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A member of the Canadian Armed Forces wheels a man into a COVID-19 vaccination clinic in Montreal, on Jan. 6.Paul Chiasson/The Canadian Press

Quebec is expanding its vaccination requirement to provincial liquor and cannabis stores, and warning that other retail is next, as Ontario says COVID-19 is so prevalent that most people with symptoms won’t get access to a rapid test to confirm they have it.

The measures in Quebec are part of an effort to clamp down on unvaccinated residents, who are far more likely to be hospitalized with COVID-19. The latest wave has put unprecedented strain on the province’s medical system.

“Unfortunately, we have to protect them against themselves, and protect our health system,” Quebec Health Minister Christian Dubé said in a news conference. “If they don’t want to get vaccinated, they can stay home.”

He announced on Thursday that the provincial liquor and cannabis stores will require customers to have proof of vaccination to enter starting on Jan. 18. And he warned that other non-essential services, such as shopping malls and hair salons, could soon be required to ask for a vaccination passport – a step that could aggressively limit freedom of movement for the unvaccinated.

Quebec has been in the vanguard of new Canadian anti-COVID measures as cases of the highly transmissible Omicron variant soar. The surge has kindled a public demand for rapid antigen tests – which are less accurate than lab-done PCR tests, but can be taken at home – that has outpaced supply, leading some provinces to limit access.

“Our framework … is first use those [rapid tests] to keep our vulnerable settings safe,” said Ontario Chief Medical Officer of Health Kieran Moore, who called testing a “luxury” and added that self-monitoring was best for most Ontarians.

“If you have symptoms compatible with COVID-19, please, you don’t necessarily need a test to confirm them,” he explained. “If I come down with the symptoms of COVID-19, so I get a fever and a cough, I’m not going to seek any confirmatory testing. I’m going to stay at home for the five days and hopefully my symptoms are resolved.”

Saskatchewan and Manitoba are distributing rapid tests widely, while British Columbia is largely restricting them to health authorities, health care workers and vulnerable communities.

Brian Conway, medical director of the Vancouver Infectious Diseases Centre, urged a rethink of the province’s rapid test strategy, saying access to the tests would benefit the public and help alleviate pressure at overwhelmed testing centres.

The limited supply of rapid tests has also sparked jousting between Ontario and the federal government.

In briefing notes released on Thursday by the Ontario Ministry of Health, the provincial government said it had anticipated receiving 15.5 million rapid tests from the federal government last month but got around 3.4 million.

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The federal government provided different numbers on Thursday.

“The province of Ontario initially requested 4.7 million rapid tests for the month of December,” Marjolaine Provost, spokeswoman for federal Health Minister Jean-Yves Duclos, said in a statement. “A second request was submitted to the Public Health Agency of Canada half-way through December for another 5 million tests.

“Ontario received a total of 5.4 million rapid tests by Dec. 31 from the federal government, exceeding their initial request for the month. In addition, Ontario is on track to get another 9.7 million tests.”

That promise far undercuts the need, according to the provincial briefing document, which states that Ontario has requested almost 69 million rapid tests for this month.

Ms. Provost said “January allocations and delivery schedules” had been communicated to provinces and territories and “delivery information will continue to be shared with them in real time.”

Once rapid tests are available in large numbers, experts say, they could provide an extra layer of security. But they are less accurate than PCR tests and cannot be relied on to be definitive – and certainly not viewed as a free pass.

Irfan Dhalla, vice-president and general internist at Unity Health Toronto, explained that a positive test is more meaningful than a negative one. His calculus was simple: a positive test should be taken as a red light, while a negative test isn’t a green light, because it doesn’t necessarily mean the person is COVID-free.

“If we are going to use rapid antigen tests widely over the next six to 12 months, we do need a communication campaign to help people understand how they should be used appropriately,” he said.

“With Omicron circulating the way it’s circulating, you don’t want to have a house party with 20 people and say, ‘have a rapid antigen test and then come to my house party and we will, you know, hang out as if it were prepandemic days, right, no masks, eating together, etc.’ No. The negative test still means you have to follow public-health guidance.”

In many provinces, that guidance has become more strict in recent weeks.

The most severe measures were taken in Quebec, which imposed a nighttime curfew last Friday, postponed the return to in-person schooling and put limits on private gatherings. On Thursday, the province said it will require Quebeckers to have booster shots as a condition of a valid vaccination passport in the coming months, when more people have received them.

Earlier this week, Ontario announced its own delayed return to in-person schooling and instituted capacity limits on restaurants and retail. And before the holidays, B.C. and Alberta announced new restrictions that include capacity limits at restaurants and other indoor venues. B.C. has also closed gyms and bars and prohibited indoor gatherings such as weddings and funerals.

Official case counts for COVID-19 are believed to be substantially below the real numbers, but hospitalizations and intensive care admissions provide a window into the worsening situation in many places.

“This will be a tough January, but I am hopeful for a better February and a brighter outlook moving into March,” said Dr. Moore, Ontario’s top doctor. “Spring will bring relief, but for now we must continue to dig deep and protect one another.”

With a report from Kristy Kirkup

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