Front Burner - Who gets the COVID-19 test, and why

Episode Date: March 18, 2020

Public health bodies like the World Health Organization tell us that widespread testing for COVID-19 is key to fighting the pandemic. But we’re also hearing that some provinces are planning to tighten criteria for who can get tested. Today on Front Burner, we speak to infectious disease specialist Dr. Sumon Chakrabarti about the testing strategy being used across Canada and how effective it is in flattening the curve.

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. Hello, I'm Jamie Poisson. Testing is a crucial part of the fight to contain COVID-19. We have a simple message for all countries. Test, test, test.

Today, we're talking to Dr. Suman Chakrabarty, an infectious disease specialist at Trillium Health Partners in Ontario, about how testing works, why kits are in short supply, and how Canada is doing big picture. This story is moving faster than anything I've ever seen before. We know more and more about this virus every day. So I also want to ask the doctor what we know now about the toll this virus can take on a person. This is Frontburner. Hi, Dr. Chakrabarty. Thank you so much for making the time to speak with me today. Hi there. How are you? Thanks for having me. Good, good. So

yesterday we talked a lot about the importance of social distancing on the podcast. The messaging around this really ramped up. We heard a lot of messaging about this from the Prime Minister and others. Vulnerable people in the community need your help. As much as possible, stay home. But we've also been hearing from the experts that testing is key to their response. On Tuesday, officials at the WHO reiterated this in their daily press conference. It's testing. It's finding all cases and testing cases, making sure that they are isolated and that they are cared for in medical facility. And if that's not possible, to make sure that they are adequately cared for at home and preventing transmission to loved ones in their household.

The experts added that we need adequate labs to test and we need an adequate amount of kits. So I'm hoping that we can address this right off the bat. From what you are seeing when it comes to Canada's response, do we have an adequate number of labs to test for this? Definitely we do. And it's important for us to remember that this idea of testing is something that changes its role depending on where you are in the outbreak. role depending on where you are in the outbreak. One thing that Canada has, and it was a situation that was much better than what happened in the States, unfortunately, is that we were able to do all this stuff very early on. So we were prepared for this based on our SARS lessons in 2003 to start looking way back in January. What this means is that, yes, you want to be looking for people who are having symptoms, but you also want to be reaching into the community and making sure you're not missing cases.

So this is important to rule out what we call a community transmission, which is what's happening now. When WHO made that announcement, what they, I think, were more referring to were countries that have not necessarily been doing that. And one of the problems, for example, in Italy, they were taken off guard a little bit because we were, all eyes were on China at the initial outset. But then when Italy started looking, they were like, wow, wait a minute, we have a lot of cases here. And the cases have probably been circulating there for a couple of weeks. So Canada, I'm proud to say we were already on top of this and we were expecting, we were looking for community transmission. We have found it. And I think this is part of the reason why that these interventions that we're putting through the social distancing will be helpful and we can get some bang for our buck. Do you think that even

today we're doing well on this front? I understand the first death, Ontario's first death was an elderly man. And it was unknown that he had COVID-19 until after he passed. The deceased was in his 70s, had other pre-existing medical conditions that would put him at risk. And so the relationship between his infection and his death is under investigation by the chief coroner's office. So what does that say about our ability to kind of search out and find these cases? I don't know the full details of that case yet. So we'll probably hear about that a bit later. But at the current time, what's happening is any individual, even without travel history,

if they're coming to the hospital with respiratory symptoms, and they're sick enough to be admitted, we're going to test them for COVID. That's important because before we were just looking at initially, okay, somebody coming back from China. Later on, it went to Italy and Iran, and now it's essentially everybody. So it will be important, though, I think that with this case where the initial reason for this person's illness was not identified, it will be very important to know the chain of events that led to that, and we'll probably hear that later today. And certainly I think that this is an important situation for us to learn from and might heighten our index of suspicion about potential cases

and therefore to be that much more vigilant for protection of hospital environments, of people working in hospital environments and investigation of potential cases. I wonder if you have a sense of whether or not we're coming up against resource issues. So I know that Quebec announced they're now rationing tests. They say there's not enough swabs going around. And I also understand that over the weekend, Ontario announced it was tightening its criteria for who is able to access testing. It's now more vulnerable people. And so what is going on there? Yes. And part of this is in terms of supplies. These swabs do come in a finite amount.

What might be interesting to note is that one of the places that makes the bulk of swabs is actually located in northern Italy. So that could be part of the problem. The other thing, though, is that we have to remember that the outbreak for us has now pivoted. So initially, it was about us searching out community spread. We've now found it, and we now have to basically assume that it's there. What the main goal is to look for the critically ill people and the people that require hospital care because that's what we really want to do. The people that are, say, if you have mild cold symptoms, but you can otherwise stay at home, it doesn't really matter if we test or not, because we're going to treat that person the same, stay home for 14 days. But if you're

