DATE:
June 2021
SUBJECT:
COVID-19 Case and Contact Management
BACKGROUND
COVID-19 spreads through direct contact with the respiratory droplets of someone who is infected with the virus. Symptoms include fever, cough, shortness of breath and difficulty breathing. On December 31, 2019, health authorities identified this novel coronavirus (COVID-19) through a series of reported cases of pneumonia in Wuhan, China. On March 20, 2020, the first confirmed case of COVID-19 was reported to the Windsor-Essex County Health Unit (WECHU).
The WECHU activated its Incident Management System (IMS) which resulted in a graduated redeployment of various staff at all levels to strategize and prioritize the COVID-19 response in our community. This model evolved over time to include a comprehensive COVID Response Team of managers, case Investigators, call centre staff, epidemiology, public health inspectors, school nurses, vaccine staff, IT and administrative assistants. In addition to these internal reassignments, Case Investigators and Contact Tracers were deployed from the centralized team of the Provincial Workforce to support these efforts.
To date, Windsor and Essex County has 16,572 confirmed cases of COVID-19, with 427 deaths. With the introduction of Variants of Concern (VOCs), 1,798 preliminary of confirmed VOCs cases have been identified in this region. With the VOCs currently driving the third wave of the pandemic, youth and young adults have become increasingly more likely to become infected, or hospitalised from COVID-19.
CURRENT INITIATIVES
Based on the extent of cases and outbreaks experienced in Windsor-Essex County, the WECHU continues at the level where re-deployment of staff is required, and case and contact management of COVID-19 remains a priority.
Case and contact management involves interviewing and isolating all suspected and confirmed cases of covid-19 infection, and their contacts, in a timely manner. Objectives are aimed at; identifying and notifying cases and contacts of their exposure, providing education on Covid-19 transmission, offering community supports, and providing symptom monitoring. Furthermore, Case Investigators perform a risk assessment to determine how the case may have acquired the infection and to whom the case may have potentially transmitted the infection. Information is collected on all high-risk contacts connected to the case, while considering exposure settings and the nature and duration of the case’s interaction with the contact. The Contact Tracer communicates testing guidance and verifies compliance with self-isolation. As per Ministry standards, cases should be contacted within 24 hours of receipt of a positive lab result and contacts of cases are to be reached within 24-48 hours of notification to WECHU. Presently, WECHU is reaching 85-93% of cases and contacts within 24 hours, on any given week.
Our region’s experience with Covid-19 has been unique for many reasons, one being our close proximity to the United States, with a large number of essential health-care workers commuting between Ontario and Michigan on a daily basis, and posing a risk for new infection. Another being the number of outbreaks we have experienced within the Agri-Farm sector and other congregate living settings. WECHU’s high-risk priority populations continue to include those affiliated with school cohorts, workplaces with shared workspaces, acute care hospitals, long term care, rest/retirement homes, and those individuals living in congregate living settings; local shelters, correctional facilities, assisted-living facilities, and bunkhouse living situations.
Ongoing collaboration with our healthcare and community partners has been integral in the overall strategy to reduce the spread of infection in WEC. This involves liaising with Infection Control Practitioners in our local hospitals, physicians across the region, laboratories, workplace owners (including farm operators), and our municipal partners in both the City and County. Partnerships with the Canadian Red Cross (CRC) Hotel and the Interim Isolation and Recovery (IRC) Hotel, have worked to eliminate isolation barriers for temporary foreign workers and other vulnerable individuals in the community, such as those without a fixed address. Furthermore, WECHU has supported, in collaboration with community partners such as the Essex-Windsor Emergency Medical Service and the Erie Shores Healthcare Team, onsite monitoring and testing of Agri-Farm workers isolating at the CRC hotel.
Local surveillance testing continues as the WECHU works with assessment centres throughout the region to detect active cases of Covid-19. WECHU have aided in surveillance testing by deploying nursing staff as needed to congregate living settings, mobile drive through clinics, and to a lesser extent individual client homes.
As with other locations in the province, the WECHU has been responsible for overseeing cases within our jurisdiction who are a result of recent travel from overseas and are undergoing mandatory isolation under federal quarantine. Travel has been identified as a risk factor in the transmission of Covid-19 Variants of Concern (VOC) to our community. VOC’s appear to be more contagious and spread quicker. As such, isolating cases of VOC’s immediately is of great importance. As the pandemic is progressing, isolation compliance is becoming more challenging, with some cases and contacts refusing to participate in isolation efforts. The staff of the WECHU continues to work closely with local enforcement authorities to ensure proper isolation requirements are followed including issuing orders under Section 22 of the Health Protection and Promotion Act.
Vaccination is a key public health measure in reducing the rate of infection in our community. The WECHU continues to work with municipal and hospital partners to provide access to COVID vaccines through mass vaccination clinics across the region. This has involved the hiring of new staff and redeployment of WECHU nursing staff from Case Management to aid in vaccination efforts, with the orienting of additional team members to Case Management on a semi-regular basis.
The Case and Contact Management System (CCM) is a core database for COVID-19 case and contact management developed by the Ministry specifically for use during this pandemic. The CCM database allows for timely reporting of cases, as well as provides a means for WECHU to establish links between cases, their contacts and potential outbreaks. WECHU strives to educate and train its staff in utilizing this new and evolving system by creating ongoing educational material, such as live training sessions and orientation documents including pre-recorded training videos and corresponding tip sheets on individual CCM topics. As Covid-19 infection continues to pivot, the Windsor Essex County Health Unit will continue to keep up-to-date with ministry guidance, thereby making every effort to continue to protect the health and wellbeing of our residents.