Public health agencies across Canada — including Ontario, Alberta and British Columbia — are shifting their COVID-19 testing to sick health-care and other frontline workers who are more likely to have come into contact with the virus, and people with severe symptoms who are hospitalized.

The message to everyone else with mild symptoms is they will likely not be tested. Stay at home, get better and keep away from other people. If your symptoms get dramatically worse — chest pain, shortness of breath, extreme lethargy — then it’s time to go to emergency.

In Toronto, Canada’s largest city, the new protocol was put in place last Friday. Doctors say that is the case across Ontario, though officials with the provincial health ministry would not confirm the new protocol Monday.

People who do not fit the protocol and are turned away by testing centres have complained to public health officials (and the media) about the fairness of the system.

Infectious disease specialist Dr. Michael Gardam (who is also chief-of-staff at Humber River Hospital) agrees with the protocol. He is a veteran of other outbreaks in Canada, including SARS (2002-04).

“Ontario has clearly adopted a strategy of, if we socially distance everybody, and if we isolate everyone who has travelled and we isolate people who have symptoms then a lot of those people don’t need to be tested because they are going to be off the grid anyway and hopefully they won’t transmit to anybody,” Gardam told the Star.

As for the testing of health-care workers (at least 26 have the virus in Ontario as of Monday including 13 in Toronto) Gardam says there is a very good reason for that being a priority.

“Testing the health-care workers makes sense not because we are so special,” says Gardam. “We are testing the health-care workers because we need to make sure we have capacity in the health-care system to care for the public.” If a health-care worker with symptoms tests negative, they can get back on the job that much more quickly, Gardam said.

Among the provinces publicly acknowledging this new protocol are Alberta and British Columbia, both provinces that, like Ontario, have had a high number of cases. Quebec officials said their strategy could change, but for now they are “prioritizing tests for people returning from travel.”

On Monday, the Alberta government announced it was falling in line with the new protocol that minimizes tests for members of the general public with mild symptoms. They will prioritize the following individuals: people hospitalized with respiratory illness; health-care workers with respiratory symptoms; residents of long-term-care homes; and people returning from travelling abroad between March 8 and March 12, before self-isolation protocols were in place.

“Anyone with symptoms who does not fit any of these categories should stay home and self-isolate for a minimum of 10 days from the start of their symptoms, or until symptoms resolve, whichever is longer,” said a release from the Alberta health ministry.

British Columbia’s Centre For Disease Control has come out with a similar directive for testing — patients sick in hospital suspected of having the disease; health-care workers, residents of long-term-care facilities and those who are “part of an investigation of a cluster or outbreak.”

Others with mild symptoms, or returning travellers are to be “managed at home,” the B.C. centre said in its release.

Dr. Bonnie Henry, B.C.’s Provincial Health Officer, said Monday in her daily briefing that it is “incredibly important” people take social distancing seriously. She also sounded a warning about health-care workers, backing up the need to test those on the frontlines.

“We know that people in the community are transmitting it to each other and that is leading to the outbreaks we have been seeing in long-term-care homes, in hospitals,” said Henry. “It means that health-care workers are getting infected. They’re getting infected in the community and then bringing it into work, in some cases, or transmitting it between each other and between their families.”

And in Ontario, where the Star has looked at the past 15 days of testing data, the percentage growth of positive tests (out of total tests completed) continues, a possible sign health officials are increasing tests on people more likely to be sick, due to previous contacts they have had and other factors.

Infectious disease specialist Dr. Gardam said “those numbers are driven by our testing capacity and who we are actually swabbing for (COVID-19).”

As of Monday, 2.5 per cent of all completed tests in Ontario were positive, confirming the person had the virus. That percentage has been steadily creeping up over the past 15 days.

But Dr. Gardam sounded a cautionary note: “We know that the numbers we are reporting are not the real numbers.”

He and other disease experts estimate the actual number of cases in Canada is as many as 10 to 50 times the reported number because so many people, due to the protocol and lack of testing capacity in the system, are not being tested.

As of Monday evening, there were 2,055 confirmed cases in Canada, with 24 deaths. The hardest hit provinces are Quebec (628), Ontario (503), B.C. (472) and Alberta (301).

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To prevent an exponential spread of the disease, Dr. Gardam said people must do everything they can not to spread it further in the community.

“I think that strategy does make sense. If people have mild symptoms, and there is no treatment for this, then your number one priority is to have that person not spread to someone else. That’s where the isolation comes in. Whether you test them positive or not you are still going to isolate them.”

Compared to SARS, which was primarily a disease passed on in hospitals, COVID-19 moves through the community. It also has a longer incubation period, and people can “shed” the virus to others in the incubation stage before symptoms show, during symptoms and after. Dr. Gardam said it could last as long as four weeks in some people.

“Everything with this coronavirus is longer. The incubation period is longer. How long you are sick for is a bit longer. How long you shed the virus is longer as well,” said Dr. Gardam.

Governments in Canada are encouraging the public to use an online testing link to see if their symptoms match the virus. The federal government recently released one, available at https://ca.thrive.health/covid19/en.

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