Tough

Updated: November 1, 2020

How close are we to having rapid reliable COVID-19 tests widely available in every community?

Summary

As of May 24, 2020, Ontario opened testing to include individuals who have at least one symptom of COVID-19, even mild and atypical symptoms, and those who are concerned they might have been exposed [2]. As of October 6, 2020, all assessment centers are operating by appointment only [6]. The Ontario Health Coalition has compiled a list of Ontario COVID-19 assessment centres and their individual criteria for access, which is regularly updated [6]. The province of Ontario has also provided a list of 302 testing locations by city, including 114 in the Greater Toronto Area and 23 in the Ottawa Area [3]. At their current capacity, the Public Health Ontario Laboratory processes 60% of results in 24 hours and 80% within 48 hours [4]. In Ontario, people who cannot tolerate other forms of testing, such as the preferred nasopharyngeal (NP) swab, which is still the most accurate, can now have saliva testing in some assessment centres, although this test is less accurate [4]. The types of specimens or samples that can be collected currently are listed here by Public Health Ontario; sampling types currently in practice include nasopharyngeal swabs, throat swabs, mouth rinsing, saliva, etc.  Ontario has also continued to fund projects that make COVID-19 testing more readily accessible. For example, McMaster University is developing a rapid high-throughput test for COVID-19 with the goal of testing up to 6,000 samples per lab daily and a stool test for 4,500 samples from outpatient clinics that will better identify asymptomatic individuals [5]. A point-of-care test (POCT) is a test that can be administered at the time a patient is receiving care, rather than sending samples to an outside laboratory. The RAPID COVID Study being done at the University of Ottawa Heart Institute is collaborating with Spartan Biosciences to develop a 45-minute bedside POCT to provide rapid results and decrease resource utilization [5]. Health Canada is currently reviewing 102 devices which can be used for COVID-19 testing, 21 of which are POCT devices [1]. Currently Ontario is taking a targeted testing approach to identifying priority populations who are at higher risk of exposure or COVID-19 related complications and deploying mobile testing units to these settings [2]. It is advised to check the Ministry of Health COVID-19 website regularly for updated guidance on testing guidelines. 

Contingencies

The development of a detailed, robust answer relies on several factors. To provide a detailed REAL Note requires knowing the following:
o  Speed of reviewing test applications by Health Canada
o  Canadian/Ontario policy and decision making
o  Accessibility and cost of a test that is both rapid and reliable
o  Adding additional assessment centres across Ontario and increasing the number of primary care settings that perform testing

Evidence

Review of Evidence

Resource Type/Source of Evidence Last Updated
Ontario Opens Up COVID-19 Testing Across the Province: Strategy Expands Testing for General Public, Frontline Workers, First Responders and Workplaces
— Government of Ontario
Guidance Last Updated: May 28, 2020
Coronavirus Disease 2019 (COVID-19) PCR Testing
— Public Health Ontario
Guidance Last Updated: October 4, 2020
Ontario Announces First Phase of Research Projects to Fight COVID-19: Ontario-Based Solutions Contribute to the Global Effort against the Outbreak
— Government of Ontario
Guidance Last Updated: May 20, 2020
Testing devices for COVID-19: List of applications under evaluation
— Government of Canada
Report Last Updated: October 15, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

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