Contact tracing in Alberta’s 2nd wave: Documents show huge backlog, staff shortages

It started slowly, but surely. As summer of 2020 turned to fall, the number of Albertans contracting COVID-19 started to rise and high daily case counts quickly became the norm.

A second wave had already started in other countries — and other provinces — and there was concern from health experts that it was only a matter of time before the ripples seen in Alberta would turn into a tsunami of COVID-19 cases.

By early November, the daily case count was growing exponentially and it was obvious the second wave would be dramatically different from the first.

Strategies to curtail the pandemic were well-known by that point: measures to stop or slow the spread, increased testing to find cases and contact tracing so health officials could track where spread was happening and warn those who might have been exposed.

The provincial government resisted calls for more restrictions — for a “circuit breaker” — despite multiple letters from doctors saying it was necessary to prevent the healthcare system from becoming overwhelmed. It did increase testing capacity in the lab.

But the province was firm that its contact tracing system was “robust.”

It was wrong.

Internal Alberta Health Services documents obtained by Global News reveal — for the first time — the extent of the growing backlog of cases for contact tracers during the second wave and that its workforce was insufficient to keep up with soaring case numbers.

This, despite repeated assurances to Albertans that work was underway to remedy the faltering system.

“We are working with AHS to support them to hire and train contact tracers as quickly as possible,” said chief medical officer of health Dr. Deena Hinshaw on Nov. 5, 2020.

Experts said the province should have been more prepared for contact tracing, saying it was — and continues to be — an important tool in stopping the spread of COVID-19.

More alarming is the assertion from health experts that the uncontrolled spread due to the collapse of the system not only led to more cases but possibly caused more deaths.

During the second wave, roughly described as between mid-October 2020 and mid-January 2021, there were 94,171 new cases reported and 1,115 Albertans died from COVID-19.

Many days, deaths were in the double digits. In December alone, 505 Albertans died from the disease.

“It just makes you wonder…how many calls weren’t even put through, how much spread of COVID was occurring that we didn’t even know about and people weren’t even aware they were a contact?” said University of Calgary epidemiologist Kirsten Fiest.

A Global News investigation shows that the backlog of COVID-19 cases for contact tracers climbed steadily from 2,053 on Nov. 2, 2020 to 23,527 on Dec. 11, 2020. That same day, an AHS report indicated that it would take 340 days for contact tracers to clear all cases.

“I wasn’t expecting to see such a large volume of backlogged cases at that time,” said Fiest.

The reports also indicate that on Nov. 16, 1,260 full-time equivalent contact tracers were required to handle the caseload; but only 331 staff were working that particular day.

By Dec. 7, the staffing issue was still not resolved – AHS reports indicate 2,264 staff were required to deal with the caseload; only 244 were working.

“I think we had very little sense just how many contact tracers we needed that we didn’t have,” said University of Calgary health policy expert Lorian Hardcastle.

Global News obtained more than 200 pages of documents from AHS through a Freedom of Information request that paint a stark picture of the state of the contact tracing system as Alberta was logging record-high case numbers.

The documents contain status reports on contact tracing and briefing notes for the executive leadership team at AHS from November to December 2020.

The documents reveal alarm bells were being sounded within AHS in early November about the state of contact tracing and intensified as the situation worsened:

• Nov. 3, 2020: “Each case has on average approximately 15 close contacts that require investigation and management. We anticipate that by next week, the backlog, without any further mitigation strategies, will be at approximately 4,000.”
• Nov. 12, 2020: “We would need on average 400-500 more staff a day on the team to get through the daily volumes we are seeing right now.”
• Nov. 17, 2020: “The current contact tracing workforce is not sufficient to manage the current COVID-19 surge.”

However, at the same time, public officials insisted that efforts were being made to fix the situation.

Three weeks after Hinshaw’s comment about AHS hiring more contact tracers, Premier Jason Kenney said on Nov. 24, 2020, that Alberta had the most robust contact tracing system. However, at the same time, he admitted it was compromised because of a “significant” spike in cases.

Then, on Dec. 4, 2020, AHS President and CEO Dr. Verna Yiu said the province had more than 900 contact tracers and AHS was trying to double that number by the end of 2020; though, ultimately, that did not happen.

Yiu, when asked whether it was too late to be hiring contact tracers, said the health authority had been progressively boosting staffing.

“Pre-pandemic, we started with 50 people in our CDC (communicable disease control) team, so we’ve been increasing all along. Obviously, with the exponential increase, we’re trying to obviously catch up with that,” Yiu said at the time.

Hardcastle, a professor in the Faculty of Law and Cumming School of Medicine, said there was a sense in the fall that the government was hiring contact tracers faster than they were.

“But I think what the public didn’t understand, where there was a lack of transparency, is in the fact that the needed tracers seemed to have not been hired and that there was a constant need for more that just was going unsatisfied,” Hardcastle said.

Contact tracing is the process of working with a person who tests positive for COVID-19 to identify all their close contacts and movements in the days prior to the positive test.

