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Hundreds of people and family members line up around a football field for COVID-19 testing at Brewer Park, on Sept. 17, 2020 in Ottawa.

Dave Chan/The Globe and Mail

Children in British Columbia who need a coronavirus test can now skip the deep-nasal swab and spit into a tube instead, an advance that comes as other parts of Canada grapple with a massive spike in demand for testing.

Hours-long lineups at COVID-19 assessment centres have prompted some epidemiologists and physicians groups, including the Ontario Medical Association, to demand an overhaul of how Canada tests for the coronavirus, beginning with reserving tests for people who are sick or have come into contact with a confirmed case.

Alberta, the first province to allow anyone who wanted a test to get one, has already heeded that call, announcing on Thursday that it will halt indiscriminate testing of people without symptoms.

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Experts say Canada could also benefit from more widespread use of sample-collection methods that go beyond standard swabs, including the swish-and-spit approach B.C. announced on Thursday.

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And they say the federal government should consider technologies that can return results in 15 minutes at the testing sites, even if they aren’t as accurate as those produced in currently overburdened labs.

“For schools and work sites to function, more rapid on-site testing strategies could be a game-changer,” said David Naylor, a leader of Canada’s COVID-19 Immunity Taskforce and the author of a report on the 2003 SARS outbreak.

Renewed pressure on COVID-19 testing systems – which are run primarily by provincial governments – comes as Chief Public Health Officer Theresa Tam warned on Thursday that the country’s control of the epidemic could be slipping.

“The ongoing increase in new cases being reported daily continues to give cause for concern,” she said in a statement. “With continued circulation of the virus, the situation could change quickly and we could lose the ability to keep COVID-19 cases at manageable levels.”

Canada has recorded an average of 779 new coronavirus infections a day over the past week, up from fewer than 300 a day in late July. Hospital admissions and deaths have, for the most part, remained low and stable because most new COVID-19 cases have been diagnosed in young people, who are less likely than the elderly to fall severely ill.

Still, concerns about the spike, and school policies that require children with mild cold and flu-like symptoms to be tested for COVID-19, have sent people stampeding to testing centres, especially in Ontario and Quebec.

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Among those turned away from a testing centre in Ottawa this week after waiting hours were new Conservative Leader Erin O’Toole and his family. Mr. O’Toole said in a statement later that they used testing made available by the House of Commons for MPs and their families on Thursday morning in Gatineau, Que.

Montreal had to add 222 new cases to its numbers from the past four days owing to a testing backlog. Marie Montpetit, the Quebec Liberal health critic, told the National Assembly that testing clinics were in “chaos,” with people waiting a week for results. Health Minister Christian Dubé acknowledged that lineups were poorly managed and blamed shortages of staff and lab equipment, but vowed to improve the situation.

“I don’t think this was unpredictable, with the return to school,” said Ashleigh Tuite, an infectious-diseases epidemiologist at the University of Toronto. “Kids tend to get sick. We’re not in winter yet, but in the fall, we start seeing more respiratory infections.”

In B.C., Provincial Health Officer Bonnie Henry said the new method of sample collection for those aged four to 19 is among the first of its kind, and the collection tubes will come from a company in the province.

“This reduces our dependency as a province on the global supply chain, which we know has been one of the challenges, and particularly around our lab testing,” she said.

She added that the new method might be expanded to include older people in the coming months.

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Alberta and Ontario are also validating new methods for collecting samples, senior lab officials in both provinces said. Ontario is rolling out more throat swabs and shallow nasal swabs that should be easier on children, said Vanessa Allen, medical director of Ontario Health’s COVID-19 Provincial Diagnostic Network Operations Centre.

When it comes to identifying coronavirus infections from those samples, Canada relies exclusively on highly accurate polymerase chain reaction (PCR) testing conducted in labs.

According to Health Canada, at least six companies have applied for approval of an on-site antigen test, which is less reliable than PCR, but could be performed by a health-care professional in about 15 minutes on devices not much larger than a smart phone.

Quidel Corp. and Becton, Dickinson and Co. (known as BD), two of the companies seeking Health Canada approval, received emergency-use authorization for their rapid antigen tests from the U.S. Food and Drug Administration earlier this year. .

Federal Health Minister Patty Hajdu has so far rejected calls for on-site antigen tests, saying the technology is not yet accurate enough.

“We will not at Health Canada approve a test that in any way endangers Canadians' health,” Ms. Hajdu said on Wednesday. "Can you imagine a scenario where people could purchase a rapid test in a pharmacy, let’s say, and it’s only 50-per-cent accurate? We’re just not there yet.”

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Dr. Naylor said the antigen tests could have a place in screening for infection rather than confirming it.

“What we’re talking about are rapid tests that can be done on-the-spot for screening purposes of asymptomatic people in contexts like schools or worksites with a view to getting results in minutes, not hours or days,” he said by e-mail. “That’s different from, say, the definitive PCR test in a public health lab that should be done when someone presents with worrisome symptoms and a COVID-19 exposure history."

With faster testing technologies seeming a long way off, another route to reduce lineups and testing times could be to prohibit tests for asymptomatic people who haven’t come into contact with a case, as B.C. does and Alberta has vowed to do.

“The vast, vast majority who were tested in that [asymptomatic] category have tested negative,” said Deena Hinshaw, Alberta’s Medical Officer of Health. “So we really are moving back, anticipating that as we move into the next few months, there will be many more people who have symptoms, who need to be tested rapidly.”

With reports from James Keller and Les Perreaux

Amanda Antoine, manager of a medical clinic in a small Ontario town, was forced to self-isolate when she tested positive for the coronavirus. She shares her debilitating COVID-19 symptoms and the impact of her illness on her family and her workplace. The Globe and Mail

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