As cases rise, state contact tracing has seen a quiet revolution

“We want to address the most risky metrics early and first,” Ms Matson said. age and Sydney Morning Herald.

“If you work in a nursing home or you work in a hospital or you work in a nursery where of course the children could not be vaccinated, we are going to want to talk to you and understand your situation before we understand someone who could be a barista or a landscaper.

People wedded to the idea of ​​what contact tracers did will see it as a public health failure, but Rhonda Stuart, an infectious disease expert who heads the Department of Health’s South East Public Health Unit , describes it as a necessary response to a COVID-19 landscape.

Finn Romanes, the director of the Western Public Health Unit which covers some of Melbourne’s suburbs hardest hit by the pandemic, says there is “intense pragmatism” behind the change.

“We looked at where there were risks and where there were consequences and tried to shift our efforts, our people and our focus to where we could make the biggest difference,” he says.

Professor Stuart describes the new approach as ‘risk stratification’, a form of public health triage that prioritizes those most at risk and those who will benefit most from early intervention. His unit is treating more than 5,000 cases of COVID-19.

“We don’t have the capacity to call every person and say you’re positive,” she says. “They’ll get a text straight from the lab saying you’re positive, stay home, self-isolate. There will also be a questionnaire they can fill in asking “are you double vaccinated, do you have any risk factors, have you been in a sensitive environment”.

“Areas where people are at risk will still be searched, but generally cases will be managed in the community and close contacts will be defined as their household. We’re going to have to start letting the public take responsibility for containing the virus. »

Now that Victoria, like NSW, has abandoned its goal of COVID zero, much of what we have learned about contact tracing and case management is being reviewed by Chief Health Officer Brett Sutton and his public health team.

The old practice of contact tracers starting with one case and working their way outward through increasingly distant concentric circles of contacts has been abandoned, with health officials acknowledging that the virus is spreading massively to residence.

Terms such as primary and secondary close contacts and sites of exposure are becoming redundant, with Dr Romanes saying his team is embracing simpler language and a clearer public health message.

The origin of new cases – the stories behind the numbers, as Premier Daniel Andrews said – is less important than carrying out rapid risk assessments on whether a case is likely to end up in intensive care or infect someone who will.

The rules governing our public health response – requiring all positive cases and people they come in contact with to self-isolate for 14 days – are being revised to reduce the time people are forced to spend out of work or school.

The new rules will take into account different risks associated with vaccinated and unvaccinated people. “We’re still working on it as a public health team, but I’d like to think that in a few weeks we’ll be communicating some changes,” Ms Matson said.

Victoria Department of Health Deputy Secretary Kate Matson.Credit:Chris Hopkins

Some of these possible changes are being tested in supermarkets, where vaccinated employees potentially exposed to an infected colleague no longer have to stay at home for two weeks. “Our response needs to evolve with the community’s response,” says Professor Stuart.

The impact of vaccination is a key consideration for contract tracers, with compelling data coming from outbreaks in Victoria and New South Wales. Ms Matson said that in the past three months only 7.4 per cent of Victoria’s COVID-19 cases had been fully vaccinated. Dr Romanes said NSW data suggested that for every four people in their 50s vaccinated against COVID-19, one fewer person ends up in hospital.


The flip side of this equation is clear. “Eventually, if you don’t get vaccinated, everyone is going to get infected with COVID in the coming months,” says Dr. Romanes. “It is impossible to stop COVID. If you choose to get vaccinated, you can significantly reduce your risk of hospitalization and death.

There is an emerging treatment that offers a lifeline for people infected with COVID-19 who are most at risk of dying from the disease. Monash Hospital in Clayton has started intravenous infusions of the newly approved drug Sotrovimab, a monoclonal antibody that significantly reduces the risk of serious illness. The treatment will also be offered by Western Hospital in the coming days.

Professor Stuart says that to be effective, sotrovimab must be given within five days of the onset of symptoms of COVID-19. This is another reason why contact tracers focus on those who need their help the most.

“By decreasing the calls on each case when we know the majority will be fine isolating at home and focusing only on those at risk – those who need an infusion or are more likely to transmit to d ‘others – we free up the ability to do other important things,’ she says.

“We are not failing; we are shifting focus so that we can deal with this virus, in all of its tricky ways, and focus on those most at risk.

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