Don't just rely on rapid tests ahead of holiday gatherings: Ontario testing panel chair

·6 min read
People wait in line to receive a COVID-19 test in Montreal on Tuesday.  (Graham Hughes/The Canadian Press - image credit)
People wait in line to receive a COVID-19 test in Montreal on Tuesday. (Graham Hughes/The Canadian Press - image credit)

A frank conversation between family members about what it means if someone has COVID-19 is a better bet than just relying on a rapid test result, says the head of Ontario's panel on COVID testing.

Dr. Jennie Johnstone, who chairs the Ontario Provincial Testing Expert Strategy Panel, says there's a margin of error with COVID-19 rapid tests, including if the self-tester is using it correctly.

People getting together for Christmas dinner should instead talk about what would happen if one of them did have COVID.

"Have an open and frank discussion with your family members or loved ones, and say if, in fact, somebody did have COVID in retrospect, are we OK with that?" she told CBC News.

Johnstone also talked about the testing backlog, how we're using rapid test data, and other questions around testing. The following has been edited for length.

If tests are backlogged or aren't available, what's the best indicator of how many people are positive right now?

One thing to note is that our lab testing capacity is actually excellent. The pinch point is the assessment centres, because many individuals appropriately and necessarily have been pulled away to do vaccinations. And that is where we need to have our priority.

The province is looking at trying to improve the potential for self and drop offs for PCR testing as a means that doesn't rely necessarily on as much stuff. We do want to continue to maximize the PCR testing capacity that we do have. Once the test is in the lab, the turnaround times are excellent.

But almost certainly, we're missing cases. Our test positivity in the province is somewhere in the realm of 10 per cent, which means for every person tested, I'm sure there are additional individuals that we're missing.

How many, do you think?

It's difficult to say. What we need to know is that there is a lot of COVID out there and we need to act accordingly. We know how this is spread. So let's think through the gatherings that we're going to have. Is it masked, or is it unmasked? Is it indoors or is it outdoors? We know that outdoors is safer. We know that masked is safer. I know that's very hard to hear at a time when individuals want to gather and have meals together.

More people are expected to get COVID than ever before. How should we be rethinking our testing strategy to deal with this?

We have evolved our testing strategy over the last two years. What we're doing now isn't what we were doing in May 2020. I think we need to continue to evolve. Every wave is different and we do have to adjust accordingly.

So in the coming weeks, as the demand for PCR testing increases, we know that we need to preserve that capacity for hospitalized patients, residents of long-term care, staff who are working in those settings, and individuals who may benefit from treatment. Whether or not we need to pivot then … I'll leave it to the chief medical officer of health to make a decision. But we may need to do that in the coming days and weeks.

Peterborough Public Health is getting people who test positive on rapid tests to share the results with them. Could we be using rapid tests better to help track COVID?

One of the challenges with pivoting to a rapid testing strategy for diagnostic purposes is that right now, we get all of our data from PCR testing. That's how we know how many cases we have, where the hot spots are, and who's getting COVID. Once you go to a self-reporting system, you're going to lose a lot of data.

I think it is a great strategy to have people self-report so we continue to know: where the hot-spot neighbourhoods? What are the hot-spot regions? Who are the individuals that are getting COVID? Then you can target your public health measures. I expect that the province is looking at something like what Peterborough has done so we can continue to have some data if, in fact, we pivot to using rapid antigen tests for the purpose of diagnosis in lower-risk individuals.

What's your advice for someone who tests positive with a rapid test? Should they go in to get a molecular test?

At this moment, that is the provincial recommendation. And again, it's less about the fact that you need to confirm that it's positive. Almost certainly, it is positive.

But again, we haven't set up a different structure for reporting. So if you don't get that PCR test, we don't have a system to either identify you, be able to link in with the public health system, identify high-risk contacts, and have that data capture. I do think that as we think about transitioning away from the current system, we similarly have to have a parallel conversation about how we are going to capture those cases that aren't coming in through PCR testing.

How heavily should we be relying on rapid tests over the holidays?

There is a lot of confusion about rapid antigen test. I think that stems from the fact there are multiple uses for them and I find they get collapsed into one, which makes it difficult.

First of all, there is the strategy that I anticipate we're going to have to rely heavily on in the coming weeks, which is testing health-care workers and other essential workers daily after a high-risk exposure in combination with some PCR testing to try and allow them to work if there are critical staffing shortages. We know we're going to have staffing shortages in the coming weeks. A lot of people are going to get sick in this wave and be high-risk contacts.

Sinai Health
Sinai Health

The second one is the asymptomatic screen testing, which is what we have in long-term care for the staff testing two to three times a week to identify anyone positive before they enter the building. Then there's the diagnostic testing for symptomatic individuals. And then the fourth one: pre-holiday gathering testing.

That one, I think we have to be really careful about relying on. A better strategy is to have an open and frank discussion with your family members or loved ones, and say if, in fact, somebody did have COVID in retrospect, are we OK with that? What are the consequences of that? Do we have individuals who are older or frail or immunocompromised or under-vaccinated? Where do they work or do they care for individuals who are vulnerable?

Have that conversation. If the answer is yes, do we all agree that we're going to take this risk? At that point, you may consider adding a rapid antigen test because a positive test will prevent you from attending that gathering. But a negative test might mean you're negative, but it also may mean that the test missed it. It may mean that you did poor self collection. Or it may mean that you were negative at the time you collected it. But several hours later or at the gathering, you became positive.

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