ON VIRUS TESTING, A NEW LAG EMERGES
Many who test positive unaware for days after
On Sunday night, Jemy Joseph, an emergency medicine physician in Toronto, received a frantic phone call from a colleague. He had a patient, he told her, who had tested positive days ago for COVID-19, but hadn’t been informed. Joseph’s colleague was worried. He needed to know how many other patients, from one of the large COVID testing centres in the Toronto area, were in a similar boat. Could she help?
So for the next several hours, Joseph and four of her colleagues, all doctors, worked the phones. They each had a list of patients with positive test results. They called them one-by-one to make sure they knew. “Some of them did get phone calls from public health already, so, ‘Yay,’” Joseph said. But several hadn’t. Joseph herself reached three patients who had not been informed of their results, including one whose test had come back positive four days earlier.
“We don’t know where the delays are. We don’t know how long the delays are,” Joseph said. But she thinks the problem is likely with the local public health unit. “There are only a finite number of human beings in that office. So they’re not able to keep up.”
Doctors in Toronto and all over Canada have been warning for weeks about holes in the public health response to the COVID-19 pandemic. Many are worried about the available supply of personal protective equipment, like masks and gowns. Others believe Ontario and other provinces should have moved earlier, and with more aggression, to close businesses and limit public movement.
But the testing regime for COVID-19 has emerged as a particular flashpoint for criticism. Many physicians believe, and have said publicly, that the provinces are testing far too narrowly for the infection. The growing backlog of unprocessed tests, meanwhile, means public data on the pandemic has always been, at best, several days out of date.
But several physicians this week have highlighted what they believe could be another testing problem. Even once positive test results are coming in, they say, they aren’t always being communicated back to patients in a timely manner. One Toronto-area emergency medicine doctor said Wednesday that he’s heard from several colleagues that have had the same problem that Joseph’s colleague did. They’re doubling back to check on patients who were swabbed and came back positive, only to find the patients haven’t been informed of the results by health authorities.
On one level, that shouldn’t matter, doctors say. Anyone who is getting tested for COVID-19 should be acting like they have it until they hear otherwise. That means strict self-isolation pending a negative result and firm social distancing afterward. But the human realities are more complicated.
“Even if you’re told you should presume you’re positive, that’s still different than being told you’re positive as far as the way you behave and self isolate,” said Dr. Yoni Freedhoff, an associate professor of family medicine at the University of Ottawa. “We know there’s lots of people out there, sadly, that do not take physical distancing recommendations and stay-athome recommendations as literally as they should.”
Some patients with mild symptoms might assume they’re fine to leave the house as soon as they’re feeling better. Others might feel pressure to return to work as soon as, or even before their symptoms subside.
“If you’ve now been swabbed … and it’s five days later you might think, well, they would’ve called me by now if I was positive. I guess I could go see grandma,” said Freedhoff. “That might be last time you say hi to grandma.’”
Any delay in notification also means contact-tracing, the process of reaching out, warning and isolating the contacts of a positive case, gets delayed too. “The patients that I called (Sunday) night, I said, do your own contact-tracing for now,” said Joseph. “Anyone that you came in touch with, give them a call, tell them to stay away from everyone … because you don’t know how long it’s going to take for the message to trickle down.”
It’s hard to know right now how significant or widespread a problem this is. A spokesman for Toronto Public Health said in a statement that the agency initiates an investigation “as soon as” they are notified of a positive COVID-19 test result. That includes “contacting the person who is positive to determine their contacts.”
Regardless, for Dr. David Carr, a Toronto-area emergency physician, what this highlights is the importance of hammering home one message to anyone who gets a test. “I tell them to act like you have COVID,” he said. “You have to live your life like you have COVID.”