National Post (National Edition)
Testing is no longer sufficient
Daily briefings on COVID-19 case counts and deaths from federal officials and the various provinces and territories are not giving Canadians the information they need. Statistics on the number of confirmed infections is no longer the most important metric for understanding this pandemic. Neither is the death toll (though that obviously matters in human terms). From here on out, the key number Canadians should be watching is how much remaining capacity there is in our hospitals, particularly our intense care units. That’s where this pandemic’s toll on Canada will be determined.
The first problem with testing is that it’s not sufficient. Limiting testing capability has meant that many Canadians
with COVID symptoms — we have no idea how many, and that’s the problem — have not been tested. Mild cases will go untested while people ride it out, hopefully in isolation at home. COVID also infects many who present no symptoms, and most of those cases will never be recorded in official statistics. Early testing priorities focused on those with a recent history of travel abroad or those with close contacts with cases, or with high-risk profiles.
But community spread is now confirmed across much of the country. It’s out there. How far and wide? Without mass testing, with rapid results, we won’t know.
The second problem with testing is that it’s a lagging indicator. Even if you’ve been selected for a test, your results can take days to arrive (I’ve heard anecdotally from friends and associates of delays of a week or more). A patient may progress into an acute medical crisis, or shake off mild symptoms, before they hear back from a lab.
In short? Testing is important, and should continue — indeed, it should be expanded. But beyond a certain point, it stops being the most important indicator of how we are performing. That’s the hospitals’ job now.
The reason is simple. in areas where testing results are either in low supply, backlogged, or show a small, stable group of infected patients, yet each day brings more ICU patients with COVID symptoms, always in greater numbers than the previous day, you would know there’s a problem. You wouldn’t need testing results to know what you were seeing — you’d want them, of course, to rule out other respiratory issues, but doctors would see the boom and know what it was.
Let’s be optimists: it’s just as easy to imagine a scenario in which a surge in patients never materializes despite lots of local positive test results. That, too, would serve as a revealing indicator at the spread (or lack thereof) in the community, or that mild or asymptomatic cases were more common than realized, meaning COVID-19 is less lethal than feared.
(Colby Cosh discusses this in more detail in these pages.)
But in any case, given the limited testing, the backlogs for results and the certainty that some infected Canadians have been missed, the real measure Canadians should be watching is the rate of hospitalizations. That will tell the tale. If demand soars, we’ll know we have a problem, and won’t need daily updates on testing tallies to know it. If positive tests soar but ICU usage remains low, that too will reveal much.
But finding the data is surprisingly difficult. It doesn’t need to be. In Ontario, this data is now being aggregated by the government but not released in a simple, accessible form to the public (some physicians have made a point of sharing the data they receive with the public, but there’s no reason the data couldn’t simply be proactively released). The Quebec government has launched a website that shows daily demand on hospitals and ICU beds, but not how many beds remain unused (though that data can be inferred by looking at previous reporting about the system’s overall capacity). Alberta updates its tallies daily, but unlike Quebec’s website, doesn’t include tallies from the earlier days, making tracking trends cumbersome — you have to look back each day at the previous day’s press release.
Is this the best we can do in 2020? The Ontario data, thus far, is the best, but even that depends on the goodwill of doctors sharing the internal data with the public on their own initiative.
Compared to some of the struggles faced by Canadians on the frontlines of this pandemic, a bit of legwork and math is small sacrifice for a journalist. But it’s an unnecessary one. The various provinces can and should do a better, more consistent job reporting on figures other than confirmed positive tests and COVID-caused deaths. Showing Canadians how many patients are in hospitals, how many need an ICU bed and how many specifically need a ventilator should not be particularly difficult. And though there will no doubt be others, one early lesson learned in the pandemic of 2020 is that Canadian governments remain laggards in the rapid publication of clear, consistent and concise stats and data.
Canada may well be on course of avoid the worstcase scenarios that have overtaken much of Europe and are now beginning to occur in the United States. Then again, we may not be. The coming days and weeks will tell. And the verdict won’t come from the daily tallies of tests. It’ll come from the strain on our hospitals. Stay tuned.