Nova Scotia discovers grassroots success with COVID-19 rapid-test kits

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Downtown Halifax’s restaurants and bars have become home to volunteers offering rapid COVID-19 tests so patrons can socialize with some assurance they are free of the virus, an experiment that is giving a window into what a new normal could look like.

Since the pop-up clinics launched in Nova Scotia in December, just a handful of the nearly 14,000 people who have been tested were confirmed to have COVID-19. Public-health officials in Nova Scotia see even that low rate as a success: Fifteen people who were asymptomatic – and likely shedding the virus – did not end up inadvertently spreading COVID-19 in their community. As well, by testing asymptomatic individuals, the province is gaining an early warning system for potential outbreaks.

While health authorities across the country have been slow to utilize the millions of rapid test kits acquired by the federal government, the Nova Scotia experiment is demonstrating a grassroots-powered public-health program that is uncomplicated and nimble. Those doing the tests are recruited from the general public, and they become ambassadors for testing as a way to help live with the pandemic.

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“We wanted to have something that helped us know how many asymptomatic people were out there who had COVID, but also to offer people the opportunity to start thinking about routine testing as part of their safer COVID living,” said Dr. Lisa Barrett, who spearheaded the program. “It gets the community engaged.”

The program fits with the recommendations of Health Canada’s COVID-19 Testing and Screening Expert Advisory Panel, which says the tests do not need to be performed by a health professional – an important shift that could help overcome bottlenecks and limited capacity in lab-based testing capacity. But in other provinces, public-health officials still insist that these tests need to be administered by someone with medical training.

Canada has distributed more than 14.3 million rapid tests to the provinces and territories. There are three different types of kits, each with different processing methods, but all three allow for results at the point of testing in one hour or less. The tests are not as reliable as lab testing, but they are a tool for surveillance that can detect outbreaks of the virus in a community quickly.

Dr. Barrett is an infectious-diseases expert in Dalhousie University’s department of medicine, who approached public-health officials in November with an unusual pitch: Medical professionals could train members of the public – ranging from high-school students to retired librarians – to take nasal swabs and run them through the Abbott Panbio rapid test. The next day, she had the first clinics up and running.

The strategies for using the rapid tests varies by province. British Columbia has not advanced past pilot projects and has more than one million test kits still in storage.

Alberta is somewhere between B.C. and Nova Scotia in deploying the kits. It is in the process of setting up 48 assessment centres where residents, if they are experiencing possible COVID-19 symptoms, can get rapid tests. The province has used 12,000 of its test kits and has found more than 1,300 COVID-19 cases – a much higher rate than Nova Scotia because Alberta is focusing mostly on people who are already showing symptoms.

“We are trying to maximize [the tests’] potential by targeting people who have a high likelihood of having COVID-19,” said Dr. William Stokes of Alberta Precision Laboratories, who is heading up the province’s rapid testing initiative. These tests are helping reduce the burden on the lab system, he added, because those who test positive are treated as positive, without following up with a lab test.

However, Dr. Stokes, who is an infectious-diseases specialist at the University of Alberta, says the rapid tests are too complicated and time-consuming to use, for example, to broadly test workers at long-term care homes. “A nasal pharyngeal specimen has to be collected by a trained health care professional. That’s one of the biggest limitations,” he said.

He said the Panbio rapid test provides subjective test results. “It doesn’t give you a positive or negative; it gives you a colour change and you have to interpret that colour change.”

Dr. Robert Strang, Nova Scotia’s Chief Medical Officer of Health, said he was reluctant at first to put the test kits in the hands of non-medical staff, but said he is grateful that Dr. Barrett and her colleagues pushed. “It’s a fundamentally important part of our overall testing strategy, and our overall COVID response,” he said.

“We’ve learned now with COVID that by the time you start to see increased activity through your symptomatic testing, you probably had several generations of transmission of the virus before we even detect it,” he said.

Rapid Test and Trace Canada is an alliance of academics and business leaders seeking to help reopen the economy. Co-founder Sandy White is proposing to use rapid testing in Banff, Alta., as a pilot project to see if the tourism-dependent community can safely welcome visitors back. The proposal, currently in front of the Alberta government, would be funded by businesses and would involve testing the entire population as a continuing COVID-19 surveillance initiative.

Mr. White said the resistance to widespread use of rapid tests across the country – outside of Nova Scotia – is frustrating.

“The more testing we do, the more cases we find. The more cases we find, the faster we stop the spread of this disease. And that we’re spending all this time navel-gazing at who can even perform these tests,” he said, “this is like watching a building burn down in front of you and wondering what type of hose you should use.”

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