Ontario's test and trace efforts aren't working well enough, physicians say

Amid a surge of coronavirustransmissionin Ontario, some physicians warn the province's plan to ramp up efforts to prevent new infections will fall short unless further measures are taken to clamp down on community spread.

Ontario on Monday reported 700 new confirmed cases, marking the highest one-day total since the pandemic began.

The ongoing increase throughout September comes as Premier Doug Ford's government rolls out a plan to boost testing capacity to 50,000 daily tests, whilebringing on 1,000 more staff to manage cases and trace their contacts.

"We had an opportunity in the summer when case counts were low to really fine-tune our system around test, traceand isolate," said Dr. Tara Kiran, a Toronto-based researcher and family physician.

"I think the recent spike in numbers showswe weren't ready."

In Toronto,the epicentre of Ontario's second surge of cases, testing and contact-tracing efforts are already lagging behind on several fronts.

On average, more than half of people getting tested don't see their result for two days or more, while close to half who do wind up testing positive aren'tbeing reached by contact tracers within 24 hours, the latest Toronto Public Health data shows.

Given the challenges, various physician leaders,including the Ontario Hospital Association,are pushing the province to return to Stage 2restrictions onindoor bars and restaurants, gyms, places of worship, movie theatresand other non-essential businesses.

While Ontario officials are striving to avoid widespread closures or a lockdown in favour oftargeted restrictions,Kiran said a broader "pause" is crucial toreduce the virus' spread, giving the testing and tracing system a chance to catch up.

"We need to do something to reduce the number of social contacts now, before it gets to a level that's unmanageable for even a larger number of contact tracers," she said.

"I worry we're getting to that territory with the explosive rise in rates of transmission."

Hours-long lineups

One epidemiologist warns Ontario has already hit that tipping point. Dr. David Fisman, a professor withat the Dalla Lana School of Public Health at the University of Toronto, stressed with current case counts and turnaround times, it's likely people infected by someone who's currently being contact-traced are already infecting a third round of contacts.

"When we're up above 500 cases a day," he said, "you can't meaningfully contact-trace."

Provincial officials, however, maintain they're meeting the rising demand.

The province plans to bring on500 Statistics Canada staff to help with contact management while hiring an extra 500 contact tracers, eventually bringing the total staff count from 2,750 to 3,750.

"Additional capacity will ensure that cases and contacts continue to be reached quickly," said Ministry of Health spokesperson Miriam Mohamadi in a statement.

Reaching that point in the process is already proving time-consuming, given the struggles many Ontarians arefacing getting tested in the first place with reports of hours-long lineups at various assessment centres in recent weeks.

To combat that bottleneck, the Ford government isoffering testing at pharmacies, has largely cracked down on the practice of getting tested without symptoms or risk factors, and announced three Ontario hospitals are conducting saliva collection, with more assessment centres offering this option in the coming weeks.

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But the capacity to process those tests remains limited. While laboratories are now completing upwards of 40,000 tests a day, with provincial plans aiming to hit 10,000 more, there's also a backlog of nearly 50,000 tests in the queue.

"It doesn't seem like they have quite enough capacity to stay ahead of the spread," said Dr. Irfan Dhalla, vice-president at Unity Health Toronto and a professor at the University of Toronto.

That means Ontarians could see increasingly longer turnaround times for their results, Kiran warned.

"It's going to take longer for us to know who is positive, and contact them, then contact their contacts," she said. "It's a chain of events."

Red-alert items

On average, only 20 per cent of new COVID-19 tests in Toronto currently have a turnaround time of 24 hours, according to data from Toronto Public Health, while around44 per cent have a 48-hour turnaround, leaving more than half of people tested waiting even longer for their results.

Both metrics have been deemed red-alert items on the city's COVID-19 dashboard forfalling well below targets.

Public health officials are also struggling to contact those confirmed cases in a timely manner.

The latest numbers show only 55 per cent of people who've recently tested positive for the virus are being reached within 24 hours, leaving 45 per cent waiting longer another metric that's lagging behind.

"Sometimes, we are unable to reach a client despite numerous attempts," said Toronto's associate medical officer of health, Dr. Vinita Dubey, in a statement.

"This can be because they may not have voice mail set up on their phone, or their number is no longer in service. These factors, combined with a case's living, work and social situations, as well as the volume of cases, can impact [our] ability to reach newly reported cases within 24 hours."

When it comes to tracing all the contacts of those newly-confirmed cases, that's the one metric in good shape, with 96 per cent of contacts successfully reached within a day but it comes only after all the previous delays.

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Given those kinds of challenges faced by certain public health units, McMaster University infectious disease specialist Dr. Dominik Mertz said the province needs to deploy resources accordingly.

"We have hot spots currently Toronto and Ottawa in particular where there is certainly much more people needed to do the contact tracing than in other regions where case counts are already low."

Mohamadi, speaking for the Ministry of Health, noted the centralized pool of contact tracers "can be accessed by any public health unit."

But despite those recent efforts to beef up testing and tracing, Fismanmaintainsit's"too late."

Returning to broader stage two restrictionsis now crucial for reducing transmission, he said.

"The numbers are too high," Fisman said. "So contact tracing is not a lever you can realistically use to bring these numbers down."

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