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The assertion by a senior official from the National Public Health Emergencies Team (NPHET) last Friday that restaurants were the main driver of Covid-19 transmission came as a surprise to many, not least to Dublin cafe owners. they had to close their businesses for hours. later under the latest round of restrictions in the capital.
But Professor Philip Nolan’s claim that public health physicians “don’t need to know” where a person contracted the virus also raised troubling questions about our contact tracing system, which, with testing, is supposed to be the primary weapon that we have in this pandemic.
“We would like to go back and find out where people get the virus, but we do not have the time and resources to do this academic exercise,” Professor Nolan tweeted.
For months, public health officials, without a qualifier, have published figures showing a low number of outbreaks in restaurants. But Professor Nolan abruptly changed this narrative by saying that there was “a lot of international evidence” of the role of restaurants and bars in driving community broadcasting.
Later, he clarified his comments by saying that public health physicians “would locate the source if they had the resources to do so, but they don’t.”
This amounts to the same; either we are not interested or we do not have the time / money / staff to investigate the ultimate source of the outbreaks.
In fact, public health physicians are involved in source case investigation, but contact tracing teams that handle community cases do not.
It is perhaps understandable that in the white heat of a pandemic, the immediate prevails over the important. The importance of tracing contacts and encouraging them to isolate themselves, thereby eliminating the risk of transmission, is considerable.
Contact tracing involves a particular skill set that is adept at relating to people and reassuring them about doing what’s best for them and the community, notes Professor Mary Horgan, an infectious disease expert.
Professor Philip Nolan’s claim that public health doctors “don’t need to know” where a person got the virus raised troubling questions about the contact tracing system. Photography: Colin Keegan, Collins Dublin
“Along with laboratory scientists, contact tracers are the unsung heroes of this pandemic,” said Professor Horgan, President of the Royal College of Physicians of Ireland.
However, we have already been through several stages of this pandemic, including an extended hiatus during the summer. There has been time to put the system on a more permanent basis and to make it more ambitious in scope.
“The system has to be able to experiment,” said Professor Horgan. “We need to be forensic in at least some areas, to dig into the information and establish trends, from which we can extrapolate.”
That information is a valuable resource that can tell us a lot about people’s behavior, where the virus is being successfully transmitted, and how people adhere to current guidelines, according to Professor Horgan.
The HSE says that while contact tracing includes questions for all identified cases about the source of infection, “it is now being considered how these processes can be further improved.”
Japanese investigations
Perhaps the best example is in Japan, which specialized in retrospective case investigation in addition to the prospective investigation of current cases that most countries do.
In prospective tracing, close contacts of a Covid-19 case are monitored so that they can be quarantined if they show symptoms. But Japan also tried to find out where they were infected and then monitored the people who visited that site. The goal was to catch one in five cases who happen to be super spreaders.
While the process of tracing contacts and gathering information about their movements can be laborious, data analyst David Higgins said the process of analyzing this information electronically was not.
“Contact trackers have to collect information over a long period of time, roughly the two weeks that the virus spends incubating. They also have to get all the relevant information, ”said Higgins of Carraighill consultants.
“Details about cases, by Eircode location, can be loaded into a database, and a search can return matches by location and other criteria.”
The resulting information could help provide real-time clues to where the virus is spreading and, more generally, pinpoint general environments conducive to its transmission.
Since NPHET was making “life and death” decisions for companies, resources should be provided to ensure they were well informed, he said. “We will end up saving money in the long run.”
However, it may be too late to expand the scope of contact tracing. The World Health Organization says contact tracing can be “difficult” when transmission of the virus is “intense,” but it should be done “as much as possible.” Over the next several weeks, firefighting is likely to dominate disease detection.
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