People living on the street in Vancouver’s lower east side; pop-up site attendees across Nova Scotia; staff and visitors at long-term care homes in various places across Canada — these are all groups with access to COVID-19 rapid test pilot programs.
But, months after the first test was approved in this country, we’re still seeing pilot programs announced, and there’s no clear national picture of their use, even as the national testing advisory panel heralds rapid antigen test deployment as a priority.
“We need the federal government to procure more of them. We need the federal government to approve more of them, and then we need the provincial governments to support the more rapid use and wide scale use of them,” Testing and Screening Expert Advisory Panel Co-Chair Dr. Irfan Dhalla told Global News.
An analysis by Global News shows provinces and territories are using rapid tests in different places and for different purposes. P.E.I., Yukon and Newfoundland and Labrador have a combined 165,600 antigen tests sitting in storage with P.E.I. declaring theirs “not considered safe for use.”
The federal government has purchased more than 40.5 million rapid tests, but only about 15.4 million have arrived. A spokesperson said they are shipped to the country and distributed weekly, and remaining tests are expected to arrive by the end of March.
Global News’ analysis can only account for fewer than 1.3 million of those tests either used or rolled out to local health units. That’s the total from answers provided by provinces and territories, with five refusing to provide any specific numbers at all. Jurisdictions provided varying levels of information in their responses to questions from Global News.
There are currently seven “point-of-care” tests approved for use by Health Canada (the regulator does not define “rapid” tests).
Cepheid’s original standalone SARS-CoV-2 rapid test was the very first COVID-19 rapid test approved by Health Canada in March 2020. The company’s chief medical and technology officer tells Global News their systems have been in use in Canada for years for other tests – including for tuberculosis in remote First Nations communities.
Dr. Dave Persing says about 350 Cepheid systems are in place at most major Canadian hospitals nationwide – 175 of those machines arrived in the past year, along with 300,000 SARS-CoV-2 tests.
“Everybody wants more and we are just trying to keep up with demand. Our factories are running 24/7. We’re actually building new factories to keep up with demand. So we should see a lot more available within the next several months,” Persing told Global News. The company is headquartered in Sunnyvale, Calif.
He doesn’t think Canada is behind other countries in the rollout of rapid tests, though he won’t say exactly where our country falls on his company’s client list, “because it’ll be a little controversial.”
“I think we’re seeing a wide range of uptake of these rapid detection technologies across the world. Some countries have brought it in quickly. Others have held off,” Persing said.
There are two types of rapid tests: antigen and nucleic acid.
Nucleic acid tests involves molecular testing, same as the gold-standard traditional PCR test, which looks for the genetic material of the virus. Antigen tests look for proteins from the virus, but not the virus itself.
Nucleic acid rapid tests are more complicated to administer, hence the preference and the advisory panel’s recommendation for antigen testing.
“They’re a mini laboratory in a box, whereas with the rapid antigen tests, there’s no laboratory,” explains Dr. Dhalla, also a physician at St. Michael’s Hospital in Toronto.
Experts agree rapid antigen tests are not as good as the traditional PCR test.
“It can be quicker and easier and cheaper,” said public health physician Dr. Monika Dutt. “The downside is, is that you do get more false negatives with those tests.”
Ontario’s Chief Medical Officer of Health Dr. David Williams recently noted some of the rapid antigen tests in his province “have up to a 30 per cent false negative rating.”
“We have some concerns, but we want to use those tests for the right thing,” Williams told reporters on Jan. 18.
The right thing, according to Williams, and in practice in several provinces including Ontario, B.C. and Nova Scotia is screening: looking at a targeted group of people in a workplace, school or long-term care setting, or a remote community.
Ontario began eight-week pilot programs with more than 160 employers in November, and 152 long-term care homes are also using antigen tests for routine screenings of staff and visitors. Premier Doug Ford recently called on bigger employers to buy their own tests.
“They’re $6 apiece. You’re gonna keep your employees safe, you’re gonna keep your operations safe, so we encourage you to get out there to start testing,” he said on Thursday.
“If you have a larger group of people that you’re wanting to screen because you’re more concerned, potentially because of a certain age group or certain activities, that is one way that it does make sense to use the antigen testing,” said Dr. Dutt.
The nucleic acid Cepheid test is better suited for hospital or remote settings, says Dr. Persing.
“Patients coming into the emergency room, where you really do want to know with high confidence whether they’re positive or negative when they come in.”
That’s why the Canadian-made Spartan Cube has the potential to offer the best of both worlds: it uses nucleic acid technology, not antigen, but the system is the size of a coffee cup and can be used anywhere.
Health Canada recently gave it the green light after the company fixed two separate issues. Spartan Bioscience co-founder Dr. Jamie Spiegelman told Global News it will start filling back orders this week.
“I think it really will supplement central lab testing to open up society. It’s not going to eliminate centralized testing. I think there’s an aspect of society that needs really large scale testing where you need to do thousands of tests at a time. This is not what our business is,” he said.
As for how provinces are actually using the tests, the answer is different right across the country.
British Columbia has deployed tests in a wide range of places including remote and First Nations communities, correctional and remand settings, long-term care and the city’s Downtown East Side, where the population is not likely to come back days after a test to get a result.