As the province struggled to handle the surge of cases, changes were made to the system in November, including prioritizing high-risk settings for contact tracing, such as schools, continuing care and healthcare facilities.

Albertans who were not considered high-priority were asked to do their own contact tracing. By the end of the month, contact tracers were being told to work through the most recent cases first and not to investigate if it had been more than 10 days since an individual tested positive.

Both experts agree that there was likely more transmission of COVID-19 in the province than the public was led to believe.

“People were likely spreading COVID without even knowing it, to people who didn’t know they were a close contact of a case because they weren’t informed,” Fiest said.

“I do think that that definitely led to increased cases that we saw during the second wave.”

Hardcastle goes even further, saying the breakdown in contact tracing may have contributed to more deaths in the province.

“It’s unclear that we would have had as many cases as we had in December and as many deaths as we had in December,” she said.

“Maybe restrictions could have been more targeted or shorter if we could have tailored those restrictions to where we knew cases were coming from. But then second to that, if we knew where cases were coming from and people were contacted, that might have reduced the number of cases and ultimately the number of fatalities.”

Fiest said the contact tracing infrastructure should have been bolstered before Alberta found itself in a compromising situation.

“Hiring people earlier and maybe not even needing them would have been a more proactive approach as opposed to a reactive approach, which was waiting until we were overwhelmed to hire more people,” Fiest said.

Hardcastle agrees, saying that from the start of the pandemic, it was clear contact tracing was essential.

“That’s really one of the bare minimum requirements that we would have for an effective public health system, is one where there is contact tracing,” she said.

Hardcastle said case rates did not suddenly spike in the fall — but rather, climbed day-by-day.

“The government had time throughout September, October as rates were climbing before we found ourselves in a really concerning situation in November, December,” she said.

“It’s unclear why, of all the things the government might have prioritized, that contact tracing was allowed to fall off the rails.”

In a statement to Global News, AHS said “this is not accurate” regarding Hardcastle’s assessment.

“The needs of the COVID-19 pandemic continue to evolve and have been difficult to predict,” the health authority said.

“We recruited and onboarded staff as quickly as possible. We developed and implemented several tools to ensure we were notifying cases and close contacts as quickly and efficiently as possible.”

With the system failing, many Albertans were left to fend for themselves when it came to contact tracing,

Serena Tang was one of them. The 29-year-old tested positive for COVID-19 in late November, but she did not receive a phone call from a contact tracer.

“It never officially happened at any point,” she said.

Instead, the Edmontonian was sent a link via text message to a form to identify her close contacts.

Tang, who kept notes about where she had been and who she had seen, said her concern was about taking care of the people she had been in contact with. She took contact tracing into her own hands but there is no denying it was more responsibility than she had bargained for.

“You force yourself to do it even though you’re sick,” she said.

Isolated and feeling abandoned by the province, Tang said she was disappointed that the contact tracing system got to that point.

“I, especially when I was sick, felt let down at certain moments.”

AHS said it continued to call and complete investigations on high-priority cases and that positive cases were notified through a text or phone call. The health authority also reiterated that contact tracing has always been a shared responsibility.

“We have always asked people with COVID-19 to identify their close contacts and if they have enough information about them, we notify those contacts. AHS contacted as many close contacts as possible throughout this time and we value these partnerships,” reads a statement to Global News.

AHS said it now has approximately 2,500 contact tracers and that since Jan. 9, teams have been able to investigate a case within 24 hours of a positive result.

It said, during the peak of the third wave, from which the province is now emerging, contact tracers investigated more than 2,000 cases on multiple days.

Though the province acknowledged that there were issues with contact tracing during the second wave, Hardcastle said there should have been more transparency about the gravity of the situation – that thousands of COVID-19 cases meant to be contact traced were left languishing and many had no idea they were a close contact of a positive case.

“People may have been more vigilant about calling their own contacts and notifying people themselves if they knew the magnitude of the problem here,” said Hardcastle.

Fiest concurs that there should have been more openness about the state of Alberta’s contact tracing infrastructure.

“That might have allowed the public to themselves be a little bit more cautious about their interactions over and above the public health measures that were already in place at that time,” she said.

Alberta Health spokesperson Tom McMillan said Albertans were kept informed about the contact tracing system’s challenges during the second wave.

Likewise, AHS said it has always strived to be transparent and did its best to provide updates on the contact tracing system since the start of the pandemic.

“Contact tracing in our province has always been a shared responsibility with Albertans as well as workplaces, schools and event organizers,” reads the AHS statement.

“We value these partnerships and we will continue to share updates and information with the public and our partners to be as transparent as possible.”

The province is slowly coming out of the third wave of the pandemic and there is hope Albertans will be able to return to some sense of normal in the coming months.

However, for Hardcastle, the issue of trust in the government persists.

“With this information, now there seems to be specifically a public trust issue around contact tracing and that the government is trying to reassure people that it’s happening. But it’s hard to trust them that it’s happening knowing now what we know about contact tracing during the second wave,” she said.

“Where we don’t have public trust, that undermines public health measures and undermines compliance with those measures.”