Ontario region’s rapid testing strategy may soon spread
When it comes to rapid testing in Canada, there is a bad news story and a good news story.
The bad news is that, since rapid tests were first approved last fall, their rollout has been painfully slow and bogged down by excessive regulation, with the result being that a third wave ripped through the country while tens of millions of rapid tests sat unused.
But the good news is the situation is finally improving. Provincial health authorities, changing course with the nimbleness of an aircraft carrier, have finally begun lifting the restrictions that have hampered the use of rapid tests for months. To see the payoff, one only needs to visit a bus parked outside Waterloo City Hall on Friday.
The southwestern Ontario region of Waterloo, Kitchener and Cambridge has launched a rapid screening project called Staysafe that allows anyone to book a free rapid test at three roving mobile units. The project is also distributing free rapid tests to small and medium businesses in the region; in the two weeks since launching, it’s already given out 120,000 rapid tests to more than 1,500 businesses, with the goal of twice-weekly rapid testing for employees.
Staysafe is a joint venture by the local chambers of commerce, the provincial government and Communitech, a public-private partnership that supports tech companies. It also received a $430,000 federal grant to get up and running.
“There’s absolutely a recognized belief now that serial screening (with rapid tests), along with vaccinations, along with laboratory testing, all these tools need to be in place if we’re going to reopen and keep the economy open,” said Iain Klugman, CEO of Communitech.
Until recently, this project would have been impossible under Ontario’s rule that required rapid tests to be operated by a professional with a health care background, such as a nurse or pharmacist. But after much urging from the business community, that restriction was lifted in midmarch; most other provinces have now also lifted that restriction.
In its guide for workplaces, the Staysafe project emphasizes that rapid testing is effective because of repetition. What matters is getting the tests deployed and being performed regularly, even if it’s not being done perfectly.
“The results of a single screen in isolation is less important than the results of the screening program as whole,” the guide says. “If relaxing the health care professional requirement results in even 50 per cent more screens being administered, then the overall results will definitely be better even if there is a modest loss in sensitivity per test.”
The Staysafe project uses a relatively decentralized model that has users swabbing their own noses, with trained people nearby to help. The swabs are painless, only needing to go half an inch into the nose. Staysafe uses the Abbott Panbio devices, and Klugman said they’re easy to operate once you’ve got the hang of it: you do the swab, swirl it in fluid and then wait for lines to show up on the testing device.
“I tell people, it’s the same number of steps in a process as flossing or brushing your teeth, and about as complicated,” Klugman said. “It’s fast, it’s simple, and it doesn’t hurt.”
For its mobile units, the project uses buses that rotate through pre-set locations during the week. On Friday, for example, there were buses
parked at the Waterloo city hall, the Cambridge city hall, and a City of Kitchener operations facility. Residents register ahead of time to get an appointment; the test itself is free and takes about 15 minutes.
The mobile testing capacity isn’t huge, with each bus able to do 200 tests a day. Even so, of the 1,000 mobile unit tests performed since the project’s launch, five presumptive positive cases have been found in asymptomatic people.
“They were very surprised when their results came back positive,” said Sarah Mostowich, the Staysafe program lead. “Those are very much people who would have been going to work, continuing to go about their daily lives and spreading COVID around.”
Both the mobile units and the program to distribute rapid tests to businesses are heavily reliant on volunteers. Mostowich said they’ve got about 300 volunteers now, “from students to retirees to working professional on their weekends, their days off.”
The program is partly inspired by Nova Scotia, which has been doing free pop-up rapid testing centres since November. As with the Nova Scotia program, the main goal with Staysafe’s mobile units is to get the community engaged and comfortable with the idea of getting tested frequently.
A huge struggle in getting rapid testing implemented in Canada has been to get health officials and political leaders to stop treating it as equivalent to a laboratory diagnostic test. It was never necessary to have nurses perform rapid tests, at least once the less invasive nose swab was available. Provinces have always been free to set their own guidance on this, as Nova Scotia did early on.
Experts who advocate rapid testing say it doesn’t replace other public health measures, but it’s a crucially important tool that can help stop outbreaks before they start.
Frequency is the key to rapid testing. Lab testing is far too resource-intensive to be repeatedly used on a wide segment of the population. Rapid testing, by contrast, can be done over and over again — ideally every day, but at least twice a week in the meantime — to find cases in asymptomatic people who would otherwise not qualify for a lab test, and might then spend days passing the virus on to others before realizing they had it.
“The argument about sensitivity is moot,” said Klugman. “This is about math. This is about probability of detection based on a series of tests, which are done regularly and routinely over time … I think that was a really hard one (for officials), because everybody kept going back to, well, they’re not as accurate. But it’s not about sensitivity. It’s about frequency.”