Provincial Health Officer Dr. Bonnie Henry told reporters there have been varying levels of success, depending on the location, and called the process a “challenge.” Rapid tests have proven to be “useful” in more remote communities, and used “quite successfully” in the remand and corrections population.
In the downtown eastside, Henry said “they don’t perform as well, even in the relative non-cold that we have in B.C.”
And in long-term care – the centre of the tragedy throughout the pandemic, across the country – the “rapid” test has proven not rapid enough, according to B.C.’s top doctor.
“They’re very resource-intensive … We know that it takes at least three people, that it’s about 15 minutes per person per day, and you can do multiple sets of them at a time, but they all have to be timed specifically and you have to make sure you know which one belongs to whom,” said Henry.
In B.C., as is the case in a number of provinces, anyone who tests positive through a rapid antigen test needs a traditional PCR test to confirm their case.
Neighbouring Alberta takes a different approach: no mass screening, but only testing sick people who are within the first seven days of showing symptoms. In that province, all negative test results are confirmed in the lab.
“Rapid point-of-care testing is most effective when used on patients who are within the first week of showing symptoms of COVID-19, helping us to more quickly identify and manage positive cases in the community, especially in more rural and remote locations,” wrote Kerry Williamson with Alberta Health Services in an email to Global News.
On the other side of the country, Prince Edward Island has 30,000 antigen tests sitting in storage – Health PEI has determined they are “not considered safe to use on P.E.I. at this time.”
“This is a combination of the precautions required to process and handle the product, the accuracy of negatives and positives (only 50 percent),” wrote spokesperson Jessica Bruce in an email to Global News.
Bruce points out in the Island’s case, standard PCR testing is relatively fast, and rapid tests are less important to a province with no community spread, and a 0.12 per cent test positivity rate.
P.E.I. believes rapid nucleic acid tests are a “viable option,” and has used about 400 at a University of Prince Edward testing event, and plans to start using them at regional hospitals “as a preliminary test” this week.
Newfoundland and Labrador has 126,000 unused antigen tests waiting in storage “as the Testing Guidance Working Group are developing a community validation protocol,” wrote the Department of Health and Community Services. “Given the province’s low prevalence of COVID-19, there are no plans at this time to use them more widely.”
Yukon has 9,600 antigen tests and 15,720 nucleic acid rapid tests in storage, as it figures out its rapid test program. The territory has used 264 Cepheid tests in hospital settings.
“Yukon’s focus is the right test for the right person at the right time.”
“It is also to be noted that in a population such as Yukon, with no community spread and no active cases, it may not be appropriate to roll out these tests at this point,” Yukon Director of Communications Patricia Living wrote in an email to Global News.
In general, Dr. Dhalla says antigen test limitations shouldn’t be a deterrent from using them, noting they can be used to both prevent and limit the size of outbreaks.
“The rapid antigen tests are not perfect. They’re not a replacement for laboratory-based PCR tests, but they’re certainly better than no tests,” he says.
In the spring of 2020 we heard no end about rapid testing, but as vaccine developments took hold, the public discussion around testing took a backseat.
“I don’t know where this has gone but rapid testing to me would be an absolute game-changer,” said ICU physician Dr. Kwadwo Kyeremanteng.
“Imagine that you would get a test prior to coming into work if you were in a factory or even in long-term care, to get tested at home, you get results within minutes, that technology exists and for some reason it’s not adapted here in Canada yet.”
Working on the front lines of the pandemic in two Ottawa hospitals, Dr. Kyeremanteng believes rapid testing would be a more effective response, coupled with other measures such as paid sick live, than lockdowns.
The co-chair of Canada’s testing advisory panel says no one really understands for sure why rapid tests haven’t been widely deployed yet, but he can suggest a few reasons.
Dr. Dhalla points to the tendency of “the medical establishment to be a little bit on the conservative side and to wait for evidence and also to prefer a higher quality test over a lower quality test.”
Vaccines also took up not just people’s attention, but their time and resources.
“The health system is really overstretched,” said Dr. Dhalla.
“There isn’t a huge amount of bandwidth to do everything at the same time. And we’re seeing that now with vaccination, you know, as managers and administrators turn their attention to the vaccine rollout. What we’ve seen in a number of provinces is that testing volumes are going down.”
Dr. Dutt doesn’t think the focus on testing has lessened.
“It’s been a significant part of my work and I’m sure a lot of public health physicians and staff across the country,” she said, adding she doesn’t think the rollout has been too slow, and she expects to see rapid testing ramp up.
“I think people are using it more and more and it’s going to be even more of a part of our just regular practices in terms of dealing with the pandemic,” said Dutt.
Canada’s top doctor agrees rapid tests are a “key pillar” of the public heath response.
Dr. Theresa Tam said they have proven to be “extremely helpful” in remote and isolated communities, and she expects to see provinces roll them out in “long-term care facilities and other high risk settings.”
When case numbers drop, “before people start easing things up, it’s important that capacity is put in place,” she said Tuesday.
There are 20 more antigen and nucleic acid point-of-care tests under review by Health Canada, plus five rapid serological tests, according to a spokesperson for the Minister of Health. Health Canada publishes a list of devices under review, but the manufacturer has to grant consent to be included, and therefore it doesn’t include all products.