Task-shifting could be a force-multiplier against COVID

The headlines of the past few months have spoken of exhaustion, post-traumatic stress and depression among physicians and nurses. These essential front-line staff not only are responsible for running acute-care hospitals and providing surge capacity in long-term care facilities, they are also undertaking critical but time-consuming COVID testing and vaccination.

Provinces and territories have signalled that a primary limitation to increasing testing is qualified people. Yet we have seen limited innovation with respect to tapping into other health professions that have signalled they are prepared to assist provinces and territories in responding to the COVID-19 crisis.

Task-shifting could help address the strain on frontline workers. Pharmacists, paramedics, dentists and dental hygienists have all indicated they could be part of the COVID response. Some provinces and territories have looked to these communities to address gaps and have taken steps to address regulatory and training barriers preventing them from doing so.

Thanks to discussions last fall, dentists and dental hygienists in Quebec are now involved in administering vaccines. Issues that had to be and were addressed were scope of practice, liability, compensation, work settings and booking of appointments. Similarly, Alberta is considering having allied health professions assist its vaccine rollout and is addressing regulatory issues to support this innovation.

Ontario is leveraging paramedics to increase community testing. Some local paramedic services are employing their permanent part-time paramedics on a full-time basis, renting vans so that they can undertake testing in the community, including via home visits.

Other pilot projects have highlighted the value of task-shifting testing and screening to non-health professionals. Nova Scotia developed a community testing team of volunteers to staff pop-up testing sites. More than 250 testing volunteers have been taught how to collect samples using a nasopharyngeal swab. The province is looking to scale up the program by implementing a train-the-trainer course.

Task-shifting could be a big support to provinces and territories implementing more robust community testing and screening strategies at the same time as they are trying to ramp up vaccinations. We have known for a long time that up to 40 per cent of people with COVID-19 have no symptoms but can still transmit the virus. To accelerate the reduction in COVID cases, we need to expand testing and screening to adequately address the prevalence of asymptomatic individuals in the community. The federal minister of health's Testing and Screening Expert Advisory

Panel just released its first report, which sheds light on strategies that can be used to identify asymptomatic carriers.

So, how can we do asymptomatic testing to manage outbreaks before they get out of control, while still prioritizing testing people with symptoms or close contacts of people with COVID-19? We need to deploy rapid tests to screen for infection, administer them frequently and confirm positive results with a lab-based PCR test. Such tests are the gold standard for finding the virus but they also have speed, capacity and accessibility challenges that limit their usefulness for screening. A screening strategy involves general testing of individuals with no known exposure to the virus, or those who are in riskier environments, such as schools, some work settings, long-term care homes, or correctional facilities. Robust screening in these settings can identify asymptomatic carriers of the virus, trace their contacts, and isolate both carriers and contacts before an outbreak can start.

Along with standard labbased PCR tests, Nova Scotia has already been using rapid tests in its pop-up testing sites and encouraging the general population to get tested regularly. Ontario recently announced rapid tests for screening in schools, long-term care homes, and key sectors of the economy, including supply chains and manufacturing.

Task-shifting is a force-multiplier in the fight against COVID. Leveraging other health-care professionals and, where appropriate, volunteers, will enable provinces and territories to expand their testing capacity. Just as important, task-shifting will provide much-needed support to front-line physicians and nurses, freeing up these critical resources to provide direct care to the thousands of Canadians currently afflicted with COVID.

NEED TO DEPLOY RAPID TESTS TO SCREEN FOR INFECTION.