Rapid tests are less accessible even as COVID wave ramps up across Canada, doctors say

A couple of weeks ago, Andrew Longhurst and his family started to feel worse for wear.

Wanting to test themselves for COVID-19, Longhurst, who lives with his wife and four-year-old son in Roberts Creek, B.C.,travelled to pharmacies in nearby Sechelt and Gibsons in search of rapid test kits.

"Two of the pharmacies I went to were out [of tests] and at that point, I stopped looking because I did find some more boxes in our house," Longhurst said. "It's more than frustrating that at a time when we're going into a big surge, the only [testing] tool that we have at our disposal is not readily available."

In B.C., COVID-19 rapid tests are still being distributed in most pharmacies for free, but people like Longhurst in smaller, rural communities may have a harder time finding them.

Across Canada, experts say rapid tests are less accessible even as COVID-19 cases are on the rise, due to policy changes and inconsistent public health communication about testing.

"What we've observed is that the access to [rapid] tests has certainly declined in the last little while," said Dr. Fahad Razak, internal medicine doctor at St. Michael's Hospital and Canada Research Chair in healthcare data and analytics at the University of Toronto.

There is no shortage of COVID-19 rapid tests in Canadian warehouses, according to Health Canada data which shows there were 187 million undistributed rapid tests as of July 14.

With a spike in cases and new vaccine campaign rollouts across the country, doctors say there is a need to make testing and mask wearing more commonplace to mitigate the risks of COVID-19 spread.

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Ever-changing approaches

Rapid tests are important for several reasons, according to Dr. Dalia Hasan, aKitchener doctor who created COVID Test Finders in 2021, a tool to help people find rapid tests.

"They help stop community transmission of COVID by signalling a patient when they should isolate, use a well-fitted, high-quality mask like an N95, and also for them to know when to exit isolation," Hasan said.

They are also an important tool for people to access treatments such asPaxlovid, which needs to be administered within five days of symptom onset in order to be effective, she said.

The Ontario provincial government discontinued their free rapid test distribution program at grocery stores and pharmacies in June, but in a less publicized statement earlier this month, said health-care providers can now order tests from the province to distribute to their patients for free as of September.

The distribution system in Ontario is also up to each of the 34 local public health units, creating differences in where people can find a rapid test in each city. Ottawa, Hasan said, is a "shining example" of a health unit doing things right by distributed free rapid tests at libraries, community centres, and schools.

The situation is different in Toronto, according to Dr. Kate Dupuis, a clinical neuropsychologist who works with long-term care patients. While some pharmacies still have rapid tests available, she says people in Toronto have been relying on social media and word of mouth to find them.

"You'll see people will post online like, 'this pharmacy has them, go quickly,' or 'this Walmart is giving them away,' but it's very haphazard," Dupuis said. "People are searching for them on Facebook groups."

A spokesperson for the Toronto Public Health unit told CBC they cannot comment on how many rapid tests are available in pharmacies across the city, but said there are plans to distribute more soon.

"The City of Toronto currently has a large supply of Rapid Antigen Test kits," reads the email from the Toronto Public Health Unit. "TPH is currently planning an equity-focused approach for the distribution of rapid antigen test kits which will include select City-owned locations across Toronto this fall."

Changing guidelines across the country can be difficult to follow for people not paying close attention, Hasan said.For example, Quebec now restricts free tests in pharmacies to people who are deemed most at-risk, but has free rapid tests at vaccine centres and in schools,and New Brunswick requires an appointment to pick up a test kit.

Hasan, Razak, and Dupuishave all said that clear communication from public health officials about the need for testing, where to find test kits, and how best to use one, is essential.

They also agreed on how much illness has been spreadingin recent weeks, particularly since the start of the school year. Two out of the four people interviewed for this article spoke to CBC while at home with their sick children.

'Anybody can pass it on'

Some provinces have set restrictions on who can or should test themselves for COVID-19 based on their level of risk.

Quebec, while providing free rapid tests at vaccination and screening centres and in schools, reserves pharmacy rapid tests for those who would be considered for Paxlovid treatment, teens, students, low-income earners and seniors.

A report in May said those who are not eligible for free tests at pharmacies can buy them for $20 each. However a spokesperson for the Quebec Ministry of Health and Social Services told CBC in an email that these tests are "not intended to be sold" at pharmacies.

B.C. does not restrict who can access tests, but recommends COVID-19 testing for people who both have symptoms and "when testing could impact their treatment or care," a health ministry spokesperson told CBC in an emailed statement. "This includes hospitalized patients, pregnant people, and those eligible for treatment."

Hasan disagrees with these restrictions and recommendations.

"The whole point of public health tools is to prevent disease, and you're not preventing disease by only distributing them to people who might be more susceptible of infection," said Hasan.

"Anybody can breathe it in and anybody can pass it on to somebody else, so to restrict it only to vulnerable people ignores anybody who might transmit it to these vulnerable people."

Testing is important for Longhurst, who has asthma and other chronic conditions that could get much worse if he contracted COVID-19.

But it's also important for people who do not have co-morbidities, due to the risk of post-COVID complications, according to Dupuis and Razak.

"You don't know who is going to be the unlucky person who, for whatever reason, will have very severe disease, will develop long COVID," Razak said. "The impact of a severe infection could be life on disability, could be death, [and] the impact of long COVID could be not being able to go to school properly, or work properly, or care for your family."

For Hasan, an ideal scenario would involve governments sending people COVID-19 protection kits with tests, masks, and information about how to protect themselves from the virus. A version of this method, where people are able to order free rapid tests to their doorstep, began this week in the United States.

"I think we should mirror the pragmatic approach of the United States with respect to testing make it as easy as possible for people to have access to these tests at home," Razak said.