Front Burner - In Brief: Testing saves lives. Why isn’t Ontario doing more?

Episode Date: April 9, 2020

Ontario has fallen far behind when it comes to testing residents for COVID-19; Quebec and BC are testing about twice as many residents, per capita. Today on Front Burner CBC science reporter Kelly Crowe explains how Ontario found itself in this predicament and how the province is trying to catch up.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hey everybody, Jamie here. This is our nighttime brief edition and some headlines from Thursday. After much pressure, the federal government released their modeling numbers today. The best case scenario could see between 11,000 and 22,000 Canadians die from the coronavirus pandemic. By this time next week, we could see between 500 and 700 fatalities. I'm recording this at 4pm on Thursday, and we're sitting at 527 confirmed deaths in this country. Just a reminder

that models aren't perfect predictions here. They're dependent on people's behavior and the quality of data, and they can change. And Canada's economy lost more than 1 million jobs in March. Statistics Canada puts the jobless rate at 7.8%. But the true employment picture is likely even worse. Another 1.3 million Canadians have worked no paid hours because of lockdowns, but technically still considered themselves to have jobs. And finally, UK Prime Minister Boris Johnson has been moved out of a London intensive care unit. He had been moved to the ICU earlier this week after his COVID-19 symptoms grew more severe. Boris remains in hospital, but is said to be, quote, in extremely good spirits.

be quote, in extremely good spirits. The other big story that is playing out right now is the troubling state of coronavirus testing in Ontario. The province is not testing nearly as many people as it has the capacity to. Our colleague Mike Crawley is reporting about testing centers that are mostly empty. Given how important testing is to beating COVID-19, how can this be happening? Kelly Crowe is a science correspondent for CBC News, and I've reached her in Toronto. Hi, Kelly. Thank you so much for being here. My pleasure. So before we get rolling, can we start here? Why is widespread testing so important? Why is everybody talking about the importance of testing

testing testing well it's really it's really your best weapon you need to know who is infected so you can treat those people but also you so you can find out who they were in contact with and so those people can isolate and this will help slow down the spread so that's why testing is important at an individual level but at the population level you also need to test to know how big the epidemic is and how many people have already had the infection and would have at least some short-term immunity. And scientists at this point think about half the cases might be so mild that people don't even know they're sick. And those people obviously can still spread it. So it's important to test as many people as possible. can still spread it. So it's important to test as many people as possible. And I would imagine that governments are making decisions based on the data that they're getting. And one of the most important data points that they're getting is the data that they're receiving from testing. Right. Well, this is a big problem with the models because all of the models around the world are based on the number of cases, but the number of cases are artificial because

there's not enough testing happening. So they're missing most cases. And they're also testing the most obviously sick people. So the case results are already biased because you're selecting the people you think are sick. So yeah, it's a huge flaw in the modeling because you can't make reliable predictions when the data is so weak. So I want to understand what went wrong here, particularly in Ontario. And so briefly, can you take me back to January? This thing is exploding in Wuhan. What are health officials in Canada doing when it comes to ramping up preparedness here, particularly around testing? Well, the funny thing is, when you look back, obviously, with the benefit of hindsight, there's an interesting press conference that happened in Ontario, the very day after Wuhan

was locked down. And we had Ontario's public health leader saying, no problem, we're good. We have already been through SARS. So we have all that experience. Plus, we've already developed a test because they were able to, the world was able to sequence the genome really quickly. So all the countries were able to develop tests. And by the end of January, they'd already done a test, they knew their testing system worked. So they were pretty confident that this was going to be, it's going to be okay. I remember this, we have this confidence in January, everybody feels like they've got this in hand, or that's certainly what it seemed like. And then March comes along. And we start getting more and more cases here in Canada. This pandemic is exploding in Europe. And what is public health

