Launched in a race against the clock, they have risen to this day the industry of the approximately 51 000 people infected by the COVID-19 in Quebec to meet up with their many contacts in order to curb the epidemic. However, the déconfinement and the beautiful days of the summer that looks may double, or even multiply their task.
These detectives of the COVID-19, approximately 1000 investigators hired by the directions de santé publique (DSP) to ensure follow-up monitoring of all people infected in Quebec. However, in their war against the virus, these soldiers of the shadow are not evenly distributed. In Montreal (more than 25 500 cases of infection), 140 people work full time in the investigations, compared to 179 in the Montérégie region (nearly 7000 reported cases) and 170 in Laval (most of 5450 case).
A situation that is not without a concern for some investigators who, with the screening and the measures of hygiene and distancing physical, one of only three weapons available to the DSP to contain the epidemic.
According to Dr. Noémie Savard, a medical doctor, specialist in public health, responsible for medical follow-ups to the DSP of Mont-
réal, the number of contacts that are “close” by infected person, 2 to 3 currently, could go from 5 to 6, and even go up to 20 with the déconfinement, according to projections made in the United States and Europe. “We would like to have a crystal ball. We are preparing for it. An increase of the cases, it will involve recruiting staff, ” she said.
“What I see for weeks, it is that, when someone has [the COVID-19] at work or in a family, it is not long before the other catch. Even paying attention. Especially when the person is asymptomatic, ” said one investigator, who requested anonymity. His mission : to join every day five or six persons declared to be positive, ten when all is going well. Once the test results arrived by fax, it contacts the patient and completes an entire folder by hand.
In Montreal, two shifts (day and evening) 30 people work seven days a week to reach each new person who has been declared positive (of 212 new cases daily (30 may), draw up their balance sheets to health, and to ascertain the probable place of contamination (up to 14 days before the onset of symptoms.) Then, it is necessary to draw up the detailed list of their contacts “close” (more than 10 minutes to less than two metres) 48 hours before getting sick and for up to 14 days after. All those living under the same roof are from the outset classified positive by epidemiological link “.
A second team of 50 people, then takes the relay to reach all these contacts ” close “, by phone or by email, to inform them that they have been exposed to the virus. It checks to see if they developed the illness. Isolation and monitoring of the state of health are necessary, even for those who do not have symptoms.
“In general, people cooperate well. But sometimes, they are sick, or hospitalized. Sometimes, they are deceased. I have not lived, but it’s happened to others, ” said another investigator. For each case, the interviews stretch from 45 minutes to 1 h 30.
If the task is more easy to locate the health care workers already informed of their risk of exposure by the employer, it becomes more complicated for cases contracted in the community. “One day, a investigator next to me was talking to a person who has been declared positive, in which one of the contacts died. It bore any guilt for having transmitted the virus. The emotional load can be intense at the end of the wire, ” says this investigator.
Very often, the call that fateful is not a surprise, because the called are already sick. “For the majority, it is clear where they caught him. Some have fat on the heart, against their working conditions, their employers. They feel like a number “, she adds. His colleague recalls a difficult case. A health care worker is pregnant, and that it was forced to remain in that position. She was anxious, worried about her future. “Sometimes, there is a lot of work down,” she said.
Rarely, some people do not know how they contracted the virus. “An elderly lady who did not leave home, she did not know how she was able to be infected. She was delivering her groceries, it was the only clue, ” says the same investigator. Even people well-equipped to protect themselves fall on the battlefield. “Without that there is gross negligence, several employees of the hospitals are infected with the virus. There is still a shadow part on who is infected and why “, think of his colleague.
As the summer is coming, the challenge for investigators will be to successfully monitor the speed of spread of the epidemic. “The déconfinement, says this investigator, it is a little disturbing. It can become exponential. “
Still enmeshed in a system that is semi-computerized, the DSP de Montréal hopes to complete its computerization, and to improve “the flow of records management” within a few weeks, ” says Dr. Savard. Despite a difficult start, she argues that the surveys, to day, start now 24 hours after the arrival of the result, sometimes the same day.
One thing is for certain, at the height of the summer, slow the coronavirus is not to be based not only on the shoulders of these investigators. “People need to remember that the virus is still there, and that it is they who will make the difference in continuing to keep their distance and wear a cover face. For this to work, we must do it together. “
Many investigators of the DSP in Quebec
Montreal : 140
Laval : 170
Montérégie : 179
Outaouais : 5 to 10
Lanaudière : 74
Mauricie : 75
Saguenay : 82
Côte-Nord : 37
Capitale-Nationale : 30
Chaudière-Appalaches : 53
Bas-Saint-Laurent : 35
Gaspésie–Îles-de-la-Madeleine : 30
With the collaboration of Marie-Eve Cousineau
The research contacts to counter a second wave
The key to continue the déconfinement and prevent a second wave is to perform the largest number of screening tests possible, to search for contacts that persons reported as positive have had and to join them so they isolate themselves and go and do the test as quickly as possible, summarizes Benoît Mâsse, a researcher at the School of public health of the University of Montreal. “According to what we know of the COVID-19, it is necessary that the contacts search is extremely fast and efficient to cut off the transmission side. Of all the measures, it is the one that will help us the most to stay déconfinés and to prevent a second wave. However, it should put a lot of personal energy and effort, ” he stressed. The applications have the advantage of going more quickly to prevent the contacts, but they are not enough. They will never replace the surveys manual. Elsewhere in the world, we call the two strategies. “
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