New Ontario testing strategy won't see all symptomatic people tested, focuses instead on priority groups

Ontario's new coronavirus testing strategy focusses on high-risk groups and won't see all people who have COVID-19 symptoms tested, officials said Friday.

It runs counter to public comments Premier Doug Ford has made in recent days.

"If someone has symptoms and they come in, we need to test them," he said Thursday, "and that's the point we need to get to and I know we're going to be moving rapidly on this."

The mixed messages continued on Friday as the new strategy was rolled out.

Officials speaking to the media on background said that members of the public who show symptoms of COVID-19, but are not part of a priority group, will not be tested unless a clinician — such as the doctor working the assessment centre — thinks it's necessary.

The clinician's decision would generally be based on whether a person is likely to require hospitalization because they have COVID-19 as well as an underlying health condition — in which case they would likely be tested — or if it is likely they could recover at home — in which case they would likely not be tested.

The reason, according to the officials, is that Ontario's testing capacity remains limited at this point it time and needs to focus on the most vulnerable people. Widening the testing further would put Ontario at risk of developing a backlog again, which delays timely test results for those who need them most.

The list of priority groups includes patients requiring, or likely requiring, hospital admission, residents in long-term care and retirement homes, as well as those in other congregate settings, such as homeless shelters, prisons, and group homes. It also includes the workforce who cares for those populations, such as health-care workers and prison guards, as well as emergency first-responders and residents of Indigenous and northern committees.

However, at a press conference later in the day, both Ford and Health Minister Christine Elliott suggested people who are not part of those groups, but do have the signs and symptoms of COVID-19 will be tested, and only asymptomatic people, or "the worried well," would not.

"I want to be clear," said Elliott. "Anyone exhibiting symptoms of COVID-19 can and will be tested at the recommendation of their physician or a physician in an assessment centre."

However, when she was asked to explain the issue of the physicians' discretion, she asked Chief Medical Officer of Health Dr. David Williams to answer. He said some people with COVID-19 symptoms would be told to self-isolate and only get back in touch if their condition changes in certain ways.

Meanwhile, the province is also working on specific plans for testing other essential workers and targeted at-risk people including cancer patients, pregnant women, newborns and cross-border workers. The province is also making plans to increase surveillance testing— more widespread testing — of people in northern towns.

When testing is ramped up by the end of the month, testing all of those groups should see the province doing nearly 14,000 tests a day, with 8,000 tests a day by April 15, 2020.

These new targets come two weeks after officials announced the province would have the capacity for 18,900 tests per day by April 17.

On Wednesday, Ford had called for the province to be testing 13,000 people a day immediately, maximizing its laboratory capacity, but he endorsed the strategy of his public health officials that falls short of that promise.

"Earlier this week, I told you that we will do better when it comes to testing," he said. "I want to be in that positive position where everyone frontline health-care worker, every first responder, every worker and resident in long-term care homes, and everyone in the general public who needs it is getting tested, because the first step to winning any battle is knowing you're enemy."

He characterized the new strategy as the next step toward accomplishing that.

One of the remaining concerns is a lack of testing supplies —  the province currently has 200,000 testing swabs, and efforts are underway to get more. Meanwhile, it is also working on better co-ordinating the distribution of them to hospitals, which run the nearly 100 assessment centres around the province, some of which have been struggling with their swab supply, officials said.

Officials also said the province is looking at new testing methods, including the rapid-result test kits made by Spartan Bioscience, which could be available soon. The province is also exploring how serological testing — blood testing that checks if someone has had COVID-19, and developed antibodies — could be used later on. While officials said it will likely play a role in the coming weeks, they are cautious about the reliability of the testing and the potential for even accurate tests to deliver false reassurances to people.

Ford also spoke about the consideration on his mind for when social distancing measures can be lifted.

He spoke about the economic toll the measures are taking on the province — and vowed that Ontario will come back "stronger than ever" when they're lifted. However, he said the government remains very concerned about the potential of a second wave.

"That's concerning, that is very concerning if, God forbid, a second wave hits us in September," he said.

Lifting the emergency measures too early would be "five steps forward and 10 steps backward," he said.

"Our number one priority is the health and well-being of the people of Ontario and there's no one more who wants to get back into the swing of things and get the economy going more than I do, but before we do we have to see a difference in the numbers," he said. "And if we continue moving forward the way we are, there's light at the end of the tunnel, but this can swing any way. I wish I had the crystal ball and could tell people, you know, are we going to be fine in two months?"

The province's strategy will depend on the modelling, he said. And, according to Williams, updated modelling is expected next week.