Ontario using quarter of test capacity

▪ Experts say low rate means it’s difficult to conclude if we’re making progress in fighting spread of virus ▪ Gap called ‘mystifying’ as labs ‘stand ready’ to raise daily volumes to hit target of 19,000 by mid-April

Ontario is using less than a quarter of its capacity to test for COVID-19, despite the mounting death toll and calls from experts that more tests need to be done to get an accurate picture of the spread of the virus.

While the province has the capacity to currently complete 13,000 tests per day, according to the health ministry, the testing labs have processed tests for fewer than 4,000 patients a day since Sunday, the Star has found.

And on Tuesday, the province reported it had completed tests for just 2,568 patients, the lowest total in a week, and a drop of more than 3,500 since April 1.

That decline makes it difficult to tell whether Ontario has truly “flattened the curve,” or if it’s simply not testing enough to find the cases that do exist in the community, said David Fisman, an epidemiologist at the Dalla Lana School of Public Health at the University of Toronto.

“It’s mystifying to me,” he said, pointing to Ontario’s hospitals, long-termcare homes, prisons and homeless shelters as places where many more tests should be done. “If they have the capacity, now would be the time to use it.”

On a per-capita basis, Ontario is testing for COVID-19 at a lower rate than Canada’s other big provinces — below B.C. and less than half of those in Quebec and Alberta.

And as places such as Iceland and South Korea have shown, widespread testing gives authorities a better picture of the virus’s spread, letting them put in place stronger control measures.

Just a week and a half ago, Ontario health officials held a teleconference to announce that labs in the province would soon be able to conduct more than 8,000 tests a day, with the goal of hitting nearly 19,000 by mid-April.

“We are increasing lab capacity by leveraging not only hospital but community and research labs for clinical testing purposes,” Deputy Health Minister Helen Angus said.

But while the province says most of that capacity is already online — with tests going to 10 hospital labs, two commercial labs, six Public Health Ontario labs, as well as the national lab in Winnipeg — the numbers show we’re not doing the tests. So what happened?

In recent weeks, testing in Ontario has focused on vulnerable patients and front-line health-care workers, as well as reducing a backlog of samples that reached nearly 11,000 in late March. By Sunday, that backlog had been effectively eliminated, but the testing numbers have not gone up.

“Now that Ontario has built considerably more capacity, we’re working with leading public health officials to identify how best to use it,” Hayley Chazan, a spokesperson for Health Minister Christine Elliott, told the Star, noting the province is expecting to finalize a renewed testing strategy that “proactively targets” priority groups like residents of long-term-care homes and retirement communities, health-care workers, Indigenous communities and more.

“By expanding testing of these groups, we can identify cases as early as possible and contain the spread,” she said, adding “it’s important to note that expanded testing is being done not only after we have the capacity to do it, but also now that public health units can bring on additional resources to support contact tracing and case management.”

Speaking to reporters Tuesday, Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health, noted the province’s increased capacity and said “we need to get more people tested.”

To help achieve that, the assessment centres where patients have their tests taken are being encouraged to test more people, she said. “The capacity issue isn’t what it was. They should be testing.”

She cautioned, however, that it’s important to have a testing strategy — soon to come from an expert group — so that “we don’t want to go overboard and end up with another backlog.”

Meanwhile, the province’s increased capacity means the labs are ready to do thousands more tests a day.

In Toronto, the University Health Network and Sinai Health shared microbiology lab increased its capacity to 2,000 tests per day in response to the provincial need to reduce the backlog, but fewer than half that number of samples have been coming in for testing — an average of about 800 over the last seven days — spokesperson Roger Boyle said.

Like all labs in Ontario, “we stand ready to be part of any increase in testing determined by the province,” he said.

Mark Bernhardt, a spokesperson for Dynacare, a Brampton-based provider of medical laboratory services, said while volumes of samples coming in vary by day, they are able to meet the testing quantities required by the province.

“We are looking into methods to increase capacity should demand rise,” he said.

In recent weeks, as the province has worked to build up capacity, Ontario’s tests have been coming back positive more often.

Overall, Ontario has tested 81,364 patients, finding 4,726 confirmed COVID-19 cases for a positive rate of 5.8 per cent. That number has risen to 9.3 per cent for tests completed since April 1; on Tuesday, it was a record 14.8 per cent.

That increase could be a sign the province’s lab-confirmed totals are only capturing part of the story.

Dr. Isaac Bogoch, an infectious disease expert at the Toronto General Hospital Research Institute, put it in terms of a hypothetical: “Let’s put it this way. If every test you have is positive, you’re not doing enough tests,” he said.

“The people that are testing more have a better reflection of what the true burden of infection is in their region.”

Other data, such as the slow growth in the number of patients in a hospital intensive care unit, are giving “encouraging” signs that social distancing might be working in Ontario, Fisman added. But the low rate of testing means you can’t make any real conclusion based on the test results, he said.

Officials with the World Health Organization have pointed to a rate of one positive test for every 10 negative as a “general benchmark” of a system that’s catching most cases — but the organization’s simplest guidance has been that so long as the tests are available, sampling more people will give a better picture of the epidemic, and that will, in turn, make is easier to fight the disease.

“The testing doesn’t tell you just a story about one person. It’s a story about what happened when that person actually acquired the infection and that helps you to trigger your public health interventions,” WHO Director-General Tedros Adhanom Ghebreyesus said in a news conference last week.

“So without knowing, without testing, it’s like moving blindfolded,” he said.