somebody in the hospital admitted, it does matter if you are positive or negative for COVID, because that will mean different precautions, a different prognosis and a different way that we approach that patient. And this is the reason why the changes have happened. Can we talk a little bit more about the people who need to be prioritized for testing? So what kind of symptoms are you looking for there? It's a great question, one that we've been dealing with, and it's changed for us even over the last couple of days. So what we're looking for is we know that COVID-19 in most people causes a constellation of symptoms, things like fever, a cough, sore throat, maybe some muscle aches, joint pain, but not all of these are present in

everybody. And that's why you have to have a high degree of suspicion in anyone presenting with a flu-like illness. And we've all experienced that before. But for people who are more sick, we're looking for people who are extremely short of breath, somebody that's having difficulty catching their breath even at rest, or somebody who is having such a bad infection that they're getting very drowsy. These are the types of people that you would be not safe to watch them at home and you would admit them to hospital for further observation, just like you do any other time, even when COVID wasn't here. So in those people, we put them on the proper treatment like oxygen, antibiotics, whatever, and we will test them for COVID. And are these the kind of people that you want to come to get tested at these testing centers? Yes, those are the individuals we want. Definitely people

that are feeling very ill that you would want to go to the emergency department anyway. Another population one that's important is let's say you are somebody who, you know, you have viral type symptoms. You feel relatively okay. You wouldn't go to the emergency department, but you have a significant health issue such as emphysema or for example you're on medications for a transplant immune suppressive medications these people are those that don't need admission necessarily but they have a significant risk factor these people also should come for testing and the other people that we're doing which is very important is health care workers so health care workers even if they have mild symptoms and they have no comorbidities, we still want to test healthcare workers because we are at particular risk of getting the infection, but also at a potential risk of spreading it to others.

So these are the groups that we are trying to target in terms of testing. So just if I can sum it up there, you're trying to target people who know, people who already have severe symptoms, people who have underlying conditions, and maybe moderate symptoms, and healthcare workers, because of course, you're on the front lines. And you can also spread, spread this quite easily, because you're in contact with so many people. That's right. Exactly. And, and for the rest of us, people who might have cold-like symptoms, fever-like symptoms, a sore throat, what should they be doing right now? Should they be calling their doctors? Should they be calling their local public health authorities? Or should they just be waiting it out to see if their symptoms get worse?

Yeah, and the thing is that, remember that if you are unwell and you're wondering, there's lots of resources online, including in your local public health unit. They'll often have a web page that can have the questions that you can go through to decide whether you need to go to hospital or not. But yeah, for the rest of us, the big situation is if you have essentially symptoms of a mild cold, then it's better to just stay at home and supportive measures, fluids, things like Tylenol to help with fever and take a lot of rest. The hospital and even clinics can't do much more for you in that situation than what you can just do at home by yourself. But of course, things can change. you can just do it at home by yourself. But of course, things can change. And if you do ever get to a situation where you were initially feeling well, but then start to rapidly feel unwell with, again, severe breathlessness, things like that, then you should come to the emergency department.

Okay. And I suppose this is the same reason why asymptomatic people like the Prime Minister are not being tested, even though he came into contact with someone who had tested positive his wife sophie grigore that's right so first of all because mrs trudeau had the positive result he is by definition a close contact so he will go into isolation regardless because he could develop symptoms. But you're absolutely right. Testing him is not a good thing now when he has no symptoms because the test could be negative, even if he does eventually go on to develop the infection. So the important part is testing of people only if they have symptoms. And sorry, I just want to pick up on one thing you just said, that the test could

come back negative because he doesn't have symptoms right now? That's correct. But it could develop into a positive later if he develops symptoms? So let's say as of today, presumably he has no symptoms. If we were to put a probe in his nose and test it, this would come out as negative. But then it's very possible that tomorrow or any time in this 14-day period, he could develop symptoms. That's the best time to do the test if you're going to do it at all. And you can only get a positive result if you have symptoms? In general, that's what it looks like in people. How about I put it this way? A better way to put it is you get a reliably negative or reliably positive result if you have symptoms. This was helpful because I think there's quite a bit of confusion around this. Idris Elba,

for example, recently posted a video on Twitter. He tested positive for COVID-19 and talked about how he was asymptomatic. I got tested because I realized I was exposed to someone who had also tested positive. So it is a bit confusing, right? Yeah. It is. I saw that too. And what my impression is, I suspect that rather than being asymptomatic, he was minimally symptomatic. So people are thinking about COVID-19 as being a full out cold, like you're lying in bed,

you know, with the thermometer in your mouth, like you see in cartoons, right? But you could have just a very mild sore throat, something that some people wouldn't even think about. Those mild symptoms are still symptoms. They're minimal symptoms, but in those situations, we recommend testing. I want to talk to you more about what this virus can do to a person's body. But first, I just want to loop back to the availability of tests with you for a moment. So I understand your point about who we need to prioritize. But are you concerned at

all that we're hearing stories about a lack of tests. Why is there a lack of tests? It's a very big point. One, even before this whole thing happened, the question was, you know, if we do see a ramp up of cases, and this is all over the world, by the way, you know, will we have enough testing kits? So yes, it's a concern in my mind. And it's one, again, that we have, we're going to have to evolve with as this outbreak evolves but the the overall overarching concerns that we do want to be able to make sure that no matter what we have with the testing that the highest risk people especially ones that are admitted to hospital that we are being very careful to identify them early isolate them and treat them in a way that we are minimizing the risk of infection of others.

