Tests and follow-up of contacts are essential to ease social restrictions. But is Canada ready?

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There may be many different routes to the new “normal” COVID-19 as the provinces announce various plans to gradually ease social restrictions across Canada.

But all share a critical requirement: the ability to widely test the infection and find contacts, in order to isolate those exposed and break the chains of infection.

Are we ready? Has Canada resolved the test delays and shortages that hit the headlines just a few weeks ago?

Infectious disease experts at the forefront of the COVID-19 outbreak in Canada say no, but it’s a question that has no easy answers.

‘Easy to say, hard to do’

Each province is responsible for its own screening policy and, in many cases, municipal or regional health units are responsible for contact tracing.

A member of Prime Minister Justin Trudeau’s brand new COVID-19 immunity task force said testing capacity has yet to measure up to the slower spread of the virus when social restrictions are lifted.

“I am personally concerned about testing and tracing capabilities,” said Dr. David Naylor.

Dr. Issac Bogoch, an infectious disease specialist at Toronto General Hospital, agrees.

“We are not yet able to do enough diagnostic tests to reopen,” said Bogoch. “The crucial elements of the reopening will not be barriers to diagnostic testing, and then we need an army of people to follow up on contacts to identify positive cases and their close contacts,” said he said Sunday on CBC News Network.

“Easy to say, hard to do. “

If Canadians lack confidence in the testing system, it is understandable.

During the first days of the Canadian outbreak, many were shocked to learn that they could not get tested even if they had both symptoms and a history of travel.

Shortly thereafter, Ontario, British Columbia and several other provinces reported arrears this forced some people to wait more than a week for test results.

Criteria for lifting COVID-19 restrictions in Ontario include a two to four week steady decline in new infections, a decrease in traceable source infections and the ability to trace 90% of new case contacts. within 24 hours. (Government of Ontario)

Even after chaos of testing prompted frustrated Ontario Premier to warn that he would accept “No more excuses,” Ontario has yet to reach the level of testing promised almost six weeks ago.

In March, Ontario officials said would test 20,000 people in mid-April. But in the past seven days, the province has performed only 12,500 tests per day, with a target of 14,000 tests per day by the end of this week.

British Columbia only tests about 2,000 people a day, according to Dr. Bonnie Henry, the province’s chief medical officer of health.

“Part of it is because we don’t see a lot of respiratory disease in the community right now,” said Henry. “We continue to test anyone who goes to the hospital with a respiratory illness or any other symptom that concerns us, and we have very general symptoms that we are talking about for the community. “

Canada’s Minister of Health Patti Hajdu was asked Monday about Canada’s ability to test COVID-19.

“I obviously think Canada can do better,” she said. “We have done a lot and we are very pleased with the growth in testing that is taking place in the capacity of the provinces and territories.”

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Hajdu added that the federal government had hired a New Brunswick company to supply some of the reagents that were desperately needed – including the chemicals needed to perform the tests.

“We now have a local manufacturing source for this reagent, which greatly facilitates the completion of this component of the tests. “

LuminUltra is to provide the federal government with 500,000 RNA / DNA isolation kits per week.

CEO Patrick Whalen said the company would have shipped one million test kits to provincial labs by Thursday.

“We are providing this RNA isolation kit which is optimized to work on a specific extraction device, a robotic device that processes 96 samples at a time,” said Whalen, adding that it is designed to work on a equipment commonly used in provincial health laboratories across Canada.

But other chemicals are needed at different stages of the test, and the supply of these chemicals is also tight.

“We are also increasing our capacity to produce test kits – the next step after the isolation process – but we have not yet been called upon or invited to produce them for provincial health laboratories,” said Whalen .

What about the Spartan cube?

Ottawa Spartan Biosciences has been applauded for its rapid DNA analyzer, the Spartan Cube, which has been adapted to perform the COVID-19 tests. Health Canada approved the test two weeks ago, but it is still unknown if the test added capacity to the system.

CEO Paul Lem said he could not reveal precisely how many portable Spartan DNA analyzers had shipped to the federal or provincial governments, citing the need to protect proprietary information. It would only say that the company shipped “almost 100 or more.”

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Each cube can carry out one test per hour, which corresponds to a maximum of 24 tests per day per machine. Lem said the company ships thousands of tests designed to be used with the company’s small test machine. But he could not say if they are still used.

“Good question, I don’t know,” said Lem.

Health Canada’s media office has been unable to say how many cubes have been purchased and received to date, or whether any of these cubes are currently used for COVID-19 testing.

Who to test

A key question as social restrictions are relaxed will be who will be tested.

As Henry from British Columbia pointed out, this province tests anyone with symptoms.

“We need to have a broader understanding of where the cases and clusters come from in our communities,” said Henry.

A bin full of disposable gloves at a COVID-19 driving test center near Etobicoke General Hospital in Toronto. (Evan Mitsui / CBC)

Henry said there is no point in testing people without symptoms unless they are in a specific outbreak, such as in prisons or long-term care facilities.

Hospitals want to be able to test every admitted patient, not just people with COVID-19 symptoms.

This is one reason why some primary care physicians say it is too early to relax the restrictions.

“He’s trying to find this balance between opening things up and not opening up too much because we would have such an outbreak of cases, we would go straight back to the concerns we had a month ago,” said Dr. Michael Gardam, chief of Humber River Hospital office in Toronto.

“This is an incredibly delicate balancing exercise to try to find the way forward,” he said. “To be frank, it was so much easier to close things than to open them. “

Contact tracking

The other side of the test is the need for legions of contact tracers to find all the people encountered by all the people tested positive. It’s an intimidating business.

“Tracking contacts is really important,” said Henry. “This is what helps us understand the whereabouts of people who may have been exposed to the virus and possibly develop symptoms,” she said. “Because the incubation period is so long for COVID-19, this gives us the opportunity to find people and make sure they are isolated before we can pass it on to someone else. “

BEFORE CHRIST. has developed his contact tracing capacity, said Henry.

“We are looking at how we can use technology to facilitate this, but there is really nothing that replaces an individual’s connection with each of the contacts.”

Federal government launched national call for COVID-19 volunteers to do some of the tracking and tracing, and received thousands of responses when it closed last Friday.

“There were 53,769 volunteers on the inventory from which provincial and territorial governments can call if needed,” Health Canada spokesperson André Gagnon said in an email.

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