Ontario is testing for coronavirus at a rate less than half that of the other big provinces, leaving thousands of potentially undiagnosed cases out of official statistics and instilling a false sense of confidence as the province enters a key period for flattening the curve of infection.

While Ontario appears to be well back from Quebec in terms of overall number of infections, Quebec has tested far more people and likely has a far more accurate picture of the current spread of the virus.

“This is definitely something that Ontario needs to get a handle on,” said Todd Coleman, epidemiologist and assistant professor in health sciences at Wilfrid Laurier University. “If we’re seeing (testing) at a much higher level in other provinces, then this means that there’s a bunch of people who have lesser symptoms or are asymptomatic are walking around and transmission can keep happening.”

As of publication time Monday, Ontario has tested 48,461 people for the COVID-19 virus, while Quebec has tested 65,915 and British Columbia 38,697. But when measured proportionally, because Ontario has a bigger population, it has tested only 333 people per 100,000, while Quebec has tested 777 and B.C. 757. Alberta has tested more than 1,000 people per 100,000.

Even as tests are ramping up, it could take a week or longer before Ontario has a realistic idea of where it is on the epidemiological outbreak curve and how much longer the economic shutdown and physical distancing measures will have to last, experts said.

“One of the pillars of managing an epidemic is to have diagnostic testing,” said Dr. Isaac Bogoch, an infectious disease expert at the Toronto General Hospital Research Institute. “It's very challenging to manage this if you're working in the dark.”

While Ontario appears to be catching up on its large backlog of tests without results — with provincial health authorities reporting Monday that it was down to 5,651 from nearly 11,000 last Thursday — infectious disease experts say there is not nearly enough testing to get an accurate picture of the spread of COVID-19.

The province has said it is working with labs in hospitals, as well as academic and private settings to clear the backlog. As of Friday, the province was completing an average of about 2,400 tests per day.

Speaking to reporters Monday, Dr. Barbara Yaffe, Ontario’s associate medical officer of health, said about 4,000 tests were completed in the last 24 hours. The province is aiming to reach a capacity of around 19,000 tests per day by mid-April, she said.

“We’ve heard about this backlog in diagnostic tests and we’ve heard about how they’re resolving this backlog. But still, at the end of the day, there is a backlog of diagnostic tests and we’re not testing as many people as we should,” said Bogoch.

Two weeks ago, Quebec was performing between 1,000 and 2,000 tests a day. But by last week, they were able to take swabs from more than 15,000 people in a single day, according to the Quebec provincial health institute.

The province accomplished this not only by dramatically increasing its testing capacity, opening 64 testing clinics across the province, but also by allowing major hospital labs to process their own test results, said Marie-Claude Lacasse, spokesperson for the provincial health ministry. Quebec can now obtain 6,000 test results per day.

“It’s amazing, Quebec has totally turned the corner,” said Bogoch.

While the jump in the number of tests performed in Quebec was accompanied by a jump in confirmed cases as well, this shouldn’t be seen as a sign that the virus is rapidly spreading. Instead, Bogoch said it’s a reflection of the province finally getting a more accurate picture of the current state of infection — something Ontario has yet to do.

“If you test, you find it. So, it’s no surprise, and the same thing is going to happen to Ontario. We should not be alarmed when Ontario does ramp up testing, because we will see more cases.

“Many key decisions hinge on having accurate data from diagnostic testing...Once we have a better understanding of the number of new cases per day, we will know how we’re doing on that epidemic curve.”

Meanwhile, in B.C., where testing for the virus has been done at a rate more than twice that of Ontario, officials are hopeful that the infection curve is flattening — that is, the number of new cases isn’t growing as quickly as projected by provincial health officials without social distancing.

“It’s beginning to work,” said Prime Minister Justin Trudeau on Saturday. “We see promising news out of B.C.”

The province has 970 confirmed cases, but that number hasn’t been growing as quickly as it has in Quebec and Ontario. B.C., which recorded the first case of community transmission in Canada on March 5, has employed a testing strategy that prioritizes patients and people with suppressed immune systems over the general population.

B.C.’s health officer Dr. Bonnie Henry said over the weekend that her province will consider people recovered from COVID-19 if they had a mild form of the disease and are symptom-free for 10 days; they will not need two further tests showing a negative result, a procedure reserved for more vulnerable patients in hospital or those with compromised immune systems. (Ontario has a similar policy). British Columbia leads Canada with the largest number of people who have recovered from the virus — 469 as of Monday.

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On Monday, Henry stressed that the province is at a critical juncture where either hospitals will see a “continuing trickle” or “dramatic increases” of cases after saying late last week that the infection curve in B.C. is bending in the right direction.

“We are not through the storm yet. We have not yet reached our peak,” Henry said Monday. “We have more people everyday who are in hospital and in our intensive care units, so we need to continue to do all we can across government, across our health system and in our community. Every person needs to do their bit.”

While limiting the spread of the virus is largely accomplished through physical distancing and keeping as many people at home as possible, there’s no way to tell if these measures are working without sufficient testing.

“I can’t say it is working yet. It may be working, and it is incredibly important, and the modellers have shown us that if we do this right, it is what is going to save us. It’s going to save our healthcare system, it’s going to save our communities,” Henry said Friday.

While Ontario remains behind B.C. and Quebec, Toronto General Hospital’s Bogoch is confident the province is moving quickly to ramp up testing.

“I firmly believe that there will be a quick turnaround and we will see the rapid deployment of diagnostic tests in Ontario. I know there are goals of 5,000 tests per day and scaling that up in the days and weeks ahead,” Bogoch said.