Case and contact management strategy

Protecting Ontarians through enhanced case and contact management – case and contact management strategy

Ontario continues to respond to the COVID-19 outbreak and introduce new measures to keep people safe. The province has introduced public health guidance like physical distancing and wearing a face covering; and in May, released an expanded testing strategy to ensure the province identifies any new cases of the virus as quickly as possible to contain its spread.

When Ontarians test positive for COVID-19, it’s vital that quick and thorough follow-up on close contacts is carried out by public health officials. Case and contact management plays a key role in preventing the spread of the virus. Public health staff help stop the spread of COVID-19 in the community by investigating where an individual may have acquired the virus and preventing further spread.

As Ontario continues its extensive efforts to stop the spread of COVID-19, and in preparation for a potential second wave in the fall, the province has developed an enhanced contact and case management strategy.

This enhanced strategy focuses on efforts to strengthen and standardize case and contact management by:

• Ensuring that all new cases and their close contacts are identified early, reached quickly, investigated thoroughly, advised to get tested and followed up with daily for up to 14 days;
• Supporting our public health units with additional staffing resources;
• Improving technology tools through one provincial case and contact management system; and
• Launching a privacy-first exposure notification app to alert Ontarians when they may have been exposed.

This case and contact management strategy will support Ontario in its ongoing phased reopening, as outlined in A Framework for Reopening our Province.

Updated guidance for case management and contact tracing

Ontario is implementing strengthened guidance for public health units to ensure case and contact management continues to be timely and effective in preventing the spread of COVID-19 by:

• connecting with all individuals who have had close contact with a positive case within 24 hours of being identified
• directing all close contacts to self-isolate for 14 days
• following up with close contacts every day for the duration of their self-isolation
• strongly advising testing to all appropriate close contacts

Prevention is most effective when cases and contacts self-isolate as early as possible. Supporting individuals in getting tested is a key enabler of this strategy, as the ability to alert contacts of potential exposure in order to prevent further spread of COVID-19 depends on the identification of positive cases.

The online self-assessment tool helps Ontarians identify whether they should go for testing. As part of the self‑assessment tool, Ontarians can ‘opt in’ to receive a call-back to get information about testing and the testing process, as well as self-isolation.

Public Health Ontario has developed materials for assessment centres that provide key public health guidance to ensure that individuals are self-isolating as early as possible. These materials provide clear direction on who should be self-isolating and ask individuals to think of where they might have acquired COVID-19, and to remember and write down any recent contacts so they are prepared in the event they test positive.

Ontario will work with schools, post-secondary institutions and workplaces to provide contact tracing guidance for those settings, including keeping proper attendance and records so that contacts can be identified as early as possible in the event of a positive case. The province continues to work with the federal government to provide support and guidance for returning travellers when international borders reopen.

Ontario has a plan to increase capacity for public health units to ensure the necessary resources are in place to support this new guidance.

Increasing staffing capacity

Case and contact management for reportable diseases is a fundamental role of public health units; however, the magnitude of COVID-19 has required them to scale up quickly. Currently, approximately 1,500 staff in public health units focus on following up with cases, identifying and reaching out to contacts.

In the early days of the outbreak, many groups stepped up to support contact tracing efforts. Public Health Ontario and the Ministry of Health developed and oversaw the training of medical students and retired health care professionals from around the province to provide additional surge capacity to public health units, assisting with contact outreach and follow-up. This included staff from Ontario Health, Hydro One, Osteoporosis Canada, and Health Canada. These teams have also been involved in ensuring the compliance of returning travellers, low-risk symptomatic monitoring and self-assessment tool follow-up calls.

With these additional resources, current capacity includes approximately 2,000 case managers and contact tracers.

Ontarians have done their part in staying home to stop the spread. But the number of contacts per case will increase as individuals go back to work and other restrictions continue to relax.

That’s why Ontario is providing even more contact tracing surge capacity through federal government resources from Health Canada, the Public Health Agency of Canada, and the Department of National Defence. Given evolving needs, a partnership with Statistics Canada has also been established with access to up to 1,700 staff. This multilingual workforce is experienced in protecting confidential data, skilled in data capture and collection of information over the phone and supported by a robust infrastructure and training system. Public Health Ontario will continue overseeing the training and coordination of these additional staffing resources.

In addition, Ontario will continue to build a supplementary pool of staff from the Ontario Public Service, the broader public sector, and through the province’s workforce matching tool, to use if further surge capacity is required. These pools will more than double the existing capacity and ensure Ontario is ready to identify and isolate new cases and their contacts. This will also allow public health units to execute their other important functions and public health programs, including inspections and vaccinations, as the province reopens.

Stronger systems and better technology: one provincial case and contact management system

Leveraging the best and most up-to-date technology is critical to help support case and contact staff to do their jobs more efficiently and effectively. That’s why Ontario is using Salesforce software to implement a new cloud-based provincial case and contact management technology solution that will phase out the multiple tools being used across the province and replace the provincial communicable disease database (iPHIS) for COVID-19 reporting. Salesforce will later be reviewed for implementation for the 70 other reportable diseases — completely replacing iPHIS. This tool will make current processes significantly more efficient, and reduce data entry and the administrative burden for case and contact management work.

The Salesforce platform will be customized for Ontario’s use in the COVID-19 outbreak, using technology that is scalable, interoperable, application programming interface (API)-based and flexible. It will allow for integration with the Ontario Laboratory Information System (OLIS) data, eliminating the need for public health unit staff to re-enter lab results into iPHIS. The platform will also enable data extraction, which can be analyzed to identify province-wide regional trends and hotspots. It will also allow for contact tracing to be quickly ramped up through a remote workforce when required.

