Testing and Contact Tracing – Challenges and Choices

February 4, 2021 by David Nitkin | Categories: Healthcare Series One: Issues | Tags: testing, workplace testing No Comments ↓

The Issue

Infectious disease specialists believe that widespread rapid testing can help us get back to work and school safely and rebuild the economy while we wait our turn for the vaccine. Today, Canada is administering only about 200,000 COVID-19 tests daily, numbers that fall short of recommended levels.

This blog answers three questions:

What kinds of tests are most appropriate for specific applications and target populations?
Is Canada performing tests at rates comparable to other countries?
Can the private sector play a greater role in disseminating tests?

Types of COVID-19 Tests and their Applications

There are two kinds of tests available for COVID-19:

A viral test tells you if you currently have an infection with SARS-CoV-2, the virus that causes COVID-19. Molecular and antigen tests are types of viral tests. Viral tests are also called diagnostic tests.
An antibody test tells you if you previously had an infection with SARS-CoV-2, the virus that causes COVID-19. This type of test is also called a serological test.

According to experts, there is no single, perfect approach to COVID-19 testing and screening that will effectively address every challenge the virus presents across the country. Given our diversity in geography, demographics, science and technologies available, when measured against domestic and international data, an Expert Advisory Council reporting in November 2020 to the federal Minister of Health suggested focusing on optimizing testing and screening for COVID-19. The EAC Panel identified the following priority areas for action:

Optimize diagnostic capacity with lab-based PCR testing:
- Create higher- and lower-priority streams for specimen collection and testing where capacity is constrained; and
- Implement ‘task shifting’ in the health workforce to increase capacity
Deploy rapid tests for screening:
- Use rapid tests in selected groups to screen for infection;
- Test frequently and confirm positive results from screening with PCR tests as appropriate;
- Use screening with rapid tests to limit outbreaks in congregate and high-risk settings, such as long-term care; and
- Consider operational requirements for rapid test deployment
Address equity considerations for testing and screening programs:
- Leverage both lab-based PCR and rapid tests to fill in testing gaps in key geographical locations as well as with specific populations and settings;
- Implement context-specific strategies to improve access to testing and screening in under-served and higher-risk communities; and
- Reduce barriers to testing for precarious (poorly paid, insecure, unprotected) workers
Improve communications strategies:
- Reduce language, knowledge and accessibility barriers in all forms of public health communications related to testing and screening to improve understanding and acceptance of public health messaging;
- Use targeted strategies to improve outreach to high-transmission and high-risk population groups; and
- provide clear guidance tools to help individuals identify if they need testing.

Focusing on these priority areas, says the Panel, would help to:

(a) reduce the prevalence of infections;
(b) protect Canada’s most vulnerable populations;
(c) limit the impact of the disease on the health care system and the economy; and
(d) improve communications strategies.

Canada has an inferior rate of daily testing performance compared to other countries. As this table shows, we lag behind the United Kingdom and the United States in daily tests per capita. While Canada conducts proportionately more tests per capita than South Korea or Taiwan, those counties have a fraction of our fatalities. The reasons for this, as noted in Blogs It’s Time for a Different Approach to COVID Part One (Jan 25) and It’s Time for a Different Approach to COVID Part Two (Jan 27), likely have something to do (I have argued) with those countries’ citizens willingness to wear masks, accept violations of privacy in order to ensure health for all, and their more sophisticated tracking and personal tracing systems, backed by sophisticated and strict quarantining protocols.

_{Source: Our World in Data}

Regular Versus Rapid Tests in Canada

Criticism was raised during coronavirus wave one about the slow rollout of diagnostic tests throughout the provinces and territories as well as flaws in timely follow-up notification, tracing and tracking. During wave two, steps were taken by the federal government and certain provinces to procure more rapid tests. The logic is this: a reasonably accurate test that can be turned around quickly and administered frequently is often more useful than a more accurate test that must be sent to a lab for analysis, with results not available for days.

The differentiation of types of infection testing looks like this:

Type of Test	Description	Application	Follow-Up
Deep brain tickler: slower to process PCR (polymerase chain reaction) test	PCR tests, the gold standard in accuracy, monitoring for the presence of the virus’s genetic material	Workplace testing; used by most provincial COVID-19 assessment centers	Follow up test if RSC result is positive
Nasal swab test: rapid RSC, most of which look for antigens — virus parts that trigger an immune response	Antigen tests that take about 15 minutes to deliver results. Less precise	A way to screen for COVID-19 among groups of people without symptoms, who could still infect others if they have the CoV-SARS-2 virus	Rapid Screening Consortium

As of last week, the delivery of rapid tests has been poor. While 15.4 million of the 40.5 million rapid tests Ottawa procured are actually in Canada, fewer than 1.3 million were reported as used or handed out to local health units. For example, Ontario has used 850,000 of 3.5 million RSC tests acquired; Quebec 10,000 of 2.5 million acquired; and Nova Scotia 15,000 of 287,000 acquired. Five smaller provinces and territories wouldn’t provide the number of tests used. A Global News analysis shows the use of rapid tests varies widely across the country and adding up answers from all the provinces and territories only accounts for a total of less than 1.3 million (3.2%) either used or rolled out to local health units.

We should not let perfection be the enemy of the good

Isaac Bogoch and Hindy Hyder caution that we should not let perfection be the enemy of the good. They observe that, “point-of-care tests are an important public-health tool to prevent the spread of COVID-19. The more we test, the more cases we are likely to find and the more we can limit the spread of the virus. That is why rapid tests are best suited to identify infected people with minimal or no symptoms, and to help ensure those individuals safely isolate before infecting others.”

