Canada Shows How Easy Virus Testing Can Be
Canadians’ well-funded system and careful planning has contained the coronavirus for now.
In 2018, representatives from the U.S. Cabinet and both parties in Congress, as well as the head of the Centers for Disease Control and Prevention (CDC) and a host of others, convened to discuss a response to a new influenza that had sprung up abroad. As the virus landed in America, infecting thousands, those at the table struggled to keep up.
Luckily, it was all an exercise, conjured up by the Johns Hopkins Bloomberg School of Public Health. Those around the table—representatives from academia, government, and elsewhere—were simply gaming out pandemic reactions. “Public health at the local, state, and federal levels has been diminished by years of budgets that are too small for the mission,” reads the report on the study. “To respond effectively to a pandemic, there needs to be a well-trained, agile, and strong public health workforce.”
The virus was made up but the lessons learned around the table were prescient as the COVID-19 virus currently spreads around the world.
Since a significant number of cases began appearing in late February, America has been critically slow to track new transmissions, laboratories have been hampered in their efforts to test patients, and the president has worked to downplay the reach of the virus. President Donald Trump called a press conference in the Rose Garden on Friday afternoon to tout his government’s response to the crisis, and to underline his effort to expand access to testing.
As of Thursday, the CDC reported that the United States has tested a little more than 13,000 specimens — there can be multiple specimens per patient, and patients can be tested multiple times. (There have been more than 1,800 confirmed cases of COVID-19 in America.)
It dwarfs the number of tests administered in other countries, such as South Korea, where local health authorities have made testing widely available; as of Friday, Seoul reported that it had conducted more than 200,000 tests. Nearly 8,000 people have tested positive in that country.
America’s modest testing statistics look particularly weak compared to its neighbor to the north.
Canada spent January and February putting together testing and monitoring infrastructure—efforts that look a lot like the model laid out at the Johns Hopkins table. By catching cases early, and investigating their origins, Canada has blunted the impact of the virus thus far.
In Canada, provincial and federal health authorities have managed to test roughly 15,000 patients across the country. Nationally, Canada has seen just 157 confirmed cases—the majority of which were imported from other countries. There have been very few known instances of human-to-human transmission inside Canada so far, in part because those who caught the virus have either been placed in quarantine or self-isolated quickly.
Canada has spent the past two decades preparing for this moment.
In 2003, after Canada was hammered by the SARS virus—a cousin of COVID-19—a report on Canada’s response found that “the SARS experience illustrated that Canada is not adequately prepared to deal with a true pandemic.” Ontario, specifically, “could not have withstood two simultaneous large-scale outbreaks or crises such as SARS.” Other provinces, it found, were no better off—and the federal government’s capacity to help out was low.
So Canada set out to improve its own testing capacity; the Public Health Agency of Canada even held its own tabletop exercise to prepare for an influenza pandemic. Provincial laboratories put the infrastructure in place that would allow them to run their own testing and validation without help from the federal government. At the same time, the federally run National Microbiology Laboratory (NML) in Winnipeg expanded its own capacity to support those efforts.
When COVID-19 hit this winter, the NML began accepting tests from labs across the country—which comes with a built-in lag time, as samples need to be sent by mail or courier. By mid-February, though, British Columbia and Ontario, which saw the entirety of the early cases, scaled up their own labs to both test patients locally and validate their own results. More recently, Quebec and Alberta have joined them.
“In Ontario, confirmation of positives by NML was dropped a few weeks ago,” said Krista Urchenko, a medical laboratory technologist in Ontario.
The Winnipeg lab continued to support other testing efforts. When an airplane landed from Japan, carrying passengers who had recently been on the Diamond Princess cruise ship, the NML set up a mobile lab onsite to monitor anyone experiencing symptoms.
Contrast that with the United States: Up until the final days of February, as dozens of cases cropped up across the country, all tests ran directly through the CDC in Atlanta, Georgia.