doing in regards to testing in this moment? Well, now they recognize that it's here, it's landed. So by the second week of March, there are testing centers opening up across Canada. You might remember even some drive-through testing. And people with a travel history who had fever or coughs were encouraged to get tested. But within about a week, all of the provincial labs in the larger provinces were overwhelmed. There were backlogs in BC and Alberta and Ontario and Quebec. And so to control the volume, suddenly the provinces are saying, okay, hang on. We can only test, we can't test everybody. So we can only test certain people. So they decided the most important people to get tested were frontline healthcare workers, people who

were showing up in hospital with serious symptoms. And suddenly we were getting calls from Canadians saying, look, my doctor says I have this, but I can't get a test. Right. They've like narrowed this criteria. I remember the public health officials at the time were saying, just stay home, just practice social distancing. This is how we're going to fight this thing. But you mentioned these backlogs. Like, why are we seeing these backlogs?

You know, why are we not testing more widely here? Right. And so it's hard to understand, and I had the same questions, but the answers are really surprisingly simple. There simply aren't enough machines, testing equipment, and people to do the tests. So imagine these machines are running at full tilt 24 hours a day, seven days a week, but there's only so much that they can do. And so the patient testing samples are coming in the door and they're trying their hardest to run them through the system, but they can only go so fast. And so there's a backlog. Kelly, I imagine some people listening to this will feel frustrated hearing that answer. You know, why did we not have the capacity to process the tests that we were doing? Right. Well, it's understandable. But the thing is,

we don't do this every day. So I mean, when you're making decisions about how to spend money and how to staff labs, people weren't expecting to have to do hundreds of thousands of these nucleic acid amplification tests, which basically are DNA tests every day. So they only had a certain capacity. And it's not the sort of thing that you can ramp up quickly. You have to get the machines. You have to have trained people. You have to know who's delivering the swabs and who's delivering the results. And most importantly, in this case, you need these reagents, these chemicals. And all of a sudden, everybody around the world is doing the same test and wants to do as many as they possibly can.

And there's suddenly a huge competition for these supplies. Right. You mentioned these reagents. I understand they're sort of like the chemicals that you need to process the test. And you mentioned swabbed as well. I know there have been shortages of swabs. At one of the assessment centers, Mike Crawley, our colleague, has a piece saying that they've run out of the nose swabs. So they're using throat swabs, which are less reliable. But I guess my question is, you know, why did they not see this coming sooner? This is the big question, right?

And this is the question that we'll be being tempted to answer as we, you know, in months from now, when we're writing the book about what went wrong. One doctor I talked to who runs the lab for several hospitals out of North York General, he did see this coming. As soon as he heard the word pandemic, suddenly, you know, 15 years of pandemic training kicked in and he went, oh, we're going to have supply issues. So he right away started stockpiling at first quietly, didn't want to blow the budget. So he ordered things that he knew he could use the next year's flu season if necessary. Then a couple weeks later, he realized, I have to really stock up. So he started calling the

distributors insisting on next day delivery. He has these test kits on pallets all around the lab. So he saw it coming. The question about why everybody else didn't see it coming, I can't answer. I don't know if anybody can answer it right now. I expect that those will be the answers people will be looking for. Okay. And I understand Ontario has now cleared this backlog of tests that it needs to process. Am I right to say that?

But still, on Thursday, they reported that they did 4,000 tests, which is still well under the 13,000 tests a day that Doug Ford wants to be conducting, right? Right. Right. So what basically happened is that Ontario basically had to build a bigger boat in the middle of the ocean, in the middle of the hurricane. They had to somehow create a network of labs. And so they hired an accounting firm to come in and organize the hospital labs, the three private labs that do your normal blood tests, and then the provincial lab. And so that has now been formalized. And suddenly, they can do 13,000 tests a day, and will soon be able to do 19,000 tests a day. But suddenly, then the question was, well, why didn't you do 13,000 tests today? Why did you only do two or 3000 tests? Right? Why don't they just kick this into high gear now if they can do 13,000 tests a day? So the answer to that question is

that out in the field, people are still using the old, following the old rules. They've been told to be conservative about who they test. And so the patient samples just weren't coming through the door because everybody was already operating, was still operating under the old system, which was constrained. So it's not like flipping a switch. They couldn't just say, okay, suddenly everybody go find 13,000 patients who needed testing. Those testing volumes will come up now, but it takes time. There's a lag. Right, right. Because this narrowed criteria that we were only testing the sickest people, the most vulnerable people. And so now a lot of doctors are probably still operating under those rules. And are we still seeing the same issues with the reagents and the availability for like actual testing materials like swabs?

