Canada may be missing thousands of coronavirus cases, experts say

When Amanda developed a fever, sore throat, and dry cough at the end of March she immediately thought of one thing: the new coronavirus.

With Canada, and much of the world in lockdown amid the deadly pandemic, she went online to the Ontario Ministry of Health website to see if she needed to be tested — it told her she didn’t.

“The fear is that if I get a severe version of this illness I will need a lengthy hospitalization and I have two young children,” said Amanda, who agreed to speak with Global News on the condition of using a pseudonym.

“But I hadn’t technically been in direct contact with someone who had travelled, or who had been diagnosed as being positive.

“I didn’t really meet any of the criteria for testing.”

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Amanda, an attorney in Toronto, self-isolated for 14 days and, along with millions of other Canadians, is working from home. But she is left wondering if she did in fact, have COVID-19.

Provinces like Ontario, Alberta and B.C., have limited who is being tested for COVID-19 amid a shortage of testing swabs, reduced lab capacity and a lack of reagents — the specific chemicals needed by labs to complete the tests. The priority, for now, is front-line health care workers showing symptoms, hospitalized patients or recent travellers.

READ MORE: Ontario lags behind all other provinces in COVID-19 testing

But experts worry that narrow focus will cause health officials to miss hundreds or even thousands of cases and Canada may not know whether it is truly “flattening the curve.”

“We would like to see greater access to testing so that we aren’t left in a situation where there’s uncertainty around whether a particular person may or may not have the disease,” said Peter Phillips, a clinical professor specializing in infectious diseases at the University of British Columbia. “And that applies to even people with mild disease in the community.”

Phillips said that while a positive test may not necessarily change treatment, it’s important in terms of managing community spread as people generally become more compliant with self-isolation.

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Sean Wormsbecke, an emergency doctor at Royal Columbian Hospital in New Westminster, B.C, said he sends several COVID-19 cases home without testing — given current guidelines.

“There isn’t currently a tracking system for those cases that don’t warrant admission to hospital,” he said, noting that he can’t be certain they are COVID-19. “But I’m seeing patients who have the exact same symptom profile, in terms of how they describe their cough, how they describe shortness of breath.”

He urged people to take social distance seriously and to follow all self-isolation protocols.

“I see those almost every shift and they don’t count towards the official tally,” he said. “There is a significant portion of these patients.”

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Nearly two-thirds of reported COVID-19 cases in Canada as of March 28 are related to community spread, according to the Public Health Agency of Canada, meaning a case that results from the virus being passed within a community, rather than being contracted through someone who has recently travelled.

How does Canada’s testing compare to the world?

The World Health Organization and other health agencies have continued to beat the drum over the importance to “test, test, test” to fight the spread of the virus.

Global health experts have pointed to South Korea as​ one of the few countries to contain the oubreak, reporting just 89 new cases of the novel coronavirus Thursday, down from 101 new cases a day earlier, and seemingly flattening the curve of new infections.

“They had very aggressive testing and they went after these cases and did very detailed contact tracing, including the use of cell phone and credit card data,” Phillips said.

Canada, meanwhile, is acquiring almost 1,000 new cases a day and has over 9,700 cases and over 110 deaths as of Thursday morning.

“We’re blowing right by South Korea,” Phillips said. “We’re going to have way more cases.”

Canada has tested more than 255,000 people for a per capita rate of 650 tests per 100,000, well ahead of Italy and the U.S. the hardest hit by COVID-19, but well back of South Korea who has done roughly 800 per capita.

Since its first case in February, Iceland has launched ambitious testing for the virus. Anyone on the island – home to about 364,000 people – can get tested. They do not need to have recently travelled abroad or even have to be showing any symptoms.

As a result, about five per cent of the population has been tested.

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Dawn Bowdish, Canada Research Chair in aging and immunity at McMaster University, said Canada tested “aggressively” in the early months of January to February, but ran into trouble as global supply chains became squeezed.

“In the very, very early days, we were on the higher end of average for testing,” she said. “At the time, most of our cases were travel-related or they were with contacts of people who had travelled. “

As countries began to fight for limited supplies of nasal swabs and chemicals needed to do the tests, provinces, especially Ontario which had high case numbers in Toronto, started to limit testing.

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“At that point, compromises had to be made and I believe that our public health agencies are doing the best they can with what they have,” Bowdish said.

And now with more cases appearing to be asymptomatic, meaning people are displaying little or no symptoms, there are calls for testing to be widened.

“We are absolutely missing cases”

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“One of the compromises is that we are not testing as widely as I’m sure everyone in public health would like,” Bowdish said.

Both Bowdish and Phillips say more money should be going towards testing and contact tracing, which involves retracing the steps of a COVID-19 patient and tracking down anyone who may have had contact with them.

How have governments responded?

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Tina Namiesniowski, president of the Public Health Agency of Canada, told a House of Commons committee this week that the federal government is working to ramp up testing.

“We are working hard, collectively across the country, with all jurisdictions, to advance testing,” she said. “The National Microbiology Lab continues to support provinces and territories needing assistance with testing and other reference services.”

READ MORE: Inside officials’ struggle to trace the contacts, movements of COVID-19 patients

Prime Minister Justin Trudeau also announced a $74-million investment in a new made-in-Canada testing technology to help provinces increase testing capacity.

Alberta and Ontario also announced they signed deals with Spartan Bioscience Inc., an Ottawa-based company, that produces a portable DNA analyzer that can provide COVID-19 test results in about 30 minutes.

However, it remains unclear when provinces can start using the technology as it has not yet been approved by Health Canada. The company said in a statement it expects to begin shipping thousands of test kits to provinces “soon.”

Ontario has faced criticism for its slow testing rate, with the lowest per-capita testing rate in the country at about 350 per 100,000 people, despite having nearly 40 per cent of Canada’s population.

Ontario Health Minister Christine Elliott’s’ office said this week it’s working to increase testing capacity, currently at approximately 9,000 tests per day, and has reduced the backlog of outstanding tests from 11,391 on March 25 to 3,135 as of March 31.

“We are surging the system and testing as many people as possible,” Premier Doug Ford told reporters Monday during a press conference. “We need more kits to get out there, but it’s not as quick as we would like.”

Infectious disease experts worry that with infection rates of anywhere from 30 to 60 per cent of the population, increased testing could help prevent Canada’s medical system from being overwhelmed.

“We need to be testing aggressively and not just restricting it to those patients who are sick,” Philips said. “The overload of the medical system, intensive care units and the death toll associated with those sort of percentages are absolutely daunting.