As reports of a mysterious pneumonia first emerged from Wuhan, China, Graham Tipples and his team at Alberta’s public health lab quickly turned their minds to how they might test for whatever was causing the illness, should it eventually arrive in the province.
One of the responsibilities of the provincial lab – which is actually two facilities, one in Edmonton and the other in Calgary – is to track emerging diseases, including developing in-house testing to detect them in Alberta. The lab had done some of the same prep work during previous outbreaks, including SARS in 2003, H1N1 in 2009 and Ebola in 2014.
When researchers in China identified the source of illness as a new coronavirus, the lab’s researchers started retooling existing tests for existing coronaviruses to create a potential test. At the same time, staff within Alberta Health Services’ procurement department set to work putting in large orders for supplies, including swabs, a testing component called reagent and other supplies that would be essential to ramp up capacity, which is now at about 7,000 tests a day.
“What was very hard to predict is the scale increase in volume that sort of hit in early March – that was unprecedented," said Dr. Tipples, the lab’s medical scientific director.
“If you had asked me six months ago if we would be doing this much testing, you could never imagine it.”
The result has been arguably the most successful COVID-19 testing system in the country.
The province has consistently had among the highest per capita testing rates in Canada. Alberta’s testing rate, at about 21 tests per 1,000 people, is well above the Canadian average and double Ontario’s, which has been criticized for its slow progress on increasing testing capacity.
Alberta recently expanded its criteria to include anyone in the province with symptoms – the broadest testing coverage in the country. And it plans to continue that expansion, almost tripling its capacity to 20,000 tests a day by the end of May.
One reason for that success is the province’s single health authority, which was created when a network of regional authorities merged a decade ago. Dr. Tipples said that system meant provincial labs, researchers and public health officers are already used to working together.
“When you’re in a crisis situation or emergency situation, you’re building on what’s already in place, you’re not having to reinvent networks," Dr. Tipples said.
“So when you have an emergency and you need to set up an emergency operation centre, you understand your role in that and all the players know what that’s about.”
The single health authority is also making it easier to expand lab testing capacity to more communities, as the province works to create a decentralized system that can process tests locally and give patients results sooner.
Alberta put an early focus on ordering large amounts of supplies, a strategy the government also credited for its ability to recently donate supplies such as masks to other provinces.
Dr. Tipples said the race to acquire testing supplies, which are in high demand around the world, meant finding multiple suppliers to ensure there were backups if one couldn’t deliver. That redundancy creates its own problems, since every new supplier means testing methods need to be revalidated, which Dr. Tipples said lab researchers have become quick at doing.
Late last month, there was a shortage of reagent that created a testing backlog across Canada, including in Alberta.
“Where we’re at now is we have the flexibility to use reagents from multiple different vendors to keep our test going," he said. “We’re in a good place.”
Alberta set up an online self-assessment tool last month to provide advice about who needs to be tested. The tool was adapted by other provinces.
Users who fit the criteria, which has changed several times, are asked to call the provincial health line, 811, to arrange testing, or they can provide their contact information using the self-assessment tool and wait to be contacted by a nurse.
Tests are then conducted at a network of assessment centres, some of which offer drive-through testing. The turnaround time from test to result is about 22 hours, Dr. Tipples said, though that fluctuates with demand and the availability of supplies. Patients with negative results receive an automated call to get that information out as quickly as possible.
Craig Jenne, an infectious disease expert at the University of Calgary, said Alberta’s testing success is also a reflection that Canada has been doing better than most other jurisdictions.
“I think we’ve done a fairly outstanding job in Alberta of testing, but also, for the most part, Canada-wide,” he said.
Dr. Jenne said the goal of testing changes over the course of a pandemic. Early on, officials were attempting to identify new cases in areas that didn’t already have COVID-19, which is why travellers were initially the focus, and follow the spread to close contacts and into the community.
The attention then shifted to protecting front-line health workers and vulnerable groups such as residents of long-term care homes. Alberta is now testing all residents of care homes with a reported outbreak.
The shift toward widespread testing will allow Alberta to get a detailed picture of how the disease is moving through the community, and newer tests will eventually be able to identify people who had COVID-19 but never received a positive diagnosis.
That information, Dr. Jenne said, will be crucial when it comes to reopening the economy, allowing public health officials to identify new infections and prepare for a potential second wave.
“If the strategy is to avoid somebody with an infection, then we need to be used in the testing that we have now, and I think we have a good strategy in place,” Dr. Jenne said.
“If the strategy is to determine how far through the community this has moved, and how many people in the community may have been exposed to some time, we probably are gonna have to adopt a different type of testing strategy.”
Alberta recorded 2,803 cases of COVID-19 as of Sunday and 55 deaths. Modelling data released this month projected a peak in infections could happen in mid-May; the province says it believes it has more than enough hospital beds and ventilators to respond to that surge.
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