Don't have symptoms, aren't high-risk but want a COVID-19 test anyway? Step aside, health officials say
TORONTO -- Though Ontario joined Alberta in expanding COVID-19 testing to pharmacies Friday, it simultaneously rolled back its previous declaration that anyone who wants a test can get one.
In both provinces, asymptomatic residents can head to drugstores for a swab test, but health officials say priority should be given to individuals from high-risk groups.
Neither an Ontario government announcement made Wednesday about the expansion of testing, nor a list of participating pharmacies makes any mention of restrictions on who can get tested at drugstores, aside from having to be without symptoms of COVID-19.
But Ontario’s main COVID-19 page does specify that to qualify for a test at a pharmacy, a person must be both asymptomatic and a resident of or a worker in an “at-risk setting, such as a long-term care home, homeless shelter or other congregate setting.”
The messaging wasn’t clear to Christine McMullan, 72, of Orleans, Ont., a suburb of Ottawa, who called a local pharmacy to book a test.
“I was told the guidelines had been changed overnight and I wasn’t eligible to have a test,” she wrote in an email to CTVNew.ca.
She said she was told that because she doesn’t work or live in long-term care, hasn’t been exposed to a positive case, and doesn’t require the test to travel, she couldn’t have it. She says she wasn’t asked about symptoms.
McMullan says many seniors should be tested because they have to look after their sick or disabled spouses, or want to safely see their grandchildren.
“Without assurances that they are negative and can ‘go back to normal’ people are left hanging,” she wrote.
Justin Bates, CEO of the Ontario Pharmacists Association, told CTVNews.ca that he shares concerns about communications around pharmacy testing. He says the original intention was that any asymptomatic people would qualify, but changes came from public health authorities in the last two days that only high-risk populations would be included.
He initially believed that “congregate settings” included schools, but has since learned it excludes school staff and students.
Alberta was the first province to approve COVID-19 testing in pharmacies. It announced on July 30 that a pilot program had been successful and that it would open swab testing to all pharmacies. Since then, more than 560 pharmacies have joined the program to provide asymptomatic testing.
Other provinces, including British Columbia, Manitoba, Quebec, New Brunswick and Nova Scotia, do not generally provide any testing to those without symptoms.
Alberta’s chief medical officer Dr. Deena Hinshaw recently revealed that asymptomatic testing had resulted in only seven positive cases out of 10,000 tests. The province has since focused their approach on communities who are most at-risk for contracting the virus, like essential workers in long term care facilities and people experiencing homelessness.
“With a targeted approach we have definitely witnessed fewer numbers of individuals looking for tests,” CEO of Alberta Pharmacists’ Association Margaret Wing told CTV News. “We want to make sure the system has the capacity to test everyone who needs one.”
Multiple provinces across the country have faced persistent backlogs of COVID-19 test results throughout the pandemic, as medical labs struggle to keep up with demand. Some patients have reported waiting more than a week before they received their results.
In an effort to ease the backlog, health officials have discouraged asymptomatic people from accessing testing and have placed restrictions on pharmacies.
“I feel like this is the right approach at the moment because of how long it was taking for the results to get back,” Wing says. “The test is only meaningful if you can act on the results.”
People without COVID-19 symptoms can still get tested at their own discretion. However, health officials are hoping that patients will use their best judgement and give priority to at-risk populations.
“We can still do testing for everybody,” says Dalia El Sayed, a pharmacist and professor at the University of Alberta. “Everyone will get their results at the same time, but patients should be advised of the priority list and hopefully they will make the right decision.”
Ontario is facing a surge in cases of COVID-19, recording 409 new cases on Friday, and the same number on Thursday.
The province approved extending testing to pharmacies this week and about 60 locations, mostly clustered in and around Toronto and Ottawa, have signed up in an initial rollout.
Premier Doug Ford announced Friday that an additional 18 pharmacies will begin testing early next week in southwestern Ontario and Niagara. That expansion will be ongoing, he said.
Pharmacists will have the option to administer a test with a shallow nasal swab or a throat swab, says Bates.
Testing at assessment centres will be limited to: those with symptoms, those who have been exposed to a confirmed case, residents and workers in a setting with a COVID-19 outbreak, and those who live or work in high-risk settings.
Previously, anyone who wanted a COVID-19 test could go to one of the province’s 151 assessment centres.
But lines at those sites are growing, with some reporting waiting for hours, and the province’s testing labs have a backlog of nearly 54,000 tests. Tests collected at Ontario’s pharmacies will go to a separate lab for analysis, says Bates.
“From the get-go of this, we wanted to make sure that we were not adding to the stresses of the current lab capacity,” he said on CTV’s Your Morning Friday.
Bates says pharmacies will inform patients of their test results. Patients are encouraged to book an appointment with a pharmacy and will be required to answer pre-screening questions. The test is free to patients and paid for by the province.
Bates says it will be up to pharmacy staff whether to test someone who shows up without an appointment.
Dr. Sumon Chakrabarti, an infectious disease specialist in Mississauga, Ont., told CTV News Channel Friday that testing needs to be prioritized for the highest-risk people and expanding testing in pharmacies can help.
He urged people to follow the rules set out by the province and not try to “game the system.”
“It’s imperative we all do this properly to keep everybody safe and get the most effective testing that we can.”
According to federal numbers as of Sept. 17, Manitoba is the only province that it is reaching daily testing capacity targets agreed to under the national plan to restart the economy.
Ontario’s target is 78,000 tests but its actual capacity reported on Sept. 17 was 42,434. Quebec’s actual capacity was 20,000 on Sept. 17, though its target is 35,000. Alberta is short of its target of 22,000 by 10,000 tests a day. B.C. has the greatest proportional shortfall of all the provinces at 60 per cent, missing its daily target of 20,000 by just over 12,000 tests.
Loblaw Companies Inc., which owns Shoppers Drug Mart, said late last month it had reached out to all 10 provinces to discuss in-store testing. Each of its 234 pharmacies in Alberta now offers on-site testing to those without symptoms, and who haven’t been in contact with a known case or travelled outside Canada within the last 14 days.
The company says asymptomatic testing in drug stores offers peace of mind to those returning to work or school, or Canadians who care for an elderly loved one, without the risk of being exposed to those who may have symptoms in lines at testing sites.
The hope is that capacity will grow so that everyone can be tested and that, eventually, home-based COVID-19 testing will be available, says Bates.
In the meantime, his organization will be meeting with government officials to prioritize adding more testing pharmacies in areas of the province with growing case numbers.
Expanding testing into pharmacies is part of Ontario’s plan to manage future waves of COVID-19, which also includes expanded contact tracing, recruiting health care workers and implementing what the province says will be the largest flu immunization campaign in Ontario’s history.
The province has promised to ramp up daily testing capacity to 50,000 tests, to introduce testing at primary care offices and at-home testing for certain clients, and to offer a broader range of COVID-19 testing, including nasal, throat and saliva collection.
Three hospitals in Toronto began offering saliva testing this week and that will be an option at more assessment sites in coming weeks, says the province. That comes as B.C. announced it is introducing a new mouth rinse, gargle and spit test for students from kindergarten to Grade 12.
Ford criticized Health Canada for not yet approving saliva testing for general use, but federal Health Minister Patty Hajdu said last week that the agency would not approve current saliva tests because they are inaccurate and offer a false sense of security.