“The virus is always outsmarting us”: A Q&A with Omar Ozaldin, Toronto’s chief contact tracer

Omar Ozaldin was a contact tracer long before the term entered the common lexicon. He spends his days calling up people laid low by infectious diseases—in the past, that’s been SARS, measles and mumps—and then tracking down every other person they may have been in contact with. As a manager in Toronto Public Health’s infectious disease control department, he now leads an enormous team of such disease detectives, all dedicated to stopping the spread of Covid-19. Here, he talks about the challenges of the job, how helpful Torontonians can be, and what will happen if we get a dreaded second wave.

So, where are we these days in terms of contact-tracing? How quickly are people getting contacted after someone tests positive for Covid?
The provincial target is 90 per cent of cases within 24 hours. We’re actually doing much better than that. I just looked at our recent numbers and we’re very close to 95 per cent, and some days even higher. We’ve added more staff to the response. We’re also being more creative, thinking outside the box, in terms of reaching clients when we don’t have accurate or updated contact information for them. We’ve been couriering letters to houses, doing house visits, that sort of thing.

How big is your staff now? The last number I heard was 700.
We’re deploying staff constantly. In the last 24 hours, we added 25 people. Because we wanted to give people who have been working on this from the beginning some time off, but also we want to train new people now, in the summer, when cases are lower. You don’t want to throw people into it when the outbreak is at its height.

And this is staff and volunteers?
We do have a number of volunteers. These are generally medical students and they’ve been doing an excellent job.

Being a contract tracer seems like very difficult work. You have to have the skill-set of a detective, a journalist, a psychologist, not to mention a thorough knowledge of epidemiology. What kind of training does your staff get?
The individuals who’ve been with us since the beginning of the outbreak are the core team—contract tracers who have been with public health for a very long time. They’ve dealt with other infectious and reportable diseases, and they’ve been very well trained. As we expanded the response, we trained a new group and that training involves increasing their knowledge about this specific disease but also how to communicate with the public and how to convey the messaging.

I’ve heard that you were making these calls yourself, at least at the beginning. Do you still do that?
At the beginning of the outbreak, with the first few cases, I was on the phone with the clients, to collect more data from them. I usually lead the team, but yes, in some situations I spoke to the cases myself. Part of the work is building trust with the client so that they’re more comfortable sharing information with you. You know, you’re getting a phone call from someone you’ve never met, asking about your whereabouts, asking you questions you may not be comfortable answering, and who’s also providing you information about illness. You need to build trust so they understand the message, apply it and comply.

Building trust with someone you’re calling for the first time is very challenging, isn’t it?
We use the team members who’ve done this before to coach the others. The newer staff shadows the experienced staff. You listen in to how your colleagues or mentors are talking to the public. The more you do this kind of work, you develop your own investigation and communication style.

What other difficulties do your contact tracers encounter?
When you make a large number of calls to the public, you have to expect one-off problems. You may be calling the wrong number. You may reach someone with a language or education barrier. So in our training sessions, each staff member goes through a number of Q&As and we try to identify situations like that. If you have someone with a language barrier, we have a language line to use. If you’re dealing with an individual who may not fully understand what you’re telling them, you learn how to modify the conversation so that it’s at the level of the individual’s education.

I would think the initial interview sessions can take a long time.
At the beginning, you’re right, because the disease wasn’t very common in Canada. Most of our time was spent providing the client with information about the disease, mode of transmission, prevention measures, how to protect their family. The next step is contact tracing: trace back to the period when the person could have been infectious. At the time there was not enough knowledge. Now, people know that you need to limit your interaction with the public. Stay home after you get tested, stay away from your contacts. All this messaging has been provided to the public so many times, and I think, generally speaking, the public has been responsive and responsible. They are well aware of how to protect their loved ones. A number of times clients will provide information and then, a half-hour later, call back and tell you about another contact they forgot. They’re so eager to make sure that everybody’s protected.

After you’ve first interviewed someone as part of an investigation, do you follow up with them later on?
We follow up with clients until we consider them clear. The process includes us calling them, checking on their health status, making sure they’re still compliant with the isolation. And also answering any questions they may have. Like, what about the washroom? Or, I have family members, how do I make sure they’re not getting it? We provide them with masks if they need masks and ensure them how to clean and disinfect around the house.

