Beginning Monday, Saskatchewan is expanding COVID-19 testing to include anyone working outside the home who desires a test, no symptoms necessary.
The broadened criteria will make Saskatchewan's testing program the most expansive in Canada, with other provinces still requiring people in the general population to feel sick or show symptoms before they qualify for a test.
Thus far, health officials have reserved widespread testing of asymptomatic people to outbreak locations, such as long-term care homes and meat-processing plants.
Saskatchewan's testing capacity is relatively high, at about 1,500 tests a day, but the demand has dropped significantly in recent weeks to roughly 300 a day.
On Wednesday, the government of Saskatchewan announced additional details on how expanded COVID-19 testing will work and who will be able to access a test. Residents must still call 811 HealthLine to make arrangements.
Expanded testing availability will now include:
All patients upon admission, or in advance of a planned admission, to an acute care hospital for a stay expected to be longer than 24 hours. This includes all expectant mothers entering a health facility to give birth.
Immunocompromised asymptomatic individuals, including cancer patients in advance of undergoing immunosuppressive procedures such as chemotherapy.
All health staff working with immunocompromised patients.
Increased testing for the homeless or those living in vulnerable situations.
Mobile (work site) testing in high-volume work settings (such as factories, industrial settings, etc.).
"I think testing is important not just for yourself and your family's health but … for all of us. It helps all of us reopen in a safe manner," Saskatchewan Chief Medical Health Officer Dr. Saqib Shahab said on Tuesday.
"We have fairly low COVID activity and that's where we want to keep it. I think is important just to maintain that testing level and that kind of reassurance that we are maintaining COVID-19 circulation in the community at a very low level," Shahab said.
Saskatchewan Health Authority CEO Scott Livingstone said the expanded testing was set for Monday because those operating the 811 line need time to prepare for the "extensive" list of people testing will be offered to.
"Until that's in place it would be essentially a free-for-all," Livingstone said.
He said Saskatchewan already has "one of the broadest" testing programs in all of Canada in its list of symptoms which can qualify a person for a test.
"If you have the sniffles, you can go in for COVID testing."
Livingstone said the testing criteria will continue to evolve and will be evaluated to see how it is working, and where infections are occurring that may have been missed.
"We don't have an idea of how many folks will come in. We do expect to see expanded numbers."
As of May 20, a total of 41,951 COVID-19 tests had been performed in Saskatchewan. As of May 18, Saskatchewan's per capita testing rate was 32,410 people tested per million population, while the national rate was 35,570 people tested per million population, according to the province.
Infection control specialist applauds approach
University of Toronto associate professor Colin Furness, an infection control specialist, said Saskatchewan's plan is "proactive."
"That sounds quite responsible. It sounds wise, it sounds like the population is being well taken care of," he said.
"I think Saskatchewan's approach is good. I think they have managed the pandemic very well."
Furness suggested Saskatchewan and other provinces should be even more aggressive and undertake "sentinel surveillance."
"You don't wait at the hospital for people to show up [looking] desperately ill, but you go with your testing equipment and you go to people who have known occupational risk."
He said examples of workers at risk include grocery store employees, taxi and bus drivers, and front-line health workers.
"They are the canaries in the coal mine. They're the ones who are going to get sick and not necessarily know it, but they'll be among the first to get sick," Furness said.
"If we can test all the grocery store workers in the province and we come up … negative, that would be an excellent sign."
He said that would allow for tracking community spread in a way that may not have been noticed before.
"We did the lockdown to stop occupational exposure. We know occupational exposure is risky. We know where to find grocery store workers," he said.
"There's no mystery here. It's really just a question of having the resolve to say we're going to actually go where the risk is."
Widespread testing needed to 'quash' COVID-19
An epidemiologist at the University of Ottawa said it is "good news" that Saskatchewan is expanding its testing criteria as it reopens its economy.
"That has to be done. Ultimately, we should have testing on demand for everyone and even those who don't want it," said Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa.
"That is how we're going to get out of this, is to identify the cases in real-time and quash them."
Deonandan said a lack of access to rapid test results is among the many barriers to mass testing. Currently, patients who go into a hospital have to wait to find out if they are positive.
"We would like to have our results back in minutes, not days."
Provinces should be seeking out the virus, and not waiting, he said.
"We're not actively hunting the disease yet. We should be."
Another issue with the current tests, he said, is false negatives.
"Some have high false positive rates. High false negative rates are more distressing because people think they haven't got it and they're walking around behaving as if they don't have it."
British Columbia's provincial health officer, Dr. Bonnie Henry, warned in April of the danger of false negatives in mass testing.
"The testing, unfortunately, doesn't tell us the whole story. People can be negative one minute and positive within an hour," she said.
"The false negative rate can be as high as 30 per cent early on in infection."
Testing criteria varies across Canada
Saskatchewan would be the first province to offer a test to workers regardless of symptoms. However, people will still require a referral.
In other western provinces, referrals are not required.
Alberta recently offered testing to asymptomatic people in the Calgary zone. About 3,400 people with no symptoms got tested, and more than a hundred were found to have the virus.
Both B.C. and Alberta have proactively tested in outbreak situations, such as meat plants and prisons.
Ontario just recently expanded testing for people with mild or moderate symptoms. It had previously required multiple symptoms, travel or contact with a positive person.
Both Quebec and Ontario have proactively tested in long-term care homes.