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. So we've talked about how this virus can spread, mainly through air droplets and surfaces. And we've talked a little bit about how, you know, elderly and people with underlying conditions are more severely affected. But I'm hoping we can dig

into that a little bit more. Can you tell me, based on the information we have about this virus right now, what it generally does to a person's body. And I understand there are different degrees of severity here. Definitely. So the virus is a respiratory virus. It enters your body generally by touching the mucosa of your mouth or nose. And it is generally a lower respiratory tract virus. Okay. I'm not saying that you can't get upper respiratory tract symptoms, but in general, it's like sore throat, you can't get upper respiratory tract symptoms, but in general, it's like sore throat, cough, and that situation. In people who are otherwise healthy, if they have a little bit of virus in the lung, you know, it's going to cause that cough, that irritation, but your overall immune system is number one, able to respond to it. And number two is organized in a way that the immune system

has a coordinated response. It turns on at the right time and it turns off at the right time as well. So this is 80% of people. They get a mild cold and they're fine. The people that tend to get more severe are ones where the virus is able to essentially replicate to a higher degree in the lungs because let's say the immune system can't catch up to it. And then what happens is that you get this really, really big inflammatory response where all of a sudden you have all this inflammation in the lungs and you can't breathe

properly. And in these individuals, they have to be put on oxygen and then in severe cases on the ventilator. Older people tend to not do as well on a ventilator. So the ventilator is working for them. The lungs don't recover in time. And then you start to get problems with other organs, your heart, your kidneys. And I use, I often use this with my patients. It's like a train going off the track. When you're older, if one train car goes off the track, the whole train goes off the track. And that's what we see in people who have severe courses and eventually death. And is that sort of one of the reasons or the main reason why we're seeing more deaths among elderly people? That's right. Because, you know, overall, an elderly person is much less

likely to be able to respond to, for example, impairment of their kidneys, because they may already have some, you know, if they have an underlying lung disease. And overall, an older person just has less reserve, especially if they have chronic health conditions. Okay. The idea that it's affecting 20% of people more severely. So we know it's affecting elderly people and people with compromised immune systems. But are there also cases of this affecting younger people, relatively healthy people, severely as well? Absolutely. And you know, there have been cases of otherwise young, healthy people getting very ill and unfortunately dying as well. Anecdotally, what was coming out of China is that it looks like a young person, if they get a high burden of exposure, like so a lot, a lot of virus at once. And, you know,

this is something a health care worker who does not have proper protective equipment could potentially be exposed to. So one thing I will say, though, is that this is these cases, of course, are very troubling regardless, especially when the person is younger, but it's because that they get kind of put front and center. This is not the norm. The majority of the cases of severe disease is in people that are older, just like we see in influenza. Right. I remember there was the case of the Chinese doctor who had initially sounded the alarm about COVID-19 and had gotten in trouble by the Chinese authorities. And then he tragically died. I believe this is what experts are saying could have happened to him, that he got this sort of super dose of the virus. I know that's not a very scientific term, but.

Well, actually, it makes a lot of sense to me. And, you know, very possibly, because if I'm not mistaken, I think he was an ophthalmologist, wasn't he? Yes. And in an ophthalmology clinic, you're seeing multiple patients in a day, right? And you're in relatively close contact with them when you're checking their eyes. So if he had multiple people who were infected, however mild, you know, that ongoing exposure could have been the risk factor for him. And what do you think is Canada's biggest challenge right now in addressing this crisis? I think the biggest challenge is one that's shared around the world is, you know, in order for us to combat this, you can see that we have a massive coordinated effort.

And that's what the big challenge is, coming together as a country and continuing with these very difficult measures that are clearly changing our lives at the current time and going forward. I think that it'll be important for us to act quickly and aggressively, which I think we're doing, but also making sure that if it does last for a couple of weeks or even maybe a couple of months, that we continue with the sustained effort. And that's going to be big. And I think, you know, I'm very proud of my public health colleagues, infectious disease, all my frontline healthcare worker colleagues that they're working hard. And it's going to be a tiring process. So these are big challenges that we're looking at. And hopefully, like we mentioned, flattening the curve. And if our interventions work, that's what will happen and try to take a burden and impact off our healthcare system.

Okay, Dr. Suman Chakrabarty, thank you so much. And thank you so much for all the work that you're doing right now on the front line of this. I hope that you're keeping healthy. Thanks very much. Really appreciate it. Great to be here. All right. So before we go today, a fairly dramatic rise in numbers in British Columbia yesterday. And I just want to point this out. There were 83 new cases, bringing the total there to 186. Very sadly, there were three new deaths, two at the Linwin Valley Nursing Home where there's an outbreak. Provincial Health Officer Dr. Bonnie Henry said the increased number of cases was also due to increased testing, though. The number of people going for testing, but also the expansion of five different testing sites. She said the numbers will likely increase

in the next few days in keeping with the new testing strategy the province is pursuing. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner and talk to you tomorrow.