When Shaleen Erwin became sick with COVID-19 in November, the pregnant mother from Springside, Sask., wasn’t surprised that she had a hacking cough and slept 16 hours a day.
What astonished her was that she received a phone call every day from a public health worker at the Saskatchewan Health Authority (SHA) to check on her, her husband and their three-year-old son — all of whom had contracted the virus.
“I was blown away…. It’s hours and hours of time, and time is such a valuable resource,” Erwin, 33, said. “I think there’s this misconception that if you’re not using an ICU bed or you’re not using oxygen, that you’re not using resources.”
Provincial public health authorities are advised by the Public Health Agency of Canada to contact people with COVID-19 at home every day to monitor both their symptoms and compliance with isolation rules, depending on available resources to make those phone calls. Some provinces, including Saskatchewan and Manitoba, are attempting daily phone calls while others, such as Alberta, are not.
Ontario’s Ministry of Health advises public health units to notify people of their COVID-19 positive status with a phone call, then make followup phone calls on Day 5 and Day 10, at a minimum. On other days, the person is supposed to receive at least a text message or email.
Thousands of 10-minute phone calls a day
If contact tracers, who investigate the spread of the virus, are considered the public health detectives, then case monitors are the parents — checking on how you are and making sure you follow the rules.
Pamela de Bruin, clinical standards and professional practice lead with the SHA who does planning in public health surveillance, said the health authority uses a database to investigate, track and actively monitor positive cases and close contacts.
She said the “standard of care” is a daily phone call to every person in the province with COVID-19 — currently 4,121 people — except to those already receiving care inside long-term care homes, hospitals or jails. They monitor symptoms, check on compliance and offer access to resources, such as mental health services.
“There are many social barriers that can come up when people have to be isolated for a long period of time, and they may be faced with making a choice between getting groceries or staying isolated,” de Bruin said, adding that public health workers are able to connect people with resources and services to help them comply with mandatory isolation.
The 10-minute phone calls to active cases require more than 600 staff hours a day. The SHA uses 66 people from Statistics Canada for case-monitoring calls, as well as some nurses and licensed health workers.
“We’re constantly evaluating the capacity against the number of cases,” de Bruin said, adding that the SHA has so far been able to meet the demand, and she believes it’s a worthwhile use of resources.
“We’re speaking to an individual, but when we implement measures, like all public health measures, we’re looking for an impact at a population level.”
In addition to active cases, the SHA makes a daily call to monitor their close contacts who have symptoms or comorbidities, as well as close contacts who are red-flagged in the database as being potentially non-compliant with public health restrictions.
“Sometimes right at the first [notification] call, we have indication to believe someone might not be compliant. Sometimes they tell us. And so those would be called daily,” de Bruin said.
Alberta doesn’t have active monitoring
In Alberta, where there are roughly 12,230 active cases at the moment, Alberta Health Services (AHS) does not actively monitor people who are sick with COVID-19 at home. Instead, from the start of the pandemic, it has advised people to seek medical attention from a doctor or call 811 or 911, depending on their condition.
That was sufficient for Talana Hargreaves, a 38-year-old mother of three from Edmonton whose entire family tested positive for COVID-19 in November. She was initially concerned by the lack of personal followup from AHS but was eventually satisfied with a one-hour phone call from a contact tracer.
Hargreaves, who had spent a lot of time researching COVID-19 online and following news reports, discussed her family’s mild symptoms with their doctor and didn’t have any questions about the isolation rules.
“My partner and I are both conscientious rule-followers,” she said. “I think that COVID check-in could actually be very valuable for some people who honestly don’t know what they should be doing.”
She said she is more concerned about the backlog of contact tracing in the province and allocating resources to investigating cases.
“They still don’t know where roughly 50 per cent of our positive cases have come from … so even though it would be nice to have that followup, I don’t know that it’s realistic at this point,” Hargreaves said.
Health worker sent thermometer to home
Jony Rahaman, a Regina restaurant owner who tested positive for COVID-19 in early October, did not have mild symptoms. He felt like he was choking to death.
Rahaman, 36, said the public health workers who called his family were like “guardian angels.”
“They call us every day,” he said. “Me and my wife, especially my wife, would wait for their call because we had so many questions. They’re so patient.”
The family didn’t have a thermometer to check their temperatures, so a public health worker sent one to their home.
Rahaman — who contracted COVID-19 before the rest of his family — initially self-isolated in his bedroom away from his wife, Sabina, and two children and could barely speak to them through the door.
“It was terrifying,” he said. “My wife was crying on the other side of the door, kids were crying on the other side of the door and I couldn’t breathe.”
During one phone call, a public health worker called an ambulance for him.
“They’re, like, my lifesaver,” Rahaman said.
Removing barriers to compliance
The SHA’s de Bruin said providing equipment, such as a thermometer, isn’t the norm, but she noted that each case is unique, and the goal is to remove barriers to compliance.
“I have heard the types of ends of the Earth that some of this staff have gone to, and it doesn’t surprise me one bit,” she said.
At five months’ pregnant in November, Shaleen Erwin was nervous about having the disease and scared by what she found online when she did a Google search for “pregnant covid.” The constant access to public health workers was comforting, she said.
Erwin said some of the questions from public health workers who called were likely “subtle” checks on whether her family was following the rules, which they were, but she “never felt like it was accusatory.”
Now fully recovered, she has watched the case count climb in Saskatchewan and thinks about all of the phone calls happening every day.
“People see [case] numbers and they think, ‘Oh, 99 per cent of people will be OK,’ but don’t assume that that means that you’re not a burden on the health system,” she said.
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