Launched in a race against the clock, they have gone up to date the network of some 51,000 people infected with COVID-19 in Quebec to find their multiple contacts in order to curb the epidemic. However, the deconfinement and the heyday of the coming summer could double or even multiply their task.
These COVID-19 detectives are some 1,000 investigators recruited by the public health departments (DSP) to provide telephone follow-up for all people infected in Quebec. However, in their war against the virus, these shadow soldiers are not evenly distributed. In Montreal (more than 25,500 cases of infection), 140 people work full-time in investigations, compared to 179 in Montérégie (nearly 7,000 reported cases) and 170 in Laval (more than 5,450 cases).
A situation which is not without worrying certain investigators who are, with the screening and the measures of hygiene and physical distancing, one of the only three weapons which the DSP has to contain the epidemic.
According to the Dre Noémie Savard, medical specialist in public health, responsible for medical follow-ups at the DSP de Mont-
real, the number of “close” contacts per infected person, from 2 to 3 currently, could drop from 5 to 6, and even go up to 20 with deconfinement, according to projections made in the United States and Europe . “We would like to have a crystal ball. We are preparing for that. An increase in cases will mean recruiting staff, ”she said.
“What I’ve seen for weeks is that when someone has [la COVID-19] at work or in a family, it doesn’t take long before others catch it. Even being careful. Especially when the person is asymptomatic, “said an investigator, who requested anonymity. Its mission: to reach five or six positive people every day, ten when everything is fine. Once the test results are received by fax, she contacts the patients one by one and completes a complete file by hand.
In Montreal, two shifts (day and evening) of 30 people work seven days a week to reach each new person declared positive (212 new cases daily as of May 30), draw up their health check-up and establish the probable place of contamination. (up to 14 days before the onset of symptoms.) Then, make a detailed list of their “close” contacts (more than 10 minutes within two meters) 48 hours before falling ill, and up to 14 days later. All those living under the same roof are immediately classified as positive “by epidemiological link”.
A second team of 50 people then takes over to join all these “close” contacts, by phone or email, to notify them that they have been exposed to the virus. We check whether they have developed the disease or not. Isolation and health monitoring are necessary, even for those who do not have symptoms.
“In general, people cooperate well. But sometimes they are sick, or hospitalized. Sometimes they died. I didn’t experience it, but it happened to others, ”said another investigator. For each case, the interviews range from 45 minutes to 1 hour 30 minutes.
While the task is easier to locate health care workers already informed of their risk of exposure by the employer, it is complicated for cases contracted in the community. “One day, an investigator next to me was talking to a positive person, one of whose contacts had died. She was guilty of transmitting the virus. The emotional charge can be intense at the end of the phone, ”says this investigator.
Very often, the fateful call is not a surprise, since the conscripts are already sick. “For the majority, it’s clear where they caught it. Some have big hearts, against their working conditions, their employers. They feel like numbers, ”she adds. Her colleague remembers a difficult case. That of a pregnant health worker who was forced to stay on the job. She was anxious, worried about her future. “Sometimes you get out of the messy job,” she says.
Rarely, some people do not know how they got the virus. “An elderly lady who did not leave her home did not know how she got infected. She had her groceries delivered, that was the only clue, “added the same investigator. Even people well equipped to protect themselves fall in combat. “Without being grossly negligent, many hospital workers contract the virus. There is still some shadow over who is infected and why, “said her colleague.
As summer approaches, the challenge for investigators will be to keep pace with the spread of the epidemic. “The deconfinement,” said this investigator, “is a little worrying. It can become exponential. “
Still entangled in a semi-computerized system, the Montreal DSP hopes to complete its computerization and improve “the file management flow” within a few weeks, explains the Dre Savard. Despite a difficult start, she says the up-to-date investigations are now starting 24 hours after the results arrive, sometimes the same day.
Certainly, at the height of summer, slowing down the coronavirus will not only rest on the shoulders of these investigators. “People have to remember that the virus is still there, and that they are the ones who will make the difference by continuing to keep their distance and wear a face covering. For this to work, we have to do this all together. “