“To my understanding, original FDA policy was not allowing local high-complexity labs to do testing until very recently,” said Andrea Prinzi, a clinical microbiologist. “Everything was being sent to CDC if testing was done.”
Even as local hospitals and clinics began testing patients in America, capacity remained low. The American Enterprise Institute compiles daily updates on how many patients various facilities can handle. On March 9, it estimated that the various testing sites across the country could handle no more than 8,000 patients per day—this, days after Vice President Mike Pence promised that 1 million testing kits would be distributed across the country. By Friday, the daily capacity grew to just over 25,000 patients tested per day.
Underfunding remains a core component of the failure. The Association of Public Health Laboratories, whose members are on the front line of local testing, wrote earlier this year that, despite a modest CDC budget increase, it is experiencing “a worrying, long-term trend of public health underfunding.” It identified a $4.5 billion gap between its budget and what is needed to provide adequate public health services.
“When that money goes away, if the samples are still coming to us, we’re going to have to figure something out,” said Grace Kubin, who heads the Texas Department of State Health Services, in a report published by the association. “Or else we’ll just test fewer samples.”
Guidelines, too, hampered testing. From the outset, Canada and America set out criteria for who could be tested—namely, those who had traveled to a country with a large number of COVID-19 cases or came into contact with someone who had. But the Canadian guidelines read that those who “do not fit case definition, but are considered at risk of COVID-19 by the assessing clinician will also be accepted for testing.” U.S. guidelines did not. Hundreds of Americans took to Twitter to lament that they could not get tested, despite showing the symptoms of COVID-19.
Jacob Mirsky, a physician at Massachusetts General Hospital, tweeted how the restrictions are still limiting the ability to be tested as of Friday.
“I spoke to a patient of mine this morning. She was seen in the clinic 10 days ago. She is elderly, has [chronic obstructive pulmonary disease], uses oxygen 24/7. Her flu swab was negative but she was diagnosed with pneumonia. I am in disbelief that I cannot test her, even today, because she doesn’t meet criteria.”
National Nurses United, a union representing registered nurses across the United States, reported that its members were being denied testing, even after coming into contact with COVID-19.
“I have to wait in line to find out the results,” one nurse reported in a letter to the union. “This is not the ticket dispenser at the deli counter; it’s a public health emergency! I am a registered nurse, and I need to know if I am positive before going back to caring for patients.”
Even as the government relaxed requirements for those criteria, letting doctors decide who qualifies for the test, Trump reiterated that: “We don’t want everyone taking this test, it’s totally unnecessary.”
There has been scrambling to address the testing shortfalls. On Friday, the Food and Drug Administration (FDA) fast-tracked a new testing device from Swiss health care giant Roche Holding AG. “We are increasing the speed definitely by a factor of 10,” a representative of the company told Bloomberg News.
But that test, which runs on Roche’s cobas 6800/8800 systems, might not fix the capacity issues on the local level.
“It’s an automated analyzer, so it would definitely increase testing frequency,” Urchenko said. The drawback, however, is that cobas is a closed system, meaning, as Urchenko put it, “you’re at the mercy of whatever Roche decides to put in their reagents.” While it would increase capacity at CDC headquarters, local labs that have the devices would need to rely on the company for the specific chemicals needed to make the analyzer work. The current standard, the one being used by Canada and elsewhere, allows labs to source those chemicals from anywhere.
The acute problem of testing even prompted billionaire Jack Ma, the founder of online retail giant Alibaba, to offer the donation of 500,000 testing kits to the U.S. government.
Some areas of the country are stepping up faster. In New Rochelle, New York, which has seen an explosion in cases, Gov. Andrew Cuomo opened a drive-through testing center, which is expected to test 500 residents per day in the coming week.
At a congressional hearing Thursday on COVID-19, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, summarized the situation: “The idea of anybody getting [tested] easily the way that people in other countries are doing it—we’re not set up for that. Do I think we should be? Yes. But we’re not.”