Quebec's new contact-tracing system panned by expert as 'very outdated'

Quebec's new digital contact-tracing system falls short of what's considered necessary by experts to contain the spread of COVID-19 as the province reopens.

Contact tracing, a public health practice to help stop the spread of infectious diseases, involves identifying every individual who has come into contact with an infected person.

Canada's chief public health officer has called it an "absolutely critical" tool to contain the spread of COVID-19.

A new digital platform to automate the tracing process was supposed to be delivered to the province three weeks ago, Quebec Public Health Director Dr. Horacio Arruda said earlier this month.

That platform, designed by the Quebec company Akinox, is now set to arrive later this week, but it's not clear even once it is up and running how well it will help track and curb the spread of the disease.

Relies on email chain

While jurisdictions like Alberta are adopting app-based contact-tracing tools, which use Bluetooth or GPS to determine with whom a person has spent time, the model Quebec has commissioned is email-based.

When someone tests positive for COVID-19, they will be sent an email, said Julie Barré, Akinox's director of professional services and solution delivery.

The email will include a link to a form where the patient can report the severity of their symptoms, so if needed, a public health worker can follow up with them.

The form asks them to include the email addresses of everyone they've been in contact with in the days before they tested positive for the virus.

Those people, in turn, will receive an automated email asking them to fill out a form and include the email addresses of everyone they've been in contact with — and so on.

"With the questionnaire, they fill out the information about people they've been in contact with, [and] as much as possible provide an email address for those individuals, as well," said Barré.

The platform was built in a matter of weeks. Akinox landed the contract in mid-March, just before the pandemic hit.

Barré said her team worked "crazy hours — suddenly 80 to 90 hours, for a few weeks."

McGill Prof. Jörg Fritz, an associate professor of microbiology and immunology, said at first glance, this system appears "very outdated and old-fashioned."

He said if an infected person goes into a grocery store and is in contact with a dozen other strangers, this email system would do nothing to help track those people down.

"My first reaction is it does not make sense to me at all," he said.

Fritz would like to see Quebec adopt an app-based model that tracks people's movements, making it easy to see exactly where a person was at any given time, providing they have downloaded the app to their phone.

Fritz says he's aware of the privacy concerns about tracking people's movements but said asymptomatic people are currently spreading the virus, and the province — now the seventh deadliest place in the world for daily mortality from COVID-19 — is lagging behind in curbing that spread.

"These are special circumstances, and the situation should be seen as such," he said.

"We have a world-class problem now, and I think we need to apply a world-class technology." 

Investigators still needed

The new system will not be a replacement for the laborious footwork involved in contact tracing that still must be done.

Even once an automated system is in place, health-care professionals working as contact tracers must follow up with calls to everyone who has been exposed to COVID-19.

Montreal Public Health Director Dr. Mylène Drouin said the department has 350 investigators and the capacity to conduct 500 tracing investigations per day. A spokesperson with Montreal public health has confirmed that 50 investigators are working at any given time.

Right now, there are about 800 new COVID-19 cases confirmed each day in Quebec. On average, about half of those cases are on the island of Montreal. Public health officials have said those numbers will probably rise when Quebec increases its testing.

Drouin said her team wants to hire more investigators to trace contacts more quickly but will only hire people with the right expertise.

"When you're doing those investigations, you have to have at least a training or background in health," she said.

CBC News spoke with three Quebecers who had been in contact with someone who contracted COVID-19. They all said it was more than 24 hours after the person they knew had been confirmed COVID-positive before they heard from public health.

In the interim, they were not in quarantine and risked infecting other people in their circle. 

Dr. Hai Nguyen, an orthopedic surgeon at the Charles-Lemoyne Hospital on Montreal's South Shore who is currently working as a contact tracer, said he receives a list of three or four cases to investigate each day.

Every investigation takes several hours, he said. It can take even longer, if any information in a patient's file is incorrect.

"Sometimes you have to spend some time getting the right info just to do the interview," he said.

"A lot of people don't necessarily remember where they've been," said Nguyen. "When you're trying to get this information, things come out in a very patchy way. So you get these dossiers that are very incomplete."

Surge of cases expected

"The big problem is the high number of these people are asymptomatic," said Nguyen. "We see that there are a lot of people walking around and spreading the infection."

It's why many infectious disease experts say testing widely is so important.

Although Premier François Legault has said repeatedly since mid-April that the province's goal is to ramp up testing to 14,000 tests per day, it continues to fall short of that target — reaching just 9,000 daily tests, he admitted Wednesday.

And Quebec is so far not testing people in the general population who are asymptomatic, despite the concerns of experts like UQAM virologist Benoit Barbeau.

"What goes under the radar is all the people who stay at home with mild or no symptoms," Barbeau told CBC last week.

There's no question the virus is spreading in Montreal, the COVID-19 epicentre in the province, undetected by asymptomatic coronavirus carriers, said Fritz.

What the government does now — and how it moves to trace people quickly and thoroughly — is imperative if Montreal is to avoid catastrophic results.