Canada has a goal to double its coronavirus testing capacity. How are we going to get there?

In anticipation of a second wave of coronavirus, the federal government and the provinces are looking to dramatically increase the country’s testing capacity in the coming months.

They’ve set a goal to be able to test 200,000 people per day in the event demand becomes that great.

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Right now, though capacity has grown in recent weeks, the target remains a long way off.

Here’s a look at what’s being done to boost capacity, and how Canada could achieve its goal.

Funding and capacity

In addition to provincial government spending on detecting and fighting the virus, Ottawa has committed extra funding to help pay for health-care related to the pandemic.

Some $4.28 billion has been earmarked for the provinces to expand testing capacity and conduct contact tracing. (Premiers, however, have demanded far more than the $19 billion committed overall in the Safe Restart Agreement).

In addition to the funding, the federal government is “aggressively” procuring tests and testing supplies on behalf of provinces and territories, a Health Canada spokesperson said.

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On the way to 200K

So where does the goal of 200,000 come from? A spokesperson for Health Canada said that is the anticipated demand as suggested by modelling.

The capacity goal is expected to be reached by this fall, and each province has its own target working toward that milestone.

Quebec’s goal is the ability to conduct 35,000 tests daily, for example, but as of Sept. 17, the province had a capacity of just over 20,000.

From a logistical standpoint, the challenge of increasing testing has two dimensions, explained Colin Furness, an infection control epidemiologist with the University of Toronto.

You have to collect more samples, which involves supplies such as swabs, physical locations such as pharmacies or assessment centres, and the human resources required to collect those samples.

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The other side of the equation involves what happens at the lab — the technicians and supplies needed to carry out the analysis.

Both elements need to be addressed in order for testing to truly be effective.

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“If we’re not then getting test results for a week, we’re really not able to do what testing is supposed to do, which is to prevent spread,” Furness said.

Boosting national or even provincial testing won’t necessarily mean that everyone who wants a test can get one quickly — the other challenge for provincial governments is targeting the resources.

In the last week, about 70,000 COVID-19 tests were conducted daily across the country, though the national testing capacity was most recently pegged at 92,000.

So even though there was capacity to spare in some parts of the country, frustrations mounted over long lines and hours-long waits at testing facilities in some virus hotspots like Toronto.

While increasing testing capacity is always good, what’s more important is the strategy behind it, said Furness.

A person’s risk of exposure — often due to occupation — should play a stronger role in who gets tested.

“We should be testing every waiter, every bartender, every teacher, every grocery store clerk. And we should be doing that regularly and we should go to them to do it, for that matter,” he said.​

Rapid testing

Epidemiologist Cynthia Carr of Epi Research in Winnipeg said that one possibility to grow capacity might be to expand point-of-care or rapid testing, which can be done in a doctor’s office without having to send the samples off for processing.

“Even if the sensitivity of rapid testing is not as good as the gold standard, if the sense and the sensitivity is not as good for people who are asymptomatic compared to those that are symptomatic, that might help at least alleviate some of the pressures on the system,” Carr said in an interview earlier this month.

At-home test kits, which are available in the U.S., would be a “game changer,” Furness said.

Even though they are not as accurate as the DNA-based polymerase chain reaction (PCR) tests that occur in labs, this type of product would still free up resources.

“It’s not to be seen as a diagnostic test where the accuracy has to be super high. It should be seen as a screening test, sort of like taking your temperature,” he said.

Health Canada said it is identifying and supporting the development of new testing and screening technologies, including some solutions made in Canada.

The agency has also expedited the regulatory applications for testing and other coronavirus-related products.

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The approval of rapid testing products in Canada has become a hot topic politically, with some Conservative MPs accusing the government of dragging their feet on solutions that have been greenlit by the U.S., for example.

Right now, according to Health Canada’s website, two products have been authorized for point-of-care testing. A third is approved for research use only.

On Friday, Prime Minister Justin Trudeau said that while Health Canada has accelerated approval processes, there can be no compromises on the integrity of the scientific process or the safety of Canadians.

“There are a number of rapid tests in the process of being evaluated by Health Canada, and they will be made available as quickly as possible,” Trudeau said. “We are not weighing in politically, obviously, on the process that the scientists are going through in terms of evaluating those but we are making sure that in parallel, if and when rapid tests are approved, we’re able to get them distributed rapidly across the country.”

Dr. Theresa Tam, Canada’s chief public health officer, said a range of tests and tools are being evaluated but little clinical data has been submitted to the regulator. She suggested the ball was in the manufacturers’ court.

“What I’ve seen is that they’re waiting for some response from the companies,” she said.

Pooled testing

Though it’s not occurring widely in Canada, one way to potentially process more tests with fewer resources is through what’s known as pooled testing.

It works like this: collect several samples, test them as one batch, and if there is a positive result, then go ahead and test each sample individually.

Carr said it’s one possibility that could help alleviate bottlenecks and allow people to learn their results sooner.

“Now would be a good time to use it because the rate of spread is quite low. But if it got up to 10, 15, 20 per cent, there’s limited utility,” she said.

A pooled testing pilot project was launched in Edmonton last month, using four samples at a time.

Public Health Ontario (PHO) says it started using a “validated pooling approach” earlier this month. The technique — testing three samples at once — will be used on a portion of swabs collected at assessment centres, according to the PHO website.