Ontario might actually have the right idea on rapid testing

OPINION: The province has faced criticism for failing to use many of the tests Ottawa provided. But its approach makes sense
By Matt Gurney - Published on Feb 12, 2021
Premier Doug Ford holds up rapid-testing kits during a briefing at Toronto’s Humber River Hospital on November 24, 2020. (Frank Gunn/CP)

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As the pandemic continues to grind on in Ontario and in Canada more broadly, there will unavoidably be blame between politicians and levels of government. Bucks will be passed. There have been moments of unity and co-operation, but with 21,000 dead and counting and an economy reeling from repeated lockdowns, someone is going to end up paying an electoral price for this. And every politician, everywhere and at every level, has a personal motivation to make sure it isn’t them.

A few months ago, the provincial premiers were demanding that the federal government approve so-called rapid tests. Rapid tests are exactly what the name suggests: they test for COVID-19 in a possible patient but are designed to provide a more rapid result. Testing has been a major challenge repeatedly during the pandemic. That was likely at least somewhat unavoidable during the first wave, when we didn’t fully understand what we were up against and had to invent tests that could reliably find the novel virus. Even once we had tests, there were periods when demand for tests simply overwhelmed our laboratory capacity to process the samples and provide results. There have also been communication difficulties with public-health units struggling to provide timely reporting of results to possible COVID-19 patients.

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I’ve now had the “pleasure” of seeing the process up close and personal — both of my children required COVID-19 tests in the fall after they came down with colds. Only after testing negative could they return to class. In both cases, the process was smooth. We received testing appointments at a downtown Toronto hospital the same day we requested them and had our results back the next day (negative in both cases, thankfully). But I was very much aware that our good luck was not representative of everyone’s experience.

Rapid tests offer a way out of some of these problems. A test that can be rapidly analyzed on site doesn’t clog up overburdened provincial labs. A test result that’s available fast enough simply to be relayed directly to the individual — “Hey, good news, man, you don’t have COVID!” — doesn’t need an efficient communication system. The appeal is obvious. But many of these tests aren’t getting used.

The CBC reported this week that, of the millions of tests Ottawa provided to the provinces, most haven’t been used. Alberta and Quebec were particularly stingy with utilization; Ontario looks better by comparison (and is second only to P.E.I, a province with 1/20th the humans as my city). The province has received roughly 5.4 million tests from the federal government and used approximately 1.3 million of them (the precise number, according to the CBC, is 18.47 per cent of 5,413,872). That is, again, a relatively robust number compared with other jurisdictions — our neighbours next door in Quebec haven’t used even 1 per cent of the tests they were provided with.

But one need not be a math expert — I am not! — to grasp that 18.47 out of 100 ... isn’t a lot.

But the numbers, I think, still make sense — how we use the tests matters. And Ontario might well be using them in the best way.

In November of last year, I interviewed McMaster University’s Zain Chagla, an infectious-disease expert, and asked him to explain rapid tests to me. He gave me a ton of fascinating information, but the most relevant takeaway was that there’s no free lunch in life and that what rapid tests offer us in terms of well, rapidity, they sacrifice in accuracy. The standard test used in Ontario — the one my kids used and the one that takes lab capacity to process — is fantastically accurate. So much so that it might produce some false positives by detecting dead virus cells in people who have had COVID-19 but beaten it (perhaps without ever realizing they were ill). The rapid tests, in contrast, are not as sensitive and run the risk of producing false negatives — Chagla said we’d expect them to be about 75 per cent effective at detecting COVID-19 in patients who had it.

The standard test and the rapid tests, he explained, should be used differently but in a complementary way. When seeking a medical diagnosis, in medical settings, the standard, more accurate tests would be preferable. But when the goal is to seek out COVID-19 in a group of people — and when you don’t believe COVID-19 is likely to be present — rapid tests can work as a form of screening. Using a rapid test at an industrial site, or as a line of defence among long-term-care home staff, may miss individual cases: a test that is 75 per cent accurate, after all, won’t catch a quarter of the sick. But enough tests, in a certain population, will detect the virus if it exists in any meaningful quantity amid said population. That provides early warning when a group that we don’t believe has an outbreak begins reporting positives. More accurate standard tests can be used at that time.

And this is how the province is using them. In a statement to TVO.org, Carly Luis, a spokesperson for Health Minister Christine Elliott, said that, alongside other targeted workplace screening programs, Ontario is providing “300,000 COVID-19 tests per week for asymptomatic staff in key sectors such as manufacturing, warehousing, supply chain and food processing.”

Luis added that rapid tests are also being used in “rural and remote communities which may be experiencing high turnaround times, including Indigenous communities, as well as to support early outbreak identification.” The province plans to expand testing to include new sectors, including “long-term care homes, retirement homes, schools, congregate living, high-priority communities, land borders and essential industry, such as manufacturing and construction.” The number of test kits on hand, Luis said, will be sufficient to last several months at current usage rates, but the province is planning regulatory changes to make their broader use possible and more efficient.

That all ... sounds about right?

There may be grounds for criticism of the province here — maybe we should have used even more of the tests. But, overall, it seems like the province has the right idea. Rapid tests will be key in our path back to normalcy. Ontario has already said it will seek to do more asymptomatic testing at schools, which is a great idea that should have been pursued already. But I found the CBC’s report not nearly as alarming as others did. We might not be using them enough, and if we can do better by using more, by all means, let’s do so. But we do seem to be using them right. These days, I take my good news where I can get it.

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