TO CONTROL COVID-19 IN CANADA
Testing is not an end in itself but is undertaken to inform the decisions needed to control the virus responsible for COVID-19 while minimizing unintended consequences. In A “Smart” Testing Strategy To Control Covid-19 In Canada, Vivek Goel has partnered with the PolicyWonks, Peter Nicholson and Jeff Larsen, to argue that Canada should be testing a great deal more, as is the case in the majority of countries that have been successfully controlling the virus.
Professor Vivek Goel is Special Advisor to the President and Provost at the University of Toronto and a Professor in the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health; in previous positions at U of T, he has been Vice-President and Provost, and Vice-President Research, Innovation and Strategic Initiatives. Professor Goel has a medical degree from McGill University and an MSc in Community Health from U of T and an MS in Biostatistics from Harvard University School of Public Health. He served as founding President and CEO of Public Health Ontario from 2008 until 2014 and serves on the boards of the Vector Institute, TRIUMF (Vice-Chair) and the Canadian Institute for Health Information (Vice-Chair). He is a member of the COVID-19 Immunity Task Force, the Governing Council for CanCOVID, the national research platform for COVID-19 research.
The following is a short excerpt from the paper – please download A “Smart” Testing Strategy To Control Covid-19 In Canada to read the full version.
Increased testing needs to be smart and targeted strategically because testing resources will never be unlimited, nor are tests perfect.
- A testing strategy to control COVID-19 must be tailored to the particular infection characteristics of the SARS-CoV-2 virus—the fact that transmission often occurs from individuals who are contagious but who do not yet display symptoms or who have symptoms so mild that they are unaware. Seeing no reason to isolate themselves, they move about and potentially infect others.
- The focus of traditional testing for contagious disease is on those who do present with symptoms, as well as on their close contacts. These individuals can be immediately isolated pending confirmation of infection.
- In the case of COVID-19, that approach needs to be extended to quickly identify and isolate the invisible spreaders and their contacts, an approach referred to as “test, trace, and isolate.”
- This requires a strategy for “surveillance” testing of groups that are at higher than average risk of exposure to the virus or of transmitting it to particularly vulnerable individuals.
- Surveillance requires high volume testing and thus relies on testing technologies that are convenient and inexpensive and that, in many cases, provide rapid results.
- Surveillance testing does not replace testing currently being used for diagnostic and related purposes where the accuracy of the test is paramount. Highest accuracy relies on “PCR” technology, regarded as the gold standard for detecting the virus that causes COVID-19.
- Surveillance testing, on the other hand, is complementary to diagnostic testing and requires technologies or approaches that are simpler, quicker and cheaper but do not require quite the diagnostic standard of accuracy.
- The strategy we propose would employ on the order of at least half a million tests per day across Canada—more than seven times the current testing rate—and would be achieved by significantly expanding existing PCR capacity, augmented for screening purposes with “antigen” tests that, while less accurate, are inexpensive and deliver a result in minutes.
- The implementation of this strategy requires, in addition to procurement of much larger testing resources, more widespread recognition by public health authorities of the need for surveillance testing to complement existing diagnostic testing. Both are necessary for optimal control of COVID-19.
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