When a patient gets a test for COVID-19, it is sent to a lab for testing. The physician who ordered the test receives the result and as part of the doctor patient relationship, it is their obligation under the Health Protection and Promotion Act, to notify the patient and local public health unit of a positive result. Testing labs are also required to report infectious disease to local public health. A delay or breakdown in any of these steps can result in a delay in the public health unit’s follow-up with the person who has tested positive, increasing the risk of virus spread.
Toronto Public Health staff follow up with each COVID-19 positive case in the city. Case and contact management is, at its core, about investigation. Data gathered through this process helps public health to determine where a person may have been gotten infected, how the virus is spreading in the community, and how it can be contained. This data informs the public health strategy and actions, and when we can ease our public health measures and safely reopen our city.
Public health’s case and contact management process begins when we receive a positive lab confirmation of a COVID-19 case with complete information. Public health investigators act on the information immediately to:
- Confirm that the person is isolating;
- Get a list of their contacts, to notify those people;
- Ask questions to understand how the patient might have contracted the virus; and,
- Follow up with the person for 14 days to ensure they are continuing to isolate and monitor symptoms as they recover.
Case and contact management can be complex and time-intensive. The number of contacts for each COVID-19 case can vary depending on the individual's living, work and social situations. Some people have very few points of contact – especially since the implementation of public health and physical distancing measures. This means that some contact follow up investigations can be completed quickly – sometimes within a few hours. More complex contact identification involving many close contacts across jurisdictions, can take much longer.
The Government of Ontario has set a benchmark for the 34 local public health units to have 90 per cent of new COVID-19 cases contacted by public health staff for case and contact tracing within 24 hours of receiving a test result from the laboratory. Recent data shows that we have succeeded in moving from an average of 3 days (from test result to initiation of contact with patient), to now achieving contact with over 88% of new cases within 24 hours.
As our COVID-19 case numbers have increased, Toronto Public Health has had to rapidly update systems and scale up our local response by:
- Mobilizing over 550 staff and many volunteers on case investigations and contact tracing.
- Partnering with the Registered Nurses’ Association of Ontario, the University of Toronto and other agencies to boost our workforce.
- Building a local data-tracking system in eight weeks during an emergency to improve the efficiency and effectiveness of tracking test results, hospitalizations and deaths.
- Reporting on area-based data and analysis to track impact of COVID-19 on communities and how that can inform preventive strategies.
COVID-19 is a new virus that we are still learning about. It is the largest and longest outbreak response that Canada has ever experienced. Cases will continue to increase as more people are tested for the virus, the city opens up, and more people begin to mix in our community. As the City of Toronto works with business, other levels of government and local residents to restore our lives and rebuild the economy, we need to continue to support efforts to track and monitor virus spread. By maintaining a strong and efficient case and contact management program, we can help ensure that we do not lose any progress or momentum in containing and managing COVID-19.
The COVID-19 enforcement team continues to educate residents on the City’s physical distancing bylaw and provincial Emergency Management and Civil Protection Act orders, only issuing tickets in circumstances where education efforts have failed.
Yesterday, the City received 76 complaints involving people using outdoor amenities or not practising physical distancing in parks or squares. Bylaw officers issued one ticket for physical distancing. This month, bylaw and police officers have spoken to more than 600 people in City parks about the closures and public health measures.
The City’s website is updated daily with the latest health advice and information about City services, social supports and economic recovery measures. Check toronto.ca/covid-19 for answers to common questions before contacting the Toronto Public Health COVID-19 Hotline or 311.
"The work to confront COVID-19 and stop its spread in our community is continuing and I want to again thank Toronto Public Health, under the leadership of Dr. Eileen de Villa and Public Health Board Chair Joe Cressy, for these tireless efforts. Toronto Public Health is diligently tracking this virus on the ground in our community and we have massively expanded our ability to do this work over the last three months."
– Mayor John Tory
“Case and contact tracing is a critical part of containing COVID-19. While we move forward with our plan for recovery, we must continue to stay vigilant and use every tool at our disposal to combat this virus. This is the most significant global public health challenge we have ever faced. The impact of COVID-19 on our community has been profound, yet we have managed to avoid the level of devastation seen in other cities and countries. This is because of Toronto Public Health's critical work in investigating and contact tracing for patients who have become infected. The work they do each and every day speaks to their commitment towards protecting our city."
– Councillor Joe Cressy (Ward 10 Spadina-Fort York), Chair, Toronto Board of Health
“While COVID-19 has drastically altered our lives, thus far we have averted what could have been much worse. I have stated before that the paradox of work in public health is that when it is working, the benefits are largely invisible. Over the last four months my team continued to scale up our work behind the scenes to investigate, track and put public health measures in place to prevent further virus spread. We have never faced a global emergency of this magnitude. However, my team is focused on adjusting our strategy and actions during this emergency and we are committed to protecting our city's health."
– Dr. Eileen de Villa, Toronto’s Medical Officer of Health.