, I can't keep up," said Linda, adding that fixing the contact tracing system "is going to be very difficult."
CBC News spoke with two contact tracers in Alberta for this story. They've been given pseudonyms as they fear impacts on their employment if they are identified.
'We don't have time'
At its height, during the third wave in May 2021, Alberta's contact tracing workforce numbered around 2,500.
On Sept. 25, AHS said it had approximately 320 to 360 contact tracing staff working each day — a number officials said was scaled up accordingly as cases increased. At that time, AHS didn't say how many total contact tracers were employed by the organization.
A spokesperson has since provided more detail, saying that as of Oct. 12, AHS now has approximately 1,124 total contact tracers and case investigators, as well as 295 casual staff.
It's working to fill postings to increase its pool of casual staff, redeploying workers from other areas like public health and Connect Care, and extending temporary positions.
AHS said it is managing to quickly contact those who have tested positive; at least 80 per cent of COVID-19 cases receive a phone call from a case investigator within three hours of AHS receiving the positive test result.
However, contact tracers told CBC what they're able to do on that call has been cut back.
"Now that [staffing is] low, we don't have a lot of time to do the actual investigation … we ask if they have symptoms and when they started. We don't have time to discuss their symptoms," Charlotte said in September, adding that she had gone from completing as few as two to as many as eight cases per day.
Now it's just like, 'Are you still working on that case? Why are you still working on that case? Move on to the next one.'- Charlotte, a contact tracer in Alberta
She said she doesn't feel like her work is helping to slow the spread of COVID-19, because contact tracers no longer notify close contacts to ensure they don't spread the virus.
"I have had parents tell me they won't be telling schools … they don't want their kids to be ostracized.
"It's not something that parents should be doing. It should be something that people who are trained should be doing. But it's not."
Dr. Stephanie Smith, an infectious disease specialist at the University of Alberta Hospital, said contact tracing is a vital part of a public health response.
"I think it's unfortunate that contact tracing stopped, especially because I think trying to restart it has been challenging," said Smith.
"These contact tracers are kind of facing this huge, huge workload that's almost impossible to do properly. And it's frustrating."
Missing data collection
Charlotte said it also disappoints her that she's not able to record more information — because she said even if there isn't time for the data to be analyzed now, it could help in a post-mortem review of the province's pandemic response.
"It's not even a contact tracing situation we're doing — we're notifying people … the bare minimum. We're giving them their isolation orders. So we're not spending enough time with people," she said. "Even if we want to go back and use any of this data later, it's all going to be useless. And I listen to people every day tell me about all the people they know who are sick, who are not getting tested."
As of Wednesday, the source of transmission for 84 per cent of active cases in the province was still reported as unknown. The other 16 per cent are connected to a close contact, an outbreak or travel.
AHS says case investigators currently collect the following information:
- Details about work, school, or child care, as applicable.
- Whether each case attended those places during their incubation or infectious period.
- Whether COVID-19 was acquired in Alberta, and if so was it in the community or hospital.
However, AHS said contact tracers no longer collect information about close contacts unless it's connected to a high-risk setting like a care home. Instead, positive cases are told to tell their close contacts themselves, and are given information about the importance of isolation.
AHS said it's adjusted the case investigation approach and questionnaire, as it has at other times during the pandemic, to scale its response as needed and to strike a balance between current capacity and the need to collect information.
"It frustrates me, and I've talked to other people who feel like we aren't able to do our best quality of care or do our best job because even if we know information, we're not [collecting it]," Charlotte said.
Unable to help as before
Both women also spoke about feeling like they were unable to play a greater role in caring for people with COVID-19.
Linda said before August, she was able to provide more support to patients and ask what their needs were.
"We would ask them, like, 'Are you going to have trouble isolating from others in your house?' Yeah. OK, let's make arrangements to get you into an isolation hotel'. Do we have isolation hotels anymore? No," she said.
"Now it's just like, 'Are you still working on that case? Why are you still working on that case? Move on to the next one.'"
Linda said in October that the contact tracing staff has grown rapidly in recent weeks and she's been working flat out with nearly no time off.
She said she now has a little more time to spend on each call, but she's still collecting "minimal information" from cases and that contact tracing at schools has yet to resume. AHS has said it plans to resume contact tracing at schools by mid-November.
WATCH | Alberta brings back contact tracing in schools:
"Contact tracers still feel like we could be doing a lot more — like we used to do — and should be doing contact tracing for everyone, as it will never end at this rate," she said.
Smith said in an ideal world each case would undergo extensive tracing: backwards, to determine where someone has been and might have contracted COVID-19; and forwards, to determine what directions the onward spread might take.
However, she said at a minimum contact tracing should give a sense of where clusters are occurring and a way to anticipate the size of case growth.
Case numbers declining but tracing still needed
COVID-19 case numbers are finally decreasing in Alberta, but Smith said that's all the more reason to continue tracing networks of transmission— to prevent another surge of case growth like we've seen four times already this pandemic.
"It's certainly declining … that's a time when we should not be completely backing off with contact tracing. This is a time — when we have smaller numbers — that those contact tracers actually will have the time to be able to better investigate."
Alberta Health has yet to say what its future plans for contact tracing will look like. Previously, the province had said it planned to rely on wastewater data monitoring to understand the coronavirus's prevalence in the population.
"Wastewater monitoring is really only going to identify if there is positivity in a particular area, but it's not necessarily going to tell us where transmission [is] or where we should be looking in terms of trying to mitigate risk," Smith said.
Dr. Joe Vipond, an emergency room physician and outspoken critic of the provincial government's COVID-19 response, said it's vital to anticipate the next wave — and have tracers continuing to work through the "troughs."
"The reality is we intentionally wound down most of our contact tracing … but the same way as contact tracing can be wound down, it can be wound back up," he said.
"It's a matter of political will and getting back to it."
In the meantime, the two contact tracers say they're aware of colleagues who have taken time off due to stress.
Linda said the job itself is an emotionally draining one, current challenges aside.
"You know, when someone breaks down and is bawling because you've just called them to tell them that they have COVID-19 and they're terrified? And, yet, we have a job to do and I have to get information from them, try to help them," Linda said.
"This is what I don't think the public understands what this contact tracing is about."
An AHS spokesperson said in an emailed statement that they recognize the fourth wave has been challenging and they're grateful for the incredible work contact tracers continue to do.
"We recognize the stresses our staff are facing have supports available for them through the free and confidential Employee and Family Assistance Program. We also encourage our staff to reach out to their managers to discuss any questions or concerns they may have," AHS said.