As the City of Toronto prepares for the Ontario Three-Step Roadmap to Safely Reopen the Province, case and contact management is a critical strategy to break COVID-19 transmission, particularly when contending with more contagious variants of concern (VOCs). Toronto Public Health (TPH) has continued to build responsive strategies that focus on breaking the chain of transmission by reaching at least 90 per cent of positive COVID-19 cases in Toronto and their high-risk contacts within a 24-hour period. By reaching positive cases and high-risk contacts by phone, text messages and letter, TPH staff determine the source of transmission and trace any potential contacts a positive case may have had.
On February 1, TPH transitioned to a new mandatory and enhanced provincial case and contact management (CCM) system. This new technology tool modernizes data management, is a central source for COVID-19 data in Ontario, and is integrated with the Ontario Laboratory Information System. This integration permits lab results to be available faster through frequent automatic uploads, allowing TPH to quickly access important data in a centralized location. Valuable staff resources are then focused on critical case and contact management functions, especially during Toronto’s third wave of COVID-19 when case volumes were the highest in the city.
Since May 2020, as part of its COVID-19 monitoring indicators, the province set a target of 90 per cent of newly reported cases and newly reported high-risk contacts successfully being reached within 24 hours. TPH built the infrastructure such that between June 2 and June 4, TPH successfully reached 97.2 per cent of newly reported confirmed cases of COVID-19 within 24 hours and 83.7 per cent of newly reported contacts within 24 hours.
In March, TPH introduced a virtual assistant (VA) tool to administer a rapid-response questionnaire to both cases and contacts. The VA gathers key data critical to case management including symptoms and onset date, ability to safely self-isolate, potential source of infection, risk factors and contacts. TPH also remains focused on following up on the highest risk scenarios, which include investigation of outbreaks in health care facilities, schools, child care facilities, workplaces, and congregate settings such as shelters and group homes.
As of June 1, the TPH Community Case and Contact team of approximately 1,000 skilled staff, investigate cases in hospitals, long-term care, workplaces, congregate settings, child care facilities and schools. When case volumes peak, TPH leverages the support of the Ministry of Health’s Provincial Workforce, which includes approximately 200 case managers. The strategies, resources, built capacity and innovative use of technology have strengthened TPH’s case and contact management function and have been critical to reducing spread as we prepare to reduce public health restrictions.
“We know how important Toronto Public Health case and contact management will be as we begin the province’s reopening. I want to thank Toronto Public Health for building up the largest case and contact team in Canada to support the safe and cautious reopening while also tracking the Delta variant. This is not easy work so I also want to thank the case and contact workers for helping us continue to get through this pandemic.”
– Mayor John Tory
“As we move towards reopening, case and contact management is key to our success. Contacting every confirmed case and recent contact – that’s the work underway now, and going forward. Toronto Public Health has built the largest municipal case and contact management team in the country, from 50 people in early 2020 to approximately 1,000 staff. By integrating new technologies and system enhancements, Toronto’s case and contact management team is well-equipped to help contain the spread of COVID-19 and new variants within our city – which is critical to beating this pandemic.”
– Councillor Joe Cressy (Spadina-Fort York), Chair of the Toronto Board of Health
“Timely and consistent case and contact management is one of our key strategies to support reopening and slow the spread of the Delta variant in Toronto. TPH has built a strong team and robust system to reach both newly-reported cases and their high-risk contacts in a timely and efficient way, to slow the spread of COVID-19.”
– Dr. Eileen de Villa, Medical Officer of Health
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