COVID-19 watch: Doctors left without clear guidance on who to test amid swab shortage

A physician who's been doing shifts at a COVID-19 assessment centre north of Toronto says he and his colleagues have been having to make tough decisions on the fly about who to test for the novel coronavirus, hampered by a lack of swabs and a lack of clarity from Public Health Ontario.

"There's no clear guidance," Dr. Raj Waghmare told QP Briefing in a phone interview.

The problem, he said, is that doctors in hospitals and primary care settings have a limited number of swabs and can't test everyone, so they've had to be their own "gatekeepers." He and other physicians have talked about the problem in group messages, but have found there are different approaches in different places as everyone tries to determine what is best.

The last guidance they got from Public Health Ontario came four days ago and says that people should be tested if they have a fever and respiratory symptoms — but only if they have also been in contact with a confirmed case, or have travelled to an affected area.

That would be clear enough, but the World Health Organization's list of affected areas that the document links to actually includes Canada — and that makes travel history meaningless, said Waghmare. "It's like saying if a person has a heart rate, it's an inclusion criteria."

"We could just test everybody with a fever and respiratory illness, but the fear there is the way cases are rising in other parts of the world, and possibly the way they're starting to rise here, we're going to run out of swabs (and) it would be terrible if we have a critically ill patient coming into our ICU and we can't test them for COVID-19," he said.

On Friday, one day before Waghmare got the most recent guidance from Public Health Ontario, the Ministry of Health gave some members of the media, including QP Briefing, a guidance document that excluded travel history as criteria and advised limiting testing to certain high-risk groups — those who have acute respiratory illnesses who are admitted to hospital, who reside in long-term care homes, are health-care workers, or are First Nations community members on reserve.

But the document Waghmare, who is one of the doctors doing COVID-19 testing at an assessment centre established by his hospital, got the next day does not include that advice.

Some hospitals have created their own criteria, such as including symptomatic patients with a fever who are high risk, such as those who are over 60, have co-morbidities, or are essential workers.

It's particularly important for hospitals to test people who have conditions that put them at high risk of being hospitalized, he said, because doctors will want the test results immediately if they are admitted, instead of having to wait days for the result to come back.

Ontario's Chief Medical Officer of Health Dr. David Williams has said in recent day that new guidance is being discussed and he acknowledged Wednesday the province needs to improve the flow of information. The province is currently working to resolve the swab shortage, and ramp up its testing capacity from 2,000 tests a day to 5,000. But currently, less than 1,000 tests are being processed a day, according to an update from the Ontario Associate Medical Officer of Health Dr. Barbara Yaffe.

Both Premier Doug Ford and Health Minister Christine Elliott re-iterated that the province plans to ramp up testing in a press conference on Wednesday afternoon. Elliott said the current wait time — four days — is too long, and the number of tests waiting to be processed — 3,379 — is to high. Elliott said she'd like to see the wait time come down to 24 to 28 hours.

Waghmare said he has concerns that the province will miss an exponential rise in cases across the province, or in some areas, because not enough people are being tested, and lacking that information will hamper the province's ability to respond.

But one bright spot, according to Waghmare, is that people have been understanding when he's explained the shortage to them and to see health-care professionals come together to do what needs to be done.

QP Briefing has reached out to Elliott's office about for clarity on the testing guidance but has not receive a response.