Case Synopsis

The COVID-19 pandemic has emerged as an important topic of discussion at the Public Health Agency of Canada’s federal, provincial, and territorial tables. Representatives from each Canadian province and territory have come together to discuss the discrepancies noted in the attribution of COVID-19 cases between jurisdictions. Senior epidemiologist, Nina Mendez, is leading a case attribution project to give provinces and territories a forum for discussing any jurisdiction issues they encounter when reporting COVID-19 cases. Nina notices discrepancies in the way provinces and territories are reporting cases, where the majority of jurisdictions have been reporting cases based on official permanent residence, however two jurisdictions have been attributing cases based on location of diagnosis. This discrepancy in attribution leads to a discussion about how different protocols influence the way public health measures are implemented within each jurisdiction. Specifically, in the context of when individuals such as students, commuters, visitors, or long-term temporary workers are away from their permanent residence long enough that the risk of disease transmission no longer applies to their permanent residence jurisdiction.

Case Objectives

1. Describe the fundamental epidemiological concepts involved in collecting data about infectious diseases.
2. Describe the various factors and special populations to be considered when implementing policies for case attribution in the context of the COVID-19 pandemic.
3. Understand the importance of collaborative decision-making.

Case Study Questions

1. What are the pros and cons of attributing cases to the jurisdiction of diagnosis? 2. What are the pros and cons of attributing cases to the jurisdiction of permanent residence?
3. How do you think a public health emergency changes the need for accurately attributing case counts and severe disease outcomes in a jurisdiction? What consequences can result from the inaccuracies in how counts are attributed?
4. Discuss how discrepancies in the attribution practices between municipalities in a given jurisdiction may influence public health resource allocation and public health measures being implemented? How might this municipality-level discrepancy influence the identification and targeting of hot spots?
5. How would cases be attributed for other infectious diseases (e.g., Lyme disease, measles)? What potential issues do you foresee in case attribution for these diseases?


Case attribution, case management, COVID-19, public health emergency, pandemic, regional governance, jurisdictional governance, public health response, communicable diseases, infectious diseases, notifiable diseases



Recommended Citation

Khan, A., Taylor, D., Ahmad, R., Thériault, J., McKinley, G. (2022). Case Attribution for COVID-19: Who Counts What?. in: Darnell, R. & Sibbald, S. L. [eds] Western Public Health Casebook 2021. London, ON: Public Health Casebook Publishing