On Thursday, the province changed the testing criteria for those who may (but probably don't) have COVID-19. After months of ramping up testing capacity and encouraging anyone who was worried to get a test, the province is asking us to stop doing that. A recent surge in case counts has top officials worried about a second wave of the pandemic. Meanwhile, thousands of children with the sniffles can't go to school until they either wait out a two-week quarantine or get a negative COVID-19 test result. This has led to scenes of dysfunctional testing centres with massive lineups — and accusations that the Ford government was caught flat-footed. The new criteria are designed to cut down on the number of people seeking tests: you're now asked to go only if you're symptomatic or have been exposed to a confirmed-positive case.
For many, this seemed like a defeat — the government is rolling back its testing criteria to what it was many months ago, earlier in the crisis. But I knew at least one man who would be thrilled. And readers of my work here at TVO.org might recognize his name.
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In July, as part of a series of articles on what a safe return to schools might look like, I interviewed Zain Chagla. He’s an infectious-disease expert and associate professor at McMaster University. And just a few weeks ago, in an op-ed in the National Post, Chagla called on the Ontario government to do exactly what it did: revise testing protocols to mostly exclude the asymptomatic. "[It] is crucial that symptomatic individuals have priority and easy access to rapid testing and results," Chagla and a colleague wrote in the Post on September 11. "Asymptomatic testing — meaning those without symptoms who have not been exposed, have not returned from abroad and have not been identified as part of an outbreak — needs to be minimized going forward in order to support our laboratories."
Chagla, reached by phone on Thursday night, told TVO.org it was barely two days after the Post ran his op-ed that Ontario's testing centres began to be overwhelmed by demand for testing. He was glad to have written something that the government rapidly listened to. (This journalist assured him that he should definitely not get used to that.) But he also said that he understood the public’s frustration and confusion.
"Ontario has been hammering the same message for months," Chagla said. "Testing, testing, testing. Everyone should get a test. Are you worried? Get a test. Any symptoms? Get a test. We could do that if we had unlimited capacity. We could get away with it when demand was low. But it's high now. We have to prioritize. Just having everyone get a test for any reason at any time isn't sustainable. We need to preserve our testing capacity and use it where it will make the most difference. This is just the reality of efficient public health. If we could test everyone, every day, we would. But we can't. So we put the testing we have where it's most useful."
Chagla noted that while it looks like Ontario is reverting to its earlier rules — the ones we had at a more chaotic time — it’s also worth noting that Ontario is adopting comparable rules to British Columbia and Alberta, two provinces that have generally been successful in combating COVID-19 (at least thus far). “They were finding it in every thousand tests,” he said of Alberta. “In Ontario today, that would mean you’d line up a thousand people to find one case.” Ramming a bunch of people through testing centres at near-random isn’t an efficient way of fighting the pandemic.
“There’s an elephant in the room,” Chagla added. “In Toronto, for example, we know where we were finding COVID in the community. Obviously there were challenges in the long-term-care homes and hospitals, but in the community, it was being found in high-density, multi-generational homes. This is mostly lower-income housing. The people who live in these housing situations are often working-class. They don’t have the time to line up all day for a test. There’s a real equity challenge here. Someone who can afford to spend all day in a line-up for a COVID-19 test is probably already at a very low risk of having contracted COVID-19 in the first place, and meanwhile, the areas where we’re worried COVID-19 will spread aren’t where we’re seeing these line-ups.”
“This is not a failure,” Chagla said. “It’s a recognition that we went looking for widespread asymptomatic transmission in the community and didn’t find much. It’s not as big a thing as some people thought it was. So we can change our strategy. The old one isn’t helping. It might actually be hurting our public-health response.”
The challenge, of course, is that Ontario is experiencing a jump in daily case counts just as schools are opening. Parents have been told to keep their children home if they have any COVID-19 symptoms, unless and until they get a negative test. Chagla agrees that the families are trying to do the right thing. “They’re being responsible,” he said. “Parents are doing what they’re told. But this is also why we need to clear up testing capacity. Some of these students, and also teachers and school staff, are genuinely going to have symptoms. And we need to get those people tested as quickly as possible so they can either isolate or return to the classroom. It’s not feasible to ask people to do this if it takes 72 hours to get a test result back, and it might take a few days of lining up to even get the test.”
I noted to Chagla that it was just at the start of this week that the province was announcing that pharmacies would be taking over the asymptomatic testing, specifically to free up capacity at the testing centres — and now the province is telling people not to bother getting tested if they’re asymptomatic. “Bringing in the pharmacies is fine,” Chagla said. “If they can help with testing, that’s fine. But the government also announced the flu-shot blitz. Pharmacies already know how to do that. If we’re going to make them a big part of the strategy, that’s where we should go.”
Time will tell, of course. The huge surge in cases that seemed imminent even a few days ago has seemingly slowed down — cases are still much higher than they recently were, and the weekly rolling average is way up, but the situation at the end of the week is not as bad as we might have reasonably feared at the start of it.
Still, if things go bad, Chagla is right: we only have so much testing to go around. We’ll have to make tough choices about how to use it.