The head of Ontario's Science Table says the province should provide rapid tests for elementary school students in hot-spot communities, but only if COVID-19 cases double current levels.
Dr. Peter Juni, the advisory table's scientific director, is recommending the province deploy rapid targeted testing for students under the age of 12, who are too young to be eligible for vaccination, when daily case counts in Ontario hit between 1,000 to 1,500.
The province then should look at communities where case rates are the highest and focus the rapid testing on schools that are struggling with outbreaks, he said.
In these schools, kids could complete two rapid tests a week, Juni said. If there's a positive result, that student would isolate and take a PCR lab test to confirm they have COVID. Their classmates could take a "test to stay" approach, continuing in-person learning as long as their rapid tests came back negative.
However, Juni said Ontario remains in a "very good" situation with roughly the same number of COVID cases each day, and seven-day averages hovering between 500 to 600. Currently no schools require that level of surveillance, he said.
"Rapid tests are an additional lever that can be pulled to control the pandemic but right now, we're not in a situation where any of that is needed," Juni told CBC News in an interview Monday.
"We will not be able to do a cookie-cutter approach in the entire province because the logistical challenges and the number of tests that would be needed are simply too large."
Some parents and experts are demanding the province implement large-scale rapid antigen testing — which requires a nasal and mouth swab and returns results within 15 minutes — in all schools.
Chief Medical Officer of Health Dr. Kieran Moore has been resistant to the idea in recent weeks, echoing Juni's comments and maintaining that false positives would lead students not actually infected to stay home from school and get PCR tested, overburdening labs.
Moore is expected to make an announcement about rapid testing Tuesday morning.
Juni said the science table has been working with Moore, the health ministry and other stakeholders for the last three weeks to proactively figure out the details should the need for rapid tests arise.
Dr. Barry Pakes, of the University of Toronto's Dalla Lana School of Public Health, said hyper-local, targeted rapid testing is the way to go. If all of Ontario's two million students were tested multiple times a week that would lead to thousands of false positives even if the tests were 99 per cent accurate, he said.
"Parents' desire to keep their kid safe is understandable, but it's maybe a little misdirected or not the best use of resources, when we really do need the resources for vaccinating parents and getting ready for vaccination of those kids," Pakes said.
According to the federal government, which supplied the provinces with millions of rapid tests last year, Ontario has received 20 million rapid tests and used six million. It would need far more tests to do provincewide testing in schools, he said.
Rapid testing best way to screen, experts say
The three other experts CBC News spoke to were strongly in favour of widespread rapid testing and disappointed the province hasn't used them in schools yet supplied them to businesses.
"Clearly the fact that the Ontario government is supporting businesses with rapid test shows that these rapid tests are important and can potentially help curb the spread of COVID-19," said Dr. Naheed Dosani, health equity lead at Kensington Health in Toronto.
"So why aren't children and families getting the same access? Are children and families not deserving of safety of wellbeing?"
Rapid testing is also the best tool to screen people who are asymptomatic but nonetheless spreading COVID-19, said epidemiologist Colin Furness at the University of Toronto. The tests are far superior to the current screening questions that focus on symptoms.
"Those questions don't make a lot of sense when the majority of kids, or at least half, are asymptomatic," Furness said.
Biostatistician Ryan Imgrund was a consultant on recent school guidance from Toronto's Hospital for Sick Children and the science table, which this summer recommended rapid testing where community cases were high. He said current screening questions are not working in schools and cases are detected only after they've been transmitted.
In this environment, rapid testing is ideal, said Imgrund.
It should already be in use in school districts like Hamilton where the public board has already reported more than 100 cases across more than one-third of its schools — "extremely troubling transmission," Imgrund said.
If the province had a plan in place, it could've been supplying the tests that health unit right way to be distributed through school nurses to staff and students.
"What seems to happen is with masking, with vaccine mandates, with rapid antigen testing, the government only acts when people start to shout about it," he said.