Canada has dropped ball on testing, science adviser says
Canada is struggling to contain its second wave of COVID-19 in part because it's failing to employ the basic tools of pandemic-busting — widespread testing and contact tracing, said Dr. Mona Nemer, the country's chief scientific adviser.
“In the second wave, I think we're struggling a bit, across the country, and we are not the only ones,” said Nemer, who resides in Montreal. “There are areas, especially, for example, in terms of the more rapid deployment of testing, more widespread availability of testing, that could have saved lives and perhaps limited the spread.”
In an interview with the Montreal Gazette, Nemer, whose role is to advise Prime Minister Justin Trudeau and his cabinet on the most recent science in order to guide policy decisions, said Canada is “in the middle of the pack” compared with other countries in its response to the pandemic. Now that the vaccine is available, among its top priorities will be to convince the large numbers of citizens wary of taking it that it's safe, to ensure Canada can reach the level of herd immunity necessary to quell the disease.
The country fared relatively well in limiting the spread during the first wave, with the exception of its long-term care centres, Nemer said. More than 80 per cent of Canada's deaths occurred in seniors' care centres, twice the international average among comparable countries.
As infectious-disease experts had warned, many remote communities spared during the first wave were hit in the second, “and they were not ready in terms of their health-care systems, in terms of their diagnostic capabilities as well. That was perhaps a blind spot,” Nemer said.
But it is to the topic of testing that Nemer returns repeatedly when asked what is happening during Canada's second wave.
“Look, the basics for limiting the pandemic is to detect new cases as quickly as possible, isolate them and limit the spread,” she said. “That's sort of, you know, the basics.”
Wiser through experience, the country was better prepared in the fall in that there were no supply chain issues, diagnostic equipment was available, and there were a variety of tests to be used.
Yet when the cases started coming, Canada didn't sufficiently scale up testing or contact tracing, Nemer said.
“Unfortunately, when you look at the entire country, it's not just one province, but almost all. It's a little puzzling.”
Despite the fact science has shown asymptomatic carriers often spread the disease, the tendency remains to restrict testing only to symptomatic individuals or those in contact with positive cases. Evidence from other countries has shown mass testing of entire neighbourhoods or even cities and isolating infected individuals can help stem the spread quickly. Vulnerable workplaces and longterm care centres, where the virus is brought in from the outside, are another area where regular testing should happen, she said.
Most provinces have been slow to adopt the rapid tests available, despite studies showing mass testing could help to eradicate the virus. Nemer does not mention any province by name, but Quebec has been hesitant to adopt rapid tests, saying they are often not as reliable as the standard but time-consuming swab tests.
Last spring, Nemer chastised Quebec for not providing its testing plan to the federal government despite repeated requests.
“I think I would say at times in the management of the pandemic, perfection has been the enemy of the good,” Nemer said.
“Some have said if these tests are not as good as the gold standard, we shouldn't be using them. But they can be used for completely different purposes — for surveillance, even. ... It's better to miss a few infected individuals versus missing everyone because we're not conducting the tests.”
Lockdowns are only effective until they end, Nemer said, and then people start to get infected again.
“You just end up going up and down into lockdowns, it's just not possible. I think we need to take a serious look at how we deploy all the different opportunities that we have in terms of testing.”
Nemer said she is not criticizing local governments or public health authorities who are doing their best under unusual circumstances. But it's time to look outside the box to solve what she called “hiccups” in the implementation system.
For example, doctors and nurses with foreign credentials who are not accredited to work in Canada could be employed in testing and contact tracing.
As a scientist, she said she is delighted to see how quickly vaccines were produced, using modern technology to create a new type of messenger RNA vaccine that could be produced more quickly than a classical one.
But she said she was surprised to hear of the high number of health-care workers who are declining to take it. There are many groups making up the anti-vaxxer community, including those who don't believe in vaccines, those who don't want governments telling them what to do, others who worry the vaccine was created too quickly and some who fear the new technology that created it.
But if fewer than 60 per cent of the eligible population take the vaccine, “then we are not going to be out of the woods.”
“I think the government and scientists have an important job to do of maintaining the dialogue and seeing to it that we can reap all the benefits of all this scientific and technological development that can get us out of this pandemic as quickly as possible with fewer lives lost.”
The high death toll in Canada's long-term care centres came in part because they were not considered part of the health-care bubble that received most of the focus at the start.
“It's a huge tragedy because it's one of those areas where we saw what was happening in other parts of the world and who the vulnerable people were. So it's very unfortunate we were unable to protect these vulnerable older citizens better than we did.”