Work continues with the network of laboratory sites to ensure coordination and eliminate any barriers to entering results into OLIS so that results are shared with public health units as quickly as possible. When patients view their lab results online, they will be able to enter key data in a secure online form, including information about their known contacts who may have been exposed. This information, along with the patient’s lab results, will be fed directly to Salesforce for the appropriate public health unit, providing a “quick start” for case managers. This will significantly reduce duplication and manual data entry, allowing investigators to begin their important work of reaching cases and identifying contacts much earlier.

Cases and contacts will also be able to opt for email or SMS follow-up in place of phone calls.

Protecting Ontarians: launching a privacy-first exposure notification app

Exposure notification is a critical part of reopening the province. Early warning of a possible exposure will play an important role in preventing the spread of COVID-19 as individuals return to work and adapt to a “new normal.” Exposure notification apps complement, but do not replace, traditional contact tracing efforts by providing people with a quick and anonymous way to be alerted, if they may have been exposed to COVID-19.

Ontario will be supporting the federal government to launch a new privacy-first exposure notification app within the next two weeks. COVID Alert was developed by the Ontario Digital Service and a group of volunteers from Shopify.

COVID Alert, which users can voluntarily download, gives people who test positive for COVID-19 the option of anonymously alerting all other app users who have been close contacts in the last 14 days. The app also provides current public health guidance on self-isolating, self-monitoring for symptoms, or getting tested, so that Ontarians can take the appropriate action. COVID Alert is a fast, secure and privacy-protected way to notify Ontarians of potential exposure.

COVID Alert will never collect personal data or GPS location data. Instead, the app uses Bluetooth technology to send out encrypted, anonymized codes to other nearby phones that have the app. An individual cannot receive notifications if they do not have the app on their phone. The app was built using the Apple/ Google framework for exposure notification. This ensures that the app leverages global best practices to protect privacy.

Utilizing a national application will help ensure Ontarians are notified, regardless of what province they are in helping us towards the goal of ensuring we can all move more freely.

How it works

1. Ontarians can download COVID Alert for free
2. If the app user tests positive, they can go to the Ontario’s Lab Results Viewer to receive a randomly-generated, temporary code
3. The user can enter the temporary code (if they choose) into the app, which anonymously alerts those who they have been in contact with of their exposure
4. If a user has been in contact with another person using the app that has tested positive, the user will receive a notification that they may have been exposed to COVID-19

Contacts are provided with public health guidance to self-isolate, monitor symptoms and/or get tested.

Outcomes

• As the province implements this case and contact management strategy, it will monitor the following key indicators:
  • reaching new cases within 24 hours of a case receiving a positive test result (target is outlined as 90% in A Framework for Reopening our Province)
  • reaching close contacts of a new case within 24 hours of identifying the contact
  • tracking the average number of contacts per case
  • tracking the number of Ontarians using the exposure notification app

A broader range of metrics will be developed to measure impact as Dr. Jane Philpott assumes her role as special advisor to support the design and implementation of the new Ontario Health Data Platform, and as the new case and contact management system is implemented.

Looking ahead

Frontline workers across the province, including those who work in Ontario’s public health units, are working tirelessly to help protect Ontarians. The Ontario government would like to recognize their dedication and compassion during this difficult time.

As Ontario continues to test, trace and isolate cases and contacts of COVID-19 to stop its spread, this strategy scales up the province’s capacity to manage cases and trace contacts. Ontario will continue to engage with public health units as elements of the strategy are implemented, recognizing the needs and circumstances of different regions across the province.

The significant expansion of testing of symptomatic and asymptomatic individuals goes hand-in-hand with this new robust case and contact management strategy, supporting public health units with additional tools and capacity to stop the spread of the virus. The province will continue to look for new ways, new technology and research new responses to ensure we are doing all we can to keep our families and communities safe.

Appendix A

What is case management?

Case management includes a public health unit’s initial interaction with a positive case, the investigation to determine how they may have gotten COVID-19 and the identification of all close contacts. They will receive daily follow-up for up to 14 days.

What is contact tracing?

Contact tracing is the process of reaching all individuals who have had sustained personal contact with someone who has tested positive for COVID-19. This is a critical step in helping to control and prevent further transmission of the virus. Contact tracers reach out to inform those individuals that they are at risk and instruct them on appropriate public health measures such as self-isolation, monitoring their symptoms and getting tested. They will receive a daily follow-up for up to 14 days.

What is exposure notification?

Exposure notification is the process of anonymously notifying people about their possible exposure to COVID-19 without collecting their personal details or location. This is a key, privacy-first step in helping to control and prevent further transmission of the disease. Exposure notification is typically implemented through mobile apps, which use cell phones (usually a phone’s Bluetooth feature) to detect when phones are near each other. If an app user tests positive for COVID-19, they have the option to anonymously alert other app users who have been near them.

What is a close contact?

A close contact is anyone who has been in close physical proximity (less than two metres) to someone who has COVID-19. This could include someone you live or work with, or someone you’ve been less than two metres away from for longer than a brief time.

Note: Occupational exposure in health care settings will be assessed separately.

How to self-isolate

• stay home
• avoid contact with others
• keep your distance – at least two metres
• wash your hands
• cover your coughs and sneezes
• wear a mask over your nose and mouth when visiting your health care provider or if you are unable to stay more than two metres away from others

When should I use a face covering or mask?

It is recommended that you use a face covering (non-medical mask) to reduce the transmission of COVID-19 when physical distancing may be challenging or not possible.