Ontario planning to improve flawed systems, report COVID-19 test results faster

After Education Minister Stephen Lecce came into contact with someone with COVID-19 this week, he got tested and received his results just one day later — and that came as a surprise to some who've had to wait much longer for their results.

But a government spokesperson said Lecce didn't receive any special treatment. Premier Doug Ford and Health Minister Christine Elliott also received their results within a day — something the spokesperson said is now common in Ontario.

According to an analysis of new provincial data by QP Briefing, that's mostly true — but it's not always the case, and long delays in reporting test results are still plaguing the system.

This week, the province began releasing daily data on the lab turnaround times for positive cases reported in Ontario through its open data portal. Of cases where data is available (97 per cent of all positive cases) in June, 70 per cent were reported to the local public health unit within two days of the swab being taken.

That turnaround time was only one day, or less, in 33 per cent of cases in June. However, there remain cases with long delays. A total of 93 positive tests — 3.5 per cent of all positive tests — were reported to public health units in June more than a week after the person was tested.

Toronto Public Health began releasing similar data on its COVID dashboard Friday, finding the turnaround time for tests in the city fall short of the goal times it would like to see met — 60 per cent within one day, and 80 per cent within two days.

The problem with a delay of even a few days, according to epidemiologists, is it means public health units can't effectively stop the virus from spreading.

Through the contact tracing process, public health workers follow up with all of the close contacts of confirmed COVID-19 cases and instruct them to self-isolate — but that needs to be done before those people have had a chance to become contagious and infect others.

"If you’re not doing contact tracing right away, it’s almost like you’re not able to do it at all, because the purpose of contact tracing is to break the chain of transmission," said Colin Furness, an assistant professor at the Faculty of Information at the University of Toronto.

Ashleigh Tuite, an assistant professor with the Dalla Lana School of Public Health, said the same. "Those extra couple days in terms of finding the contacts of that next case can result in those secondary cases going on to transmit to other people."

She also said informing people of their results promptly could change their behaviour, particularly if they only have mild symptoms, or are asymptomatic, and not self-isolating adequately.

The province has been struggling with the turnaround time for tests since the early days of the pandemic.

In March, Public Health Ontario's labs couldn't keep up with the small number of tests being done, resulting in long processing times. In April, Ontario Health engaged an expanded network of labs to handle more COVID-19 tests. That strategy has allowed for record numbers of tests to be processed — including 28,335 on June 11 alone.

But recently, doctors and public health experts have raised concerns about the delay in the transfer of information about positive COVID-19 tests from the lab network to public health workers who need that data quickly to do contact tracing and case management to control the spread of the disease.

One acute problem occurred when the William Osler Health System neglected to alert public health units of hundreds of positive test results, believing the hospital-based lab that was analyzing the tests was responsible for doing so. Some of the test results were well over a month old by the time the appropriate public health unit was alerted.

Earlier this week, the Toronto Board of Health acted on the advice of Medical Officer of Health Dr. Eileen de Villa to pass a motion calling for the province to "create an efficient system of transferring information from laboratories to public health units."

Toronto's associate medical officer of health, Dr. Vinita Dubey, said the time it takes labs to report positive cases to public health units is a bottleneck that the public health unit generally can't control, but it has been working with some laboratories to improve the process.

The reasons for the delays can be complex — the problem can be the time it takes the labs to process the test, or the time it takes them to report the results — which happens electronically, by fax and by mail, she said.

"Every case is a person who has this disease and can spread it to others, so every case matters," she said.

And like both Furness and Tuite, Dubey emphasized that it is important for the contacts of positive COVID-19 cases be reached before they become contagious.

Dubey said the move to release information about the processing times was positive, saying "transparency is really, really good."

"It can help tease out how complex the public health system is and where some of the pressure points are," she added.

She said the province could help fix those delays by making it clear to the independent labs processing COVID-19 tests how they report information about positive cases to public health units, and what information should be reported, and it could provide them with the same technology as the Public Health Ontario laboratories use to communicate results.

The province is working on fixing those pressure points, according to a spokesperson for Health Minister Christine Elliott.

"As indicated in the testing framework released on May 29, the government will soon release a renewed strategy to support Ontario’s public health units with case and contact management," said Hayley Chazan. "This will provide plans for improving systems and facilitating faster reporting."

Premier Doug Ford also said the province plans to make improvements in this area. Asked about the issue by QP Briefing at a recent press conference, he admitted his government has a long way to go in making the flow of COVID-19 information more efficient, but said his government has come a long way in a short time. He said the province was caught off guard by the pandemic and, likening it to an "inferno," said has been focused on putting fires out — such as the lack of personal protective equipment available and the need for space in Ontario's overburdened hospital system.

"I'm the first to admit [that] at the beginning, it caught the whole world off guard, caught us off guard, and now we're becoming a well-oiled machine," said Ford. "But let me be very clear. There's a tremendous amount of work still to be done. We aren't even close yet, a lot of room for improvement still."

-With files from Sneh Duggal