May 3, 2020
Still not enough tests… update on COVID-19 testing in Canada
The video
Three weeks ago, some friends and I put out a video though Endcoronavirus.org and New England Complex Systems Institute (NECSI) on the need for mass testing in Canada.
Since then I’ve had a lot of conversations with folks about the state of mass testing in Canada. Everyone agrees that we need it, but we’re still not where we need to be with it, so what’s going on? Here I’ll attempt to put together Canada’s current status on COVID-19 testing.
The good news is it has gotten better. The bad news is it’s not where we need it to be¹.
The good
- We’ve tested around 900,000 people².
- We have contact tracing in place (at times run by volunteers 🙏🙏🙏) to alert contacts of those who test positive, and check in on them daily¹⁸.
- People who are showing symptoms usually have access to a test¹⁶.
- Ontario can test over 16K people / day³. Quebec can test 14K people / day⁴. BC can test 7K people / day⁵. On average across Canada we’re testing 23K / day².
The bad
- Provinces are not recommending testing asymptomatic people⁶. This means we can’t nip new outbreaks in the bud⁷.
- We still don’t have capacity for the at least 100K swab tests / day we would need across Canada if we want to confidently get COVID-19 under control¹.
- Globally, it appears we still don’t understand COVID-19 well. This implies we should continue to act according to the precautionary principle and avoid policies that promote herd immunity⁸ or issuing immunity passports⁹.
You come here with no symptoms and you ask me for a test?
That we’re not testing enough, and that it seems like we won’t have the ability to test enough for awhile may be due to supply chain issues. For example, swab shortages¹ or quality issues¹⁰. There may also be logistical bottlenecks in deploying/processing the tests, and bureaucratic friction. Recall that in April, Ontario Premier Doug Ford called it “unacceptable” that the level of testing wasn’t where it should be despite the province having the capacity¹¹.
How do we act when we don’t know what we’re up against?
The point that we still don’t understand COVID-19 and should act with the utmost precaution is sobering¹⁷. We know people who get COVID-19 are generally less healthy after they recover¹². However the extent of how much less healthy is unknown¹⁷. For instance, there’s some new evidence that COVID-19 increases risk of deadly stroke in 30–40 year olds¹³. Further, hurting the herd immunity theory, there’s no evidence that previously infected people are immune¹⁴ and it’s not clear that we’ll have a vaccine in short order¹⁵.
NECSI’s “How to win” guidelines say we should prioritize preventing people from getting infected with COVID-19, and developing the ability to shut the disease down through community measures.
One of the pillars of those guidelines is testing, testing, testing. Unfortunately, testing for COVID-19 in Canada is still not where it needs to be. Worse, it’s not clear why we’re not able to test at the level we need to be. What we do know is that the experts are telling us that we need to increase testing capacity 5x to 20x¹.
As we open up the country, we need to answer this testing question, and continue to increase our testing capacity. If we can’t, then we expose ourselves to the risk of a second (or third) wave hitting us harder than the first one did.
References
[1] https://nationalpost.com/news/canada/covid-19-testing
[2] https://twitter.com/CPHO_Canada/status/1256629795993137153?s=20
[7] https://www.endcoronavirus.org/papers/how-to-win
[8] https://www.cbc.ca/news/politics/herd-immunity-should-not-be-supported-tam-says-1.5545332
[9] https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19
[12] https://www.theguardian.com/world/2020/may/02/coronavirus-britons-health-problems-covid-19
[15] https://www.abc.net.au/news/health/2020-04-17/coronavirus-vaccine-ian-frazer/12146616
