Staff and visitors walk past a sign indicating to wash hands on the elevator doors at the Jewish General Hospital in Montreal in this file photo from March 2, 2020.Christinne Muschi/Reuters
Despite assurances from public health officials that coronavirus tests are widely available, some front-line physicians say they’re having trouble getting patients tested, creating potentially dangerous gaps that could leave Canada vulnerable to outbreaks.
A key problem is lack of consistent communication about who qualifies for testing. For weeks, federal, provincial and local public health officials have been relying on a narrow list of countries experiencing COVID-19 outbreaks, such as China, Iran and, more recently, Italy, to help determine which individuals could be tested. The list has faced intense criticism from numerous experts who point out it doesn’t include places like Germany, France or the U.S., even though those countries are experiencing outbreaks of the coronavirus.
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On Wednesday, the Public Health Agency of Canada finally removed the list of affected areas from its website. Now, PHAC simply directs clinicians to the World Health Organization’s list of countries reporting COVID-19 cases and advises them to base testing decisions on advice from provincial and local health officials.
But some doctors are concerned the change in criteria is not being communicated consistently across Canada. Mario Elia, a family physician based in London, Ont., said he wanted to order a COVID-19 test on Thursday for a patient who recently attended a conference in Toronto and started to experience respiratory symptoms. Dr. Elia called his local public health unit, as he’s been instructed to do, but the nurse who answered told him the woman didn’t meet the criteria for testing. Dr. Elia said there was not much more he could do than to advise the woman to self-isolate at home.
Dr. Elia fears this type of situation means cases of COVID-19 are going undetected in Canada. He compared the situation to the U.S., where a lack of testing has led to serious outbreaks in numerous states, including at a long-term-care home in the Seattle area.
The virus that causes COVID-19 is spread through airborne droplets by coughing or sneezing, through touching a surface those droplets have touched, or through personal contact with infected people.
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The World Health Organization recommends regular hand-washing and physical distancing – that is, keeping at least two metres from someone with a cough. If you have to cough or sneeze, do it into your sleeve or a tissue, not your hands. Avoid touching your eyes, mouth or nose if you can.
The CDC says to frequently clean dirty surfaces with soap and water before disinfecting them.
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COVID-19 is much more serious for older adults. As a precaution, older adults should continue frequent and thorough hand-washing, and avoid exposure to people with respiratory symptoms.
Check the WHO’s information page for more details on the virus, and The Globe and Mail’s guide of what health officials say is helpful for the public to do or not do about it.
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“We’re not doing any better than they are with testing,” Dr. Elia said. “From a testing standpoint, we really have nothing to be gloating about here.”
Lucas Castellani, an infectious diseases physician in Sault Ste. Marie, Ont., said he’s heard of similar issues cropping up in other areas.
“I’m hearing from colleagues there’s these cases that could actually be potentially COVID that we’re not testing because of the criteria set by the current recommendations by the Public Health Agency of Canada.”
PHAC and Ontario’s health ministry did not respond to questions about testing.
Dr. Castellani said an additional problem is that Ontario has been directing health workers to use airborne precautions when treating patients who may have COVID-19. Airborne precautions include the use of special N95 respirator masks and negative pressure rooms, which are typically only available in hospitals, not at family doctors’ offices.
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Ontario’s health ministry has decided to move to droplet precautions, which includes regular surgical masks, gowns, gloves and eye protection and no other special equipment, which could help increase testing outside of hospitals.
Earlier this week, a Sudbury man tested positive for COVID-19 after attending a large conference in Toronto. Penny Sutcliffe, medical officer of health with Public Health Sudbury and Districts, said she’s been directing health-care workers in the area to shift away from the outdated, narrow list of countries experiencing COVID-19 outbreaks in recent days, which is why the man got checked for the disease.
“Honestly, we wouldn’t have identified [that] case in our area if I had stuck to that case definition,” Dr. Sutcliffe said.
While Ontario, Manitoba and other provinces are setting up standalone testing centres to help eliminate bottlenecks and reduce pressure on emergency rooms, Dr. Sutcliffe said smaller, more remote areas likely won’t have access to those facilities, at least in the near future. That could lead to backlogs processing samples and waiting for test results, in addition to issues getting patients tested.
“If you live in Chapleau or you live further away, it’s extremely challenging, and that’s just on the lab side,” Dr. Sutcliffe said.
Bonnie Henry, B.C.'s provincial officer of health, said the province has steadily broadened its testing criteria, but that even still, ensuring everyone who wants a test can get one is a difficult task, which will become even more so as the case numbers continue to rise.
In the meantime, provincial health officials are asking anyone who develops symptoms, even mild ones, to stay home.
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Carly Weeks