Are we in this together? Maybe not
COVID-19 has hit our country like a storm, disproportionately affecting lower-income and racialized people. In some Toronto neighbourhoods where we practice, the likelihood of encountering COVID-19 is five times higher than in wealthy, whiter communities.
We may all be in the same stormy seas, but we are not in the same boat. So why, in the midst of this crisis, are we seeing the rise of private, for-profit COVID-19 testing services charging upwards of $400 per test?
Long waits to access Ontario’s COVID-19 assessment centres certainly contributed, as did lagging test results in a laboratory system that is not robustly resourced enough to keep up with demands. From testing, to lab infrastructure, to our health workforce, the summer months went by in Ontario with little preparation from the Ford government for a second wave that many had predicted from the outset.
It is within this paradigm that pandemic profiteering began to take root.
Private diagnostic firms began offering at-home testing, while large corporations offered preferred testing options as job “perks” to employees. As the lines at COVID-19 assessment centres continued to grow, an option to pay to jump the queue, emerged. While Ontarians grapple with the rapidly changing requirements from employers, daycares and schools, the desire to avoid long lines is understandable. But how will a rise in private testing impact wait times in the public system?
An established body of research, including a recent decision in the Supreme Court of British Columbia, has shown that parallel, private financing for health-care services does not improve wait times within universal health-care systems. In fact, the experience of other countries has demonstrated it makes wait times worse in the public system.
This may seem counterintuitive, so how might that occur here?
Testing infrastructure is finite, dependent on limited reagents and laboratory capacity. Every test allocated to someone who can afford to pay can displace a test for someone who cannot.
As the second wave grinds on, healthcare workers are expected to have higher rates of sick calls, putting increased demand on staff working in our hospitals and clinics. Privately paid testing requires health-care workers to swab patients. One company performing them has already hired 100 nurses, with plans for rapid expansion. That means 100 fewer nurses working in publicly funded care, in a time of crisis.
Questions also remain about the degree to which these ad hoc private pay testing operations are, or are not, being co-ordinated or integrated within the greater public health response. First and second wave data have shown that lower-income, racialized neighbourhoods have been hardest hit because of dense living conditions and inadequate public transportation. Many members of these communities are essential front-line workers at our gas stations, grocery stores and other vital services.
Investing in public health at a population level means taking these socioeconomic differences into account and acting upon them. The irony of private testing for those who can afford to pay is that it takes a scarce resource and allocates it in a way that benefits some, but harms others.
What then, is the best way to address the testing backlog in Ontario? For months, experts in Ontario warned the Ford government of the impending second wave and the need to scale up testing. It took too long, nearly a week, for the premier to act on advice from local public health leaders who implored provincial leadership to return to a modified Stage 2 for hard-hit areas.
Others, whose advice is no less urgent, have been calling for a rethink of a “onesize-fits-all” institutional approach to testing, calling for adaptive, local responses led by community organizations and leaders who are experts in their neighbourhoods. Testing resources should be targeting communities with the highest needs, not those with the highest income.
When the news on privately paid testing first broke, the government was quick to declare they were looking into it. We have yet to hear what response, if any, will occur. This absence of action speaks volumes about who matters and who doesn’t.