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GPs join chorus of alarm surrounding contact tracing


Matt Woodley


27/07/2020 4:49:51 PM

Lag times for notifying close contacts have stretched to four weeks in some instances, potentially allowing the disease to spread unchecked.

Graphic representing spread of disease.
Any delay in notifying close contacts can exacerbate the spread of COVID-19.

Another 532 cases were added to Victoria’s tally of coronavirus cases overnight, taking the number of active cases in the state to 4542.
 
More than 3000 are under investigation, meaning they are still determining where the person may have contracted the virus, while 1308 cases may indicate community transmission.
 
The exponential growth of recent weeks has contributed to an increasingly daunting number of potential cases that tracers need to identify and contact, but a string of recent controversies has left major doubts as to whether health authorities will be able to effectively manage the load.
 
Matt Mclean tested positive for coronavirus in April, two days after his partner – a healthcare worker – was also confirmed as having the disease. What followed was an exercise in bureaucratic confusion.
 
It took four days for Mr McLean’s partner to undergo a full contact-tracing interview – despite Department of Health and Human Services (DHHS) workers being informed multiple times that she worked in healthcare and had potentially vulnerable close contacts – only for her to then be contacted again 10 days later for another full interview as her contact tracer ‘couldn’t read’ her colleague’s handwriting.
 
As a result, the two-week isolation period had already passed by the time the DHHS contacted her colleagues. Mr Mclean told newsGP the response left him with ‘absolutely no confidence’ in the state’s ability to conduct effective contact tracing.
 
‘We were happy with the daily contact and found that reassuring, knowing that they were checking in, and I’m sympathetic to the difficulty of the work required,’ he said.
 
‘But we were left with little faith that close contacts would be accurately contacted, or that our valid concerns were listened to.
 
‘This was also in the first wave, where there were far, far fewer people getting positive results per day.’
 
While an outlier, Mr Mclean’s experience appears far from unique.
 
A Victorian GP working in a COVID-19 testing clinic, who has chosen to remain anonymous, told newsGP contact tracing is in some instances taking up to four weeks.
 
‘Victoria was never pandemic-ready. The systems are antiquated and clunky, relying on pen and paper whenever a doctor or laboratory rings to report positive COVID-19 cases,’ the GP said. 
 
‘We had one patient who was in contact with COVID-19 on 24 June, but not notified by DHHS until 20 July. It is not unusual to have patients coming in with an SMS of contact notification from DHHS which dates more than two weeks ago.
 
‘The staff are dedicated but completely under-funded and under-staffed. The government has been made aware of this for at least a decade but nothing effective has been done to bring DHHS into the modern world. 
 
‘Hence it is a slow-moving, lumbering organisation with no ability to respond quickly and efficiently to this COVID-19 situation.’
 
It is this experience dealing with the flaws of the current system that pushed the GP to the brink of tears when a new DHHS directive arrived in their inbox last week.
 
It stipulates that GPs can only test asymptomatic cases who have already been identified as a close contact and notified by the DHHS via a letter or SMS – despite delays having already been associated with other outbreaks, such as the Al-Taqwa cluster which is now linked to 183 cases.
 
‘It’s a total shambles. I cannot believe that they would restrict the number of people we can test now, at this point in time,’ the GP said.
 
‘What this is implying is that there should be no leeway or clinical judgment outside of DHHS because their contact-tracing system is perfect, but we know that it is so far from perfect it’s not funny.
 
‘It’s an appalling decision.’
 
The GP has also undertaken clinical work at some of Melbourne’s public housing hotspots in recent weekends, and said a patient of theirs provides the best example as to why this new policy is flawed.
 
‘I tested last week a DHHS worker, young 21-year-old girl who had just been working at those high-rise towers,’ the GP said.
 
‘Totally asymptomatic, but she said, “Look, I’ve just been working there. I know I’ve got contact with vulnerable patients next week. I just want to get tested”.
 
‘Now, under those current guidelines, she would not qualify for a test. She tested positive.
 
‘They’re going to miss huge numbers of positive people.’
 
A DHHS spokesperson told newsGP the directive is a result of a current focus on symptomatic testing within Victoria.
 
‘Anyone who has even the mildest of symptoms should get tested. The advice given to GPs is consistent with our testing policy across the state,’ the spokesperson said.
 
‘Asymptomatic testing is currently only recommended for people associated with an outbreak, returned travellers, aged care workers, and close contacts of known cases on or close to day 11 following their last exposure to the case.’
 
The spokesperson did not answer questions related to the percentage of cases currently under investigation that are more than six days old, nor the average length of time it has taken contact tracers to notify close contacts of confirmed COVID-19 cases over the past month.
 
According to the Herald Sun, all information from manually completed contact-tracing forms is scanned and sent to the DHHS’s central case database. It is reportedly ‘closely guarded’ information, with only select staff in hospitals and other health settings provided access, which has led to complaints about restrictions.
 
More than 3000 active cases reportedly waited up to five days to be interviewed before the tracing team was augmented with call centre staff, bankers, graduate paramedics and the Defence Force.

Contact-tracing-article.jpgGPs can spend 90 minutes or more on the phone each time they need to report a new case.
 
Victorian GP Dr Simon Benson told newsGP the phone and paper-based system was effective in the early stages of the pandemic, but that the high number of cases means it is now taking too long for contact tracers to interview index cases.
 
‘I am not entirely sure why this can’t be notified online in the usual way – no additional information is required and, if there were any, it could be asked in an online form as well as [provide] up-to-date information to pass on to patients,’ he said.
 
‘With such large case numbers and widespread understanding among referrers and clinicians of quarantine and isolation, I think there could be a change to using an online referral specific to COVID-19, via a custom form that is checked regularly by DHHS.’
 
Every time there is a confirmed case in a clinic, GPs must directly inform the DHHS over the phone within 24 hours. However, the high call volume means GPs are sometimes being placed on hold for more than 90 minutes. Dr Benson believes a transition to an online-based system could help improve efficiency.
 
‘[Requiring doctors to call] is presumably so that there is confirmation that the notification is made, as there is some urgency in receiving the information,’ he said.
 
‘[But] with the pathology labs also sending results daily, there is a good fall-back to ensure all cases are counted anyway, which would mitigate some of the risk associated in moving to an online process.
 
‘It is critical to contact trace quickly to terminate transmission from that index patient and 48 hours is too long.’
 
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Dr Joanna Lay   28/07/2020 9:32:31 PM

Currently we are chasing our own tail. We will never get on top of this pandemic with the current system. Yes, we all know DHHS is doing their best but we need to work smarter not harder. There are multiple examples of individuals doing their own contact tracing because they have tested positive, but have not been contacted by DHHS. Given that current community spread involves work places, employers need clear guidelines and protocols set up so that they know clearly the steps they need to take if a staff member tests positive. This should be communicated broadly to the public. We all need to work together. We cannot purely rely on the current DHHS contact tracing.