How pop-up testing centres became key to pandemic fight
Inside, the COVID-19 testing site had some of the usual features: doctors in gowns and masks, piles of swabs, directional stickers on the floor to maintain safe distancing.
But the decor was very different from the typical sterility of a hospital. The site’s front window was hand-painted in a vibrant stained glass pattern. Other walls were canary yellow and grey, and the room could be divided by the type of folding partitions usually seen in kids’ rec centres.
That’s because the space is a kids’ rec centre. Usually, it’s a hub for youth in Thorncliffe Park; for four weeks in June and July, it operated as a pop-up COVID-19 testing site.
After doctors at nearby Michael Garron Hospital noticed that many people testing positive at their assessment centre came from a few distinct pockets of the neighbourhood, they worked with community health partners and a network of family physicians to set up a temporary, easy-to-access assessment centre amid the hot spot.
“There’s only so much you can do inside your doors, right?” Jennifer Sampson, the hospital’s special projects manager and COVID-19 assessment centre lead, said outside the pop-up site on a blazing June day.
“You really have to get outside your doors and work in partnership to really make a sustainable change.”
When standalone COVID-19 assessment centres opened in March, they were a novel strategy — an attempt to ease pressure and infection risk in busy emergency rooms. Ontarians continue to flock to them by the thousands.
But testing has continued to shift even further afield from hospitals and other health-care settings, with swabs ferried to people and places where targeted action is deemed necessary. Mobile testing has taken various forms, including dedicated tactical teams, community popups, and roving, retrofitted TTC buses.
With bars, gyms and schools reopening or preparing to reopen, and amid fears of a possible pandemic second wave, experts say testing will need to be even nimbler.
“It’s naive to think that as we escalate the activity and risk in the population, there will not be clusters and outbreaks,” said Dr. Jeff Powis, Michael Garron’s medical director of infection prevention and control. “We need to make sure that funders appreciate that we need to continue to have the capacity to do mobile testing in order to address hot spots as they occur. So we can get in there really quickly, and put out the embers before they become big fires.”
Ontario Health, the provincial agency that co-ordinates COVID-19 testing, now has regional “integrated response” tables across the province to co-ordinate mobile testing and other outbreak-related efforts with public health units, hospitals and other local health-care providers. Those involved say planning is underway for how the testing strategy should evolve in the coming months.
But there is no one-size-fitsall approach; an outbreak at a farm in Windsor, a factory in Peel Region or a mall in Toronto would require unique responses.
“It really is defined by what is the moment and what are the circumstances,” says Dr. Dirk Huyer, Ontario’s chief coroner, who has been working with Ontario Health on mobile and targeted testing efforts.
“Each week we learn a little bit more about how to do things more effectively.”
At Women’s College Hospital, it became evident very early that testing would have to move beyond the building: just four weeks after its assessment centre opened in mid-March, the hospital sent out its first mobile testing team.
“We rapidly realized that there’s going to be a lot of vulnerable people that are not going to be able to come to a hospital site like ours,” said Darryl
Yates, vice-president of patient care and ambulatory innovation.
The hospital started getting calls for help from shelters, long-term-care homes, and other organizations it had relationships with, and felt an obligation to contain or prevent outbreaks in these places, Yates said. Co-ordinating it all, however, was a major challenge.
“It was awful at the beginning,” said Yates. “We felt like we were like, I don’t know, pioneers cutting your way through the forest … Nobody — nobody — was ready for this.”
As the mobile testing requests piled up, Yates and another hospital executive contacted the Toronto region of Ontario Health to seek a co-ordinated approach. The response table that resulted organized smaller teams to respond to different parts of Toronto; Women’s College works with The Centre for Addiction and Mental Health, and Parkdale Queen West Community Health Centre.
Worried about the pace of bureaucratic decision-making, however, Yates said the hospital continued its own mobile testing efforts in parallel with that table; they have become more integrated over time. Their mobile teams have carried out 56 visits to 38 sites.
Similarly, at North York General Hospital, long-term-care homes started reaching out early on for help, “and our team just said, ‘OK, we’ll go,’ and we just went. We didn’t think about process,” said Dr. Rebecca Stoller, family physician with the North York Family Health Team and physician lead for the Branson Assessment Centre.
In addition to requests through the Ontario Health response table, the hospital continues to manage requests for mobile testing independently, including those beyond its official catchment area. Both Women’s College and North York General say they also help educate their partners on infection prevention and control, and are working toward shifting testing capacity into their community partners’ hands.
Pop-up testing sites embedded in communities are an even more recent development. Michael Garron’s Thorncliffe Park pop-up was its second, after one in Taylor-Massey. The hospital and its partners wound down the Thorncliffe pop-up when test positivity rates started dropping off: after completing 1,300 swabs, the mission had been accomplished.
Powis said two factors made that effort successful: strong pre-existing relationships with community health partners, since it’s very difficult to build those amid a crisis, and acting quickly, without an official provincial directive.
“At the beginning of this, we often said: ‘Do the right thing and answer questions later,’ ” Powis said. “Speed, not perfection, is the solution to a pandemic.”
Scarborough Health Network (SHN) believes it was also among the first hospitals in Ontario to bring testing into the community after data showed the virus starting to take hold in some Scarborough neighbourhoods, including Woburn, Guildwood and Malvern.
Glyn Boatswain, director of SHN’s Women and Children’s program and interim director of professional practice, says SHN’s leadership team moved quickly to expand its testing into the community after seeing which neighbourhoods were at highest risk.
“We looked at this as our duty: how do we get into high-density areas with high levels of positives (tests) and bring the testing into the community?”
Though SHN has two hospital assessment centres — at its Centenary and Birchmount sites — it was clear some Scarborough residents couldn’t easily access them, Boatswain said. As well, she said, health workers were hearing some people were reluctant to go to the hospital assessment centres, fearing infection.
“We thought: If we go directly to the community, we might get abigger and better uptake of the testing. And that is exactly what occurred.”
SHN held five pop-up assessment centres from May 29 to June 8, each in a different area of Scarborough. Anyone in the community was welcome, including those without OHIP cards, and each saw a steady stream, said Boatswain, who led the team in charge of the popups in partnership with Toronto Public Health and the Health Ministry.
Leigh Duncan, SHN’s executive director of communications and public affairs, said data shows that Scarborough residents access hospital services at a lower rate than any other community in Canada, a fact that informs all aspects of patient care.
That more than half of Scarborough’s population are newcomers to Canada, many without English as a first or second language, is one reason SHN believes residents may only visit a hospital for emergencies, rather than for ongoing care, she said.
These successes raise questions about access and equity, however. Residents and organizations that have a relationship with creative health-care providers have benefited from early and innovative solutions, while others have waited: though the northwest corner of Toronto has the heaviest burden of COVID-19, mobile testing only materialized this past week.
The pop-up at the Christian Centre Church on Jane Street saw 90 visitors on its first day. Two extra days were added at off-hours, from 4 p.m. to 8 p.m.
“We’re learning more and more (that) someone whose work is not as secure as someone else — there are various reasons that happens to overlap with the groups most vulnerable to COVID — even to take a half-day off to get tested (is difficult),” said Dr. Vanessa Allen, chief of medical microbiology at Public Health Ontario and a provincial leader on testing strategy.
“We really need to think through the economic advantages of getting testing more quickly to people.”
Boatswain said the SHN popups were a success in identifying COVID-19 cases and in connecting with residents. Of the 1,787 people tested,19 were positive.
Boatswain said SHN will consider offering additional popups, should the need arise.