Because only about 200,000 tests are conducted daily across the country at present, Health Canada last month issued tender calls to bidders for at least another 10,000 tests per day across the country, ramping up to as many as 100,000. Contractors would need to administer the swabs, analyze samples, and even do contact tracing when they identify infected people. The federal government goals for this additional (testing) capacity are to:

complement provincial and territorial public-health capacity;
support a science-based approach to manage increasing volumes of international travelers arriving in Canada;
limit the spread of new highly-transmissible virus variants;
tests would be deployed to “hot spots, regions where there are outbreaks, areas of the country where there is need for general surge support and ports of entry.

Role of Private Sector

Health Canada has asked the private sector to administer and process up to 100,000 COVID-19 tests per day of mostly asymptomatic people, partly to manage what it says will be “increasing volumes” of international travelers arriving this year. This new tender issued just over a week ago appears to mark a new thrust for coronavirus testing, which is administered now mainly by the provinces and is focused on Canadians with COVID-like symptoms. The goal would be to boost by as much as 50 per cent the total number of PCR (polymerase chain reaction) tests done nationally.

Some 15 of Canada’s largest companies have joined together for a pilot project to screen their employees for COVID-19 before they enter the workplace. The ‘Rapid Screening Consortium,’ involves different companies who will administer a rapid COVID-19 screening test twice a week to employees who volunteer to be tested. Those who sign up are screened before entering their workplace and receive the results within 15 minutes.

The project has been spearheaded by Creative Destruction Lab at the Rotman School of Management at the University of Toronto and Professor Janice Stein. These corporate participants are eager to reduce the spread of the virus in their workplaces and lift severe lockdown measures that have closed businesses across Canada and forced others into bankruptcy. The stated and unstated goals of this three month RSC trial project which commenced operations on Dec. 28 are:

Find a way to reopen workplaces
Make essential workplaces safer
Give employees more assurance that all colleagues working with them are being screened on a voluntary basis twice a week
Try to break the chain of transmission
Add an extra measure of workplace safety and protection
Give Canada’s corporate world a road map to quell the spread of COVID-19 in workplaces that have had to close or have struggled to contain outbreaks
Set up a mentoring system for other, smaller companies that wish to do the screenings, creating what it says will be a “plug and play model”.

Antigen tests are not going to solve COVID alone, but when combined with other things like PCRs and rolling out the vaccines, they’re a critical piece of the puzzle. The rapid screening tests come from Health Canada and use a light nasal swab administered by a health professional. Employees will wait to get the result before entering their workplaces. This screening is not meant to replace mask wearing or social distancing, but is intended as an extra layer of protection.

The pilot project tests workers twice a week and makes use of millions of rapid tests obtained by the federal government and dispersed across provinces, who were allowed to allocate them for businesses. After the test, employees return to the workplace and are notified of the results within about 15 minutes through an app. If the worker tests positive, the employee is asked to leave the workplace in order to obtain a PCR test from a provincial testing site, a deep cleaning occurs, and contact tracing takes place. If the PCR test is positive, the worker is required to complete the necessary quarantine and can transition to working from home. The employee will still get paid.

The program which is dependent on voluntary participation is in too early a stage of implementation to be evaluated. The following preliminary observations can be made:

The participation acceptance rate at one of the early start 12 corporations is low– less than 20% of the workforce
It is a pity the program isn’t mandatory or have more incentives
The organizers have reduced the entire screening process from seven minutes per person to 90 seconds.

Conclusion

Canadians are tired. Many of us are tired of staying at home and being separated from friends and family, tired of lockdowns and job insecurity, and exhausted from home schooling our children. Widespread rapid testing can help us get back to work and school safely and rebuild the economy while we wait our turn for the vaccine.

Need More Answers?

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Government of Canada – Priority strategies to optimize testing and screening for COVID-19 in Canada: Report:
https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/medical-devices/testing-screening-advisory-panel/reports-summaries/priority-strategies.html?wbdisable=true

City News – 2 big Canadian companies to start voluntary rapid COVID-19 testing of employees:
https://toronto.citynews.ca/2020/12/18/12-big-canadian-companies-to-start-voluntary-rapid-covid-19-testing-of-employees/

CBC – Several Canadian corporations band together for COVID-19 rapid testing project:
https://www.cbc.ca/news/business/canadian-companies-covid-testing-1.5895933

Toronto.com – MDA latest Canadian company to offer rapid testing:
https://www.toronto.com/news-story/10320852-mda-latest-canadian-company-to-offer-rapid-testing/

Global News – Air Canada, Rogers and Suncor part of group piloting rapid COVID-19 testing:
https://globalnews.ca/news/7611593/rapid-covid19-tests-pilot-airlines-banks-sports-teams-uoft/

Author
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David Nitkin

David Nitkin, founder of EthicScan, is a full-time organizational ethicist. David’s original writing, teaching, consulting and research focuses upon ethical decision making; enhancing corporate accountability and reporting; and developing corporate ethics assurance programs, including transparency, risk management, integrity management, and safe partnering.

David has provided ethics training, advice and research for over 200 clients both internationally and in Canada who collectively employ over 750,000 employees. He consults and trains widely with a variety of clients, including corporations, industry associations, public service sector organizations (integrity commissions, human rights commissions, and anti-corruption tribunals social agencies, professional ethics certification organizations, not-for-profits; and civil society organizations.