Ontario’s pandemic response feels frantic. The province’s
COVID-19 testing backlog reached 90,513 on Friday morning, or more than double the province’s daily testing capacity. The daily case count hit 732, the second daily record in a week, though that was boosted by belated cases from the spring. The City of Toronto asked the province to place the city back in a modified Stage 2 for 28 days; Ottawa Public Health’s Dr. Vera Etches said, “Our health system is in crisis … (the system) is on the edge of collapse.”
In response, the province announced mild restrictions in the hot spots of Toronto, Ottawa and Peel, which says it still has community transmission under control. The province limited social circles to immediate households, while capping restaurants, bars and nightclubs at 100 people and banquet halls and gyms at 50; neither Premier Doug Ford nor chief medical officer of health Dr. David Williams could clearly say whether people should visit other family members at Thanksgiving or not. The province continues to frantically attempt to limit testing; the premier, meanwhile, had started out the day with a video saying his overriding message was, “We’re ready.”
It was an incoherent, sclerotic mess, and the failure of the testing is a trembling pillar. A backlog delays case identification; it can render contact tracing close to useless. After three days, the RNA in samples begins to degrade, and the reliability of the test degrades with it. The backlog essentially removes large parts of the government’s ability to assess and control spread. And Ontario, for a month, has not been able to keep up with testing demand.
It didn’t have to be this way. Multiple sources familiar with the decision-making process tell the Star that expanding testing capacity was strongly recommended to the government by various parties in the past five months, to no effect. Had the province decided to fund expanded testing beyond the still-unachieved goal of 50,000 per day earlier — as early as April, as late as June or even early July — the system would already be capable of handling the surge.
“There’s 100 per cent no question that’s true,” said Dr. Kevin Katz, the medical director of infection prevention and control at North York General, who oversees the Shared Hospital Lab there between Sunnybrook, Michael Garron and other hospitals.
Sources familiar with the process indicate that the discussion on increasing capacity was being conducted as early as April and continued all summer, through various parts of the province’s overlapping web of medical data and decision-making, which includes the ministry of health, Ontario Health, Public Health Ontario, the laboratory system, and various provincial command sub-tables. Sources indicate the province was advised by its own experts to expand from a goal of 40,000-50,000 to between 75,000 and 100,000 tests throughout the summer.
But it hit political roadblocks. The money was only committed at the end of August, and announced Sept. 24. According to various sources in the laboratory system, it will take at least three months, and likely more, to get Ontario to a maximum capacity of 100,000 tests per day. Those familiar with the process said one phrase was a common thread in discussions: the bureaucrats would say, we have been told we need to be fiscally responsible.
“It took a while, because the price tag was so big,” said one source familiar with the decision-making process, who was granted anonymity due to the sensitivity of the issue. The source said they just didn’t want to spend the money. (This would have been the lion’s share of $1.07 billion later spent on testing and tracing.)
As a result, Dr. Tony Mazzulli has spent some of his busy pandemic staring at a wall. He oversees the Mount Sinai laboratory, which like all Ontario’s COVID-19 labs, has been churning full time for months. With one wall removed, supplementary testing machines the lab has sitting in storage could fit, and the lab’s daily capacity could go from 10,200 to 17,500. But who would pay for that?
During weekly meetings between Ontario Health and the major testing labs through the summer, labs told the province a few things, over and over: one, that asymptomatic testing was producing almost nothing of value, so that the province was burning through sought-after reagent and man-hours to no purpose. And two, that increasing capacity would cost money, and take time.
“On those calls in the summertime, it was a frequent topic of discussion: that if we, the royal we, need to make a decision about funding this, because it’s not going to be a snap-your-fingers, instantaneous decision,” said Katz.
“And I think there was a strategic and a political conversation around what are the targets, and there has been a target about 100,000 tests a day, in the summertime … There was definitely a lot of conversation about needing approvals to be able to be ready for September, and those approvals didn’t happen in a timely way to allow it to happen.”
“(The province) made projections,” said Mazzulli, the head microbiologist at Mount Sinai and University Health Network. “There were lots of people working on what you need to get to (in terms of increased testing). Yet nobody was actually doing it. So much time making projections for this, that and the other thing, without actually moving forward.”
One problem was that, buoyed by some of its medical advisers, and especially after the Trinity Bellwoods fiasco, the province and the premier starting saying anyone who wanted a test could get a test. Which, when cases dropped in the summer, was fine.
“It was a very ad-hoc approach in the summer months,” said Dr. Larissa Matukas, the head of microbiology at St. Michael’s Hospital, who runs the lab there. “The capacity needed to increase, the money would have helped us to get there. That’s the supply side of the equation. But the demand side should have been better managed, in my opinion. That has been advocated for for several months.”
But indiscriminate testing continued, even as lineups began to choke the centres in September. There were complicated and simple ways of calculating it, but if the province wasn’t going to change the criteria, it was clear capacity needed to increase for fall, when schools would return, and reopening would be further underway.
“If you look at the number of previous fall/winter seasons … on any given day in Ontario during that time period, you have between 75,000 and 100,000 people with sniffles, or some respiratory system,” said Matukas, whose lab has gone from 66 tests per day in March to 1,100. “So you would need capacity of 100,000 to do that every day. Minimum.”
Both Mount Sinai and the Shared Labs, among others, are only now expanding their capacities — Mount Sinai from 10,200 to 17,500 per day, and the Shared Lab from 4,000 per day to 10,000. But between renovations, instrument acquisition or calibration, and laborious training and recruiting from small pools, neither will reach those upper numbers for between one and two months.
So the provincial government is frantically
trying to reduce the amount of testing from narrowing the testing parameters at assessment centres, to
trying to push no COVID tests for sick kids and a return to school, to
memos on testing caps to multiple laboratories, to, on Friday, making
all assessment centres appointment only.
“People were aware that a second wave, whatever you want to call it, when the winter season came or the fall, that it was going to go back up,” said Matukas. “People knew. Everybody knew. And sure enough, it’s happening.”
So why didn’t Ontario want to spend the money? It’s not clear. But Ontario received Safe Restart Agreement money from the federal government in August, which provided $1.28 billion towards testing and tracing, and the decision came after that. Maybe it was a natural frugality from a government that has relied heavily on federal dollars throughout, and whose premier has said he hates the idea of raising taxes.
“Nothing is more important than protecting the health and well-being of Ontarians,” said a government spokesperson, to questions of why the province delayed in committing to funding. “That’s why our government released our comprehensive $2.8 billion Keeping Ontarians Safe: Preparing for Future Waves of COVID-19 plan.
“To be clear, we have been preparing for a second wave since the beginning of summer.”...
. The Star article spelled out the physical side of things.