Oh, yeah, that is that has not gone away. It's just going it's going to be a chronic problem throughout this whole pandemic experience. Right now, they're they're reporting in some parts of the province that they don't have these nasal swabs. In some places, they've had to use vaginal swabs that test for things like chlamydia, because because they can they can substitute. They're not ideal. The trick is to have something that has a growth medium. So you put the swab in the patient, then you put the swab into the growth medium. Now the virus is protected while it gets transported to the lab. So that's an important piece of equipment, simple but important. And the reagent problem, I mean, the head of the provincial lab told me yesterday that they actually don't know if they're getting the supplies until they show up. It's just it's that crazy. So that's what helps to have this this network now so that it's coordinated.

So, you know, if one lab runs short, another lab might have some supplies that they can give them to carry them through. But it's going to be you know, this is going to continue for weeks, months. Any timeline on when we can, when Ontario may get these numbers up at all, anywhere near 13,000? Or is it just for the reasons that you just stated too unpredictable? Well, today, they've widened the criteria, the criteria about who can be tested. So they're opening it up a little bit, but it's still, I think they're worried about creating another backlog. So I think that's one problem. They've now said that anybody with symptoms in a long-term care facility or any healthcare workers or first responders with symptoms, any people in remote, isolated or indigenous communities with symptoms. So it's still very symptom based. There's a little bit of wiggle room in that doctors are also reminded that they can send anybody for testing that they feel should be tested. But we'll see.

you know, everybody in long-term care homes tested. So this, you know, certainly is narrower than what he said at his press conferences. You know, one question I have is why BC and Quebec have done better here than Ontario? Why are they testing at double the rate that Ontario is? So I think that, I mean, there's an impression that they've done better. But in fact, if you look at the absolute numbers of tests, they're the same, right? BC has been doing about 3,000 tests per day. Ontario has been doing about 3,000 tests per day. So the actual physical tests that are running through the machinery in the lab, they're running at about the same volume. The difference is that BC has a smaller population.

So the question is, why isn't Ontario's capacity proportional to the population? And again, it's back to the original questions. I mean, how much money should they have spent, should they have always had capacity in the province to test at a higher rate relative to the population? Again, another question that will be being considered, you know, in the reviews of this experience. I wonder, you know, your thoughts here. This is the province that was hardest hit by SARS in 2003. So I'm surprised, I have to say, that it now is the province that is performing the worst on this question. And why do you think that's the case? Well, there's lots of technical explanations. For example, BC has a more integrated system for their public health network than Ontario does. Also, Public Health Ontario has been flatlined for funding for the last five or six years. So there hasn't been any sort of extra spending. I also think that the memories of SARS dimmed. We got we went through H1N1, we went through some other,

you know, epidemics that came along, and we managed to sort of get through them without any catastrophic results. So I think there was a maybe misplaced sense of security that had set in. Also, the fact is that some of the SARS recommendations, many of them were never actually implemented, or just partially implemented, for example. So the SARS Commission did recommend a national network of laboratory testing be established, and that hasn't happened. Okay. Kelly Crowe, thank you so much. Thank you. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem.

Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. All right, that's it for today. We've got an episode that's dropping tomorrow morning that I really hope you tune into. It's the story of a Toronto man who got a job at a nursing home just so he could see and support his mom. Thanks so much for listening to FrontBurner. I'm Jamie Poisson and talk to you soon.