Does shifting COVID-19 strategy mean PCR tests have had their day?
Kelsey Rutherford's one-year-old son developed a high fever the day the Ontario government announced sharp restrictions on access to PCR tests amid crushing demand due to the Omicron-fueled surge.
Unable to get the gold-standard PCR (polymerase chain reaction) test for her child, Rutherford used a rapid antigen test to confirm he was positive for COVID-19. Within a week, Rutherford and her three-year-old daughter also tested positive on a rapid test. Her husband never developed symptoms.
We had no idea what to do. I tried to call public health and they told me they weren't giving PCRs and to just assume everyone has (the virus) and to isolate for five days," Rutherford said. We ended up isolating for three weeks because I wasn't feeling well and I was still testing positive on a rapid test in mid-January."
Like Rutherford, many experiencing COVID symptoms have had to assume they are positive and self-isolate or rely on less-accurate rapid antigen tests if they are able to access them. Ontario's publicly funded COVID testing numbers have plunged since PCR access was restricted at the end of December, mainly for individuals most at risk of severe illness. Tests over the last week have averaged 25,460 per day, down from a high of over 75,000 tests processed in a day on Dec. 30. A low of 15,008 tests was reported on Sunday.
With limited testing, the province's daily COVID case counts no longer paint a complete picture of community spread, prompting the question of why the government is not re-expanding testing eligibility.
The days of getting a PCR test when you have mild symptoms are over," says infectious disease physician Dr. Sumon Chakrabarti, adding the role of testing has changed for the foreseeable future from what it was at the beginning of the pandemic and before mass immunization.
Contact tracing was very important before the vaccine because we wanted to do whatever we could to stop transmission in the community. Now people are protected with the vaccine and we don't need to know every single case on the ground."
With the government's pandemic testing strategy placing less emphasis on the PCR test to track cases, over 3 million rapid antigen tests are set to be distributed to Ontario school boards and child-care centres. Wastewater data is also being collected to help determine the rate of transmission.
This change in testing and shift in the use of PCR is a characteristic of the way we would approach the virus once it's entering the endemic phase, the end of the pandemic phase," Chakrabarti said.
Ontario's chief medical officer Dr. Kieran Moore announced on Thursday that the province is expanding eligibility for PCR tests to household members of health-care workers who deal directly with patients.
Responding to a question on testing, a Health Ministry spokesperson said the province will continue to monitor trends in testing and may look to expand PCR testing to additional groups when we have the capacity to do so."
As Omicron continues to spread, monitoring hospitalizations and ICU admissions will provide adequate surveillance of community outbreaks, the spokesperson said.
Michelle Hoad, CEO of the Medical Laboratory Professionals' Association of Ontario, says those who want to know the status of their health should be able to access tests but that the decrease in COVID testing has allowed understaffed laboratories to clear the backlog and focus on priority tests.
The drop in testing has enabled the lab to catch up with other testing that needs to happen, but we have a large concern around burnout right now among lab professionals. The demand has been massive," Hoad said.
Assuming our labs are staffed properly, there is capacity to do anywhere from 80,000 to 100,000 PCR tests a day ... A perfect world would be if you wanted a PCR test, you should be able to get a PCR test. But our health-care system is not structured that way."
As testing priorities shift, there has been some confusion surrounding COVID policies, which still require individuals to present proof of a test. The struggle to access tests has sparked concern that essential workers would not be able to provide evidence to employers that they caught the virus, preventing them from benefiting from the province's temporary paid sick-day program. Another hurdle is the issue of travel, which still requires passengers to present a negative PCR test.
While PCR tests can also be purchased at private clinics, costs are exorbitant with some charging $159 for same-day results or $350 in an hour.
Dr. Zain Chagla, an associate professor at McMaster University and an infectious diseases physician, said there is also a shift in people's behaviour towards testing.
Given how fast it's spreading and how mild many people's symptoms are, they may not come out to get testing, which makes it tough to build a surveillance system," Chagla explained.
Chagla said as testing is being focused on high-risk individuals requiring treatment, there are other effective monitoring tools to measure the spread of COVID, including wastewater surveillance and ICU and hospital admission metrics. As of Thursday, Ontario reported 2,797 people in hospital with COVID, 541 in ICU and 74 deaths from the virus.
As we're moving into a therapeutic area where testing is a gateway to treatment, we do need to prioritize that and make sure people at higher risk of hospitalization have access to treatment," Chagla said.
Following the approval of antiviral COVID-19 treatment Paxlovid, Health Canada authorized the drug for adults who are at high risk of serious illness from COVID with mild to moderate symptoms.
The strategy of testing everyone repeatedly every time they develop symptoms is tricky with limited testing," Chagla said. The capacity and the cost of PCR have to be put on the table for the sake of how we can use testing appropriately."
Ghada Alsharif is a Toronto-based staff reporter for the Star. Reach Ghada via email: galsharif@torstar.ca