I imagine many of the calls are very emotional too.
People respond to calls differently. Just like anyone getting the news of an illness. I know how hard it is when you get a call, especially if you’re not aware of your illness. Like, why are you calling me? What are you looking for? But with more knowledge of the disease, you find that people gradually become more confident. And they are, generally speaking, very happy to hear from us because we’re providing them with information about the illness. We’re making sure that anything that’s within our capacity is provided to them. Sometimes they even want us to consult other family members or communicate with their health provider.

Do you know how many contact-tracing calls are being placed each month now?
I can’t give you an actual number but you can think about it this way: every patient who’s tested positive, we continue to call them daily, for at least 14 days. And their contacts as well.

That’s a lot. Am I right in thinking that you don’t tell contacts who exactly might have infected them? But only the date of exposure?
We always make sure we protect the identity of the cases, so we only reveal what’s needed to ensure the protection of the public. For example, you were exposed on this day, at this time, at this mall. The reason we tell them this is because we want to make sure they were actually there. We don’t really need to tell them the person who they were exposed to. “So, what do you want me to do?” they ask. Well, this is the level of risk we think you’ve been exposed to, we need you to do X or Y. Most of the time, the answer is, “We want you to isolate yourself at home for the next 14 days, monitoring symptoms. We will be in touch with you daily. This is my number to call me back if you have these symptoms.” And we generally send them information or direct them to our website. If we have a low-risk situation, we may not tell them to self-isolate but to self-monitor.

Your job must be getting more difficult now, though, with more and more opening up. Are you worried about the GTA going to Stage 3?
I’m not so worried. We have been anticipating that there will be an increase. We are planning in case another wave happens in the fall. We have this in our calculations. We talk about what happens when Toronto joins Stage 3. There’s a risk that we’ll have an increase in cases and lose some of the progress that we’ve already achieved. But it’s just part of our work to anticipate and adjust accordingly.

You seem very calm about it all. To me, it would be very frightening or at least intimidating. I imagine, if people are mingling in bars and restaurants with people they don’t know, that contact tracing would be much more difficult.
That’s right. And that’s why our medical officer of health, Eileen de Villa, requested that the province consider some modifications to Stage 3 when it comes to Toronto, like maintaining detailed client logs. We’ve seen what’s happened in our cities when they move to Stage 3, that cases have started to increase. We hope that the province will consider our recommendations and if these changes happen, it’ll put us in a better situation to control the outbreak when we open up.

Do you think the province will listen?
We’re hoping. As you know, we always hope for the best and prepare for the worst.

That’s your motto, right?
That’s why you think I’m calm. I’m calm because we are working on preparation. But as I was just saying to my staff a few hours ago, this virus has always been outsmarting us. Every time we prepare it throws us a curveball. Being vigilant about this is helping us to adjust as we go. Throughout this outbreak and with other responses that we’ve had before, we’ve always needed to improvise.

The Covid Alert mobile app, which will notify users if they were exposed to Covid, is supposed to launch in Ontario soon. In other countries, there have been big concerns around surveillance and data breaches with similar apps. Balancing privacy and public health concerns must be very tricky.
Yeah. This is not new for us. Balancing the privacy of individuals and the public health measures that need to be in place is something we always deal with. But as you mention, there have been privacy concerns in other countries so this is actually an opportunity for us to learn. I’m confident that the province looked into all this previously and looked into the lessons learned.

What plans do you have if there is a second wave? Will you increase the size of your staff?
Public health professionals and entities around the world are trying to consider all the possible scenarios. One of the possible scenarios is a second wave. So far, the virus has shown us that it’s not always predictable. We’re currently planning for several different scenarios and measures. We are ready to escalate or de-escalate the response according to what we see on the ground. Because we’re really not sure.

I guess things can change very fast.
Yeah. As we’ve seen in other countries, we will continue to be vulnerable to the outbreak as long as it’s available internationally. We are only as protected as the rest of the world. We just need to be always vigilant. We need to always be planning. We need to continue to respond and be ready as the situation evolves. I think if you talk to anyone in the public health realm, they will give you the same message: there is so much to learn, but we are also planning for the worst and hoping for the best.