The new pandemic reality: limited testing and do-it-yourself contact tracing

“The public is not trained to navigate these types of conversations. Even we in healthcare are finding it difficult.”

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When Paul Peters’ 11-year-old son suddenly fell ill over the weekend with a high fever and extreme fatigue, he immediately suspected it was COVID-19.

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His suspicions were quickly confirmed when the boy tested positive with one of the rapid antigen tests provided to Ontario school children to use during the holidays.

So began a stampede that continues three days later for the Ottawa family amid the exponential spread of the Omicron variant and rapidly changing public health advice.

The family’s experience illustrates the worsening situation in Ottawa as COVID-19 testing facilities and contact tracing teams are overwhelmed by an explosion of new cases, leaving people waiting – or unable to do – test and having to inform their contacts themselves. Fewer people are expected to qualify for PCR testing in the coming days as essential workers and high-risk populations are prioritized.

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Twenty-one months into the COVID-19 pandemic, “We’re in uncharted territory here,” University of Ottawa epidemiologist Raywat Deonandan said of how the Omicron variant impedes the ability public health officials to respond.

Peters said his son started feeling unwell on Friday night and on Saturday he had pains all over his body, a headache, a throat so sore he could barely speak and a temperature of 105 degrees Fahrenheit .

“I’ve never seen him with such low energy, I’ve never seen him so sick. We had to help him out of the bath, that sort of thing.

Paul Peters.
Paul Peters. .jpg

Peters and his wife tried to book a PCR test for their son at the Brewer Park Children’s COVID-19 Assessment Center, but no appointment was available until Wednesday, December 22. Peters went to the Brewer Clinic in person, thinking he might be able to get a walk-in appointment or a take-home PCR test kit, but no luck either.

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Peters said he wanted to warn anyone his son had come into contact with before crucial days passed.

Ottawa Public Health protocol now states that if you have tested positive for COVID-19 in a PCR test, you must tell anyone you have been in contact with, as the contact tracing system is overloaded. But the family were unable to get a timely PCR test for their son to confirm his positive rapid test and had no guidance on what they should do.

Peters decided it was necessary to act immediately. What if it takes a week to book a PCR test and get the results?

“We wanted all the other parents to know and we wanted the school to know.”

He notified teachers, parents of children in his son’s class at Hopewell Avenue Public School whose contact information he had and also asked a friend with a Facebook account to post a notice on a neighborhood group to alert the parents.

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Peters soon received reports via email and Facebook that several other children in her son’s class had tested positive for PCR or rapid tests or had other symptoms.

He also called Ottawa Public Health — they don’t answer the phone on weekends, he said — and 311 to try to notify authorities of the situation.

“I wanted this to get into the system so that public health would be notified as soon as possible so that other parents would receive a letter.”

There appears to be a gap in the system, Peters said. There were no public health instructions on whether to notify close contacts if you have a suspected case of COVID-19 or a case that was only confirmed by a rapid test.

That will likely change as Ottawa Public Health continues to process more cases than it can handle. But there will inevitably be gaps, experts say, as more of the burden of managing the pandemic falls on individuals.

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On Monday, OPH tweeted that testing sites are seeing an unprecedented surge “and cannot keep up with demand”. Public health advised people to self-isolate if they had symptoms, tested positive or had close contact with a positive case.

Ottawa’s COVID-19 testing task force says testing will change in the coming days to prioritize essential workers and vulnerable populations.

The situation leaves the management of the pandemic more to individuals. And that creates challenges, especially at a time when pandemic fatigue has never been higher.

Do-it-yourself contact tracing, for example, is seen as a last-resort strategy to manage the COVID-19 pandemic, but is increasingly relied upon in Ottawa and elsewhere in the face of the explosive growth of the Omicron variant.

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This has an additional emotional impact on people already dealing with COVID-19. Uncertainty about advice adds to this burden. People who have had to call contacts report that they sometimes face anger and backlash in addition to questions they cannot answer.

“The public is not trained to navigate these types of conversations. Even we in health care are finding it difficult,” said Fatima Tokhmafshan, a bioethicist and science communicator who studies medicine. She said she made calls on behalf of friends and found it difficult.

And, with pandemic fatigue high and some cases of the Omicron variant mild, it could become increasingly difficult to convince people to self-isolate, especially if testing and contact tracing are not widely available, said Deonandan.

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Deonandan said the goal must be to continue to slow the transmission of the virus until more people are vaccinated in order to mitigate its effects and protect young children who are still unvaccinated.

There will likely be gaps in the system as cases continue to rise, he said, but if enough people with symptoms stay home and other policy tools such as limits on capacity are in place, that should make a difference.

Peters and his family, meanwhile, have had first-hand experience of the new reality of the pandemic.

“If it’s the Omicron strain, it seems so contagious,” he said. Her son was following all pandemic protocols at school. “I’m sure he was wearing a mask and they were following all the rules.”

Peters says his son feels better now. He, his wife and two other children are all isolated at home.

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