Federal government officials say Ottawa is doing what it can to help provinces ramp up their COVID-19 testing and contact tracing — but insist their ability to intervene in provinces that fall behind is limited.
Most experts acknowledge that without a lot more and more widespread testing, it would be difficult for the country to return to normal while avoiding the threat of another major outbreak.
Those making the decisions on when and how to open up the economy need to have a better understanding of the virus's community spread. That's not something they have right now in provinces where testing is limited to specific categories of people.
"We don't have enough information to be able to make those decisions in a robust way," said Dr. Camille Lemieux, the medical lead for the COVID-19 assessment centre at the University Health Network in Toronto — which has had to turn symptomatic people away because they were not sick enough to be hospitalized, meaning they didn't qualify for testing under Ontario's restrictive rules.
"It's like having one arm tied behind our back" she said.
Provinces decide who gets tested
Experts warn that provinces that fail to increase testing rates will be faced with a stark choice between delaying the return to normalcy and choosing to ease restrictions while risking a runaway outbreak.
The federal government and provincial governments have collaborated on testing but it's ultimately up to the provinces to decide who gets tested and how the data are being collected.
Watch: Health Minister Patty Hajdu on helping provinces increase the number of COVID-19 tests they can do:
Ontario, for example, reserves testing for those sick enough to be admitted to hospital, long-term care residents, health care workers, Indigenous people and those living in remote locations.
Quebec is also prioritizing those who live and work in long-term care facilities, essential health and public safety workers and people who live in at-risk settings, such as homeless shelters.
Manitoba had similarly narrow criteria until recently, when it expanded them to include workers in all essential services.
Alberta, on the other hand, makes testing available to anyone showing symptoms of the virus — cough, fever, shortness of breath, runny noses and sore throats.
Testing is the key that reopens the economy
A senior federal government official familiar with the issue said the provinces "get territorial" when it comes to their jurisdiction over health delivery.
On Friday, Prime Minister Justin Trudeau was asked what level of testing Canada needs to reopen the economy.
"We need to continue to ramp up our testing capacity. We need to do a better job of coordinating on testing methodology and approaches across the provinces so that we can have a better vision of what is exactly happening," said Trudeau.
Watch: Prime Minister Justin Trudeau on opening the economy again and if there should be a national standard:
The federal government has been instrumental in procuring testing supplies for the provinces, which have struggled with shortages of key items like swabs and reagents. Trudeau recently announced that Canada now has a domestic producer of the necessary reagent.
And Health Canada has expedited its approval process of new tests, including a promising new rapid coronavirus test.
"It normally takes a really long time for approvals to happen and one of the most beautiful things we've seen with COVID is the rapid ramping up of approvals," said Christine Nielsen, CEO for the Canadian Society for Medical Laboratory Science, the national certifying body for medical laboratory technologists.
'Labour-intensive' contact tracing
She said the process of validating new tests — comparing their results against other tests for accuracy — also has accelerated, as have validations of new labs to process the tests.
Scientists say they hope an accurate and rapid blood test will be developed eventually to look for COVID-19 antibodies — helping to identify people who have had the virus (even if they were never tested when they had it) and determining if those people are now immune, at least in the short term.
Health officials say Ottawa also can help assemble the vast number of people needed to do contact tracing. The government recently put out a call for volunteers; so far more than 36,000 have applied, although it's not clear if any of them have started working with the provinces on contact tracing.
"Imagine a virus that takes 14 days where you may or may not be contagious. I mean, the tracking for this is really very labour-intensive," said Dawn Bowdish, Canada Research Chair in aging and immunity at McMaster University.
"And so, we have not been able to do the level of testing for the virus that we would have liked to do."
Part of the challenge is that the federal government has no power to set enforceable national standards on who should be tested, or whether the list of testing criteria should now be expanded.
A need for national standards
Some experts believe Ottawa could at least provide some more forceful guidance on that.
"I would give the federal government the power to prescribe standards after consultation with the provincial ministries of health," said Amir Attaran, who teaches at the faculty of law and the school of epidemiology and public health at the University of Ottawa.
Watch: Chief Public Health Officer Theresa Tam on strengthening contract tracing resources:
Attaran and other researchers at the University of Ottawa reviewed the online self-assessment tools provided by the provinces and found no uniform approach on who should get tested — or even on a list of symptoms that indicate possible infection.
"The game-changing thing right now would be complete data about where the epidemic is, because we are fighting a war and the generals need to know where the battles are occurring," he said. "They need to know where the cases are … They do not know that."
Ontario the 'laggard'
Government officials say federal Health Minister Patty Hajdu and federal public health leaders continually reach out to provincial ministers to offer help.
"[The provinces] need to put their hands up," said the senior federal official. "If the [testing] numbers don't go up, there will be more conversations."
"It's a challenge for us. We have the financial resources and the people capacity, but they have the jurisdiction."
Ontario — which has the lowest rate of testing per 100,000 in the country and is not testing at its full capacity, according to Premier Doug Ford — is the clear "laggard," said the federal official.
There is wide variation in testing rates between all the provinces but federal officials say Alberta and British Columbia are the clear leaders in testing. All provinces have promised to ramp up testing.
Alberta, for example aims to test 20,000 people per day by the end of May, while Ontario wants to get to 16,000 per day by early May.
Dr. Theresa Tam, Canada's chief public health officer, said Monday that she expects there will be an increase in testing.
"We're working really closely with every province and it is their collective goal to increase testing in Canada," she told a news conference.