Is B.C.’s approach to testing people for COVID-19 hurting the effort to fight the pandemic?

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Provincial health officer Dr. Bonnie Henry says no.

But critics like Peter Phillips, the head of the infectious diseases division of the UBC School of Medicine, argue a much larger testing program is needed.

The province has completed tests on 44,639 people in its so far successful effort to slow the spread of the virus. About 2.4 per cent — 1,066 people — have tested positive. Only Saskatchewan and Alberta have conducted more tests on a per-capita basis.

Henry says B.C.’s focused testing approach is effective in identifying and responding to cases.

“We’re focusing on those most likely to have this disease and those most likely to need health care or hospital care,” she told reporters this week. That includes health-care workers and people with symptoms in high-risk environments, like seniors’ homes.

Health officials can then trace the contacts of people who test positive. “We’re talking with people who have this, who have mild enough illness that they’re able to stay at home. And for the most part, that is working.”

The B.C. approach is based, in part, on the premise that everyone should assume COVID-19 is present in their communities and practise social distancing. Anyone with any symptoms of illness should stay home, officials say.

B.C. is also doing “surveillance testing,” Henry said, to understand rates in communities.

“We’ve been doing that from the beginning,” she said. “It’s how we picked up some of our first community cases.” People being tested for flu or other respiratory viruses are automatically tested for COVID-19 as well.

“We’re still doing those tests as well,” Henry said. “They have occasionally come up positive, and that leads to an investigation in that area.”

Amid reports of a global shortage of chemicals needed for the tests, B.C. is doing about 3,000 tests a day at health authority labs and through LifeLabs, a private company that has long conducted tests for the provincial health-care system.

B.C.’s testing rate is 8,753 per million population, according to Virihealth, a website tracking the virus in Canada. That’s behind Alberta and Saskatchewan, but 25 per cent above the 6,978 average for all provinces, and more than twice the Ontario rate. (Testing rates are much higher in the northern territories.)

Henry said this week that even if shortages of testing materials weren’t an issue, the province would be taking the same approach.

“We still would not be testing everybody who has very mild illness for a variety of reasons,” she said. “Not only because of capacity, because it’s a waste of resources for a lot of people, but also because we know this test is not 100 per cent. Early on, and when people have very mild symptoms, it can be falsely negative.”

That could result in people failing to self-isolate in the false belief they don’t have the virus.

Testing “doesn’t change what we’re going to tell people,” Henry said.

“We need to tell them on a population level, anybody who’s sick, especially if you have a fever and a cough, you need to stay away from others no matter what, whether you have COVID or anything else.”

The same is true for people coming in from other countries, Henry said. In the early days of the pandemic, travellers returning to the province from places known to have outbreaks were a priority for testing. Now they are being told to self-isolate for 14 days.

“They need to know, and we’ve talked about this, they need to know that they’re at risk of this, and they need to stay home and isolate themselves so they’re not passing it onto anybody else. That’s their obligation right now.”

Much of the outbreak in B.C., especially in Vancouver and the Lower Mainland, has been focused in long-term care homes, so much of the province’s attention and testing has been concentrated there.

“At this point in our epidemic, the important thing is identifying those chains of transmission and where people are getting sick,” Henry said. “That’s why the focus is on the health-care system, on health-care workers. But also community transmission.”

Testing is warranted in places where clusters have been identified and people have been exposed and may or may not have symptoms, she said.

“But a broad testing of well people in our community, right now, is not what we’re going to be doing.”

Henry has said the level of testing in B.C. is higher than many other jurisdictions and comparable to the strategies used in Singapore and South Korea.

Widespread testing has been credited with helping slow COVID-19’s spread in countries like Singapore, South Korea, Hong Kong and Taiwan. A lack of testing has been an issue in virus hot spots like Northern Italy, Iran and New York.

The World Health Organization has said testing is one of the most important tools for authorities to accurately track the spread of the virus. “The most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate,” said WHO chief Tedros Adhanom Ghebreyesus.

There are critics of the B.C. approach.

UBC’s Phillips argued in an email to The Tyee’s Crawford Killian that B.C.’s restrictive testing policy “undermines the ability of public health to be successful in containing further spread in the community.” Widespread community testing would let health officials identify people with the virus and their contacts and ensure they stayed in isolation, Phillips argued.

COVID-19 Will Stretch, But Not Break, BC’s Health System read more

And an emergency room doctor at Royal Columbian Hospital in New Westminster, Sean Wormsbecker, posted a video on YouTube calling for wider testing, including of people with mild symptoms.

Telling people they should presume they’re sick and self-isolate for 14 days isn’t enough, he said.

“Ten years of clinical practice have taught me that unfortunately patients aren't consistent in following direction,” he said. “Often what’s heard, no matter how we say it, is that if we’re not testing you, we’re not really taking you seriously, and that’s not the case.”

Alan Cassels, the author of Seeking Sickness: Medical Screening and the Misguided Hunt for Disease, said the key question with testing is whether or not the results will make any difference to treatment or behaviour.

“If the answer is ‘no,’ you don’t test,” Cassels said, adding that while individuals might want to know if they’re infected, it’s better to follow physical distancing advice than to trust a test that is unlikely to be 100-per-cent accurate.

The province’s modelling released last week showed that while the number of cases had been rising by 24 per cent a day in the early weeks of the outbreak, that was reduced to 12 per cent a day after the introduction of strict physical distancing measures.

On Thursday the province announced 55 new COVID-19 cases in B.C., bringing the total number of cases in the province to 1,121, about a 5.2-per-cent increase from a day earlier.

Henry has expressed cautious optimism about the trajectory in B.C., but stresses that continued success depends on everyone doing what they can to keep a physical distance of at least two metres from others in public and to stay home when they’re sick.

“It’s challenging for all of us to not know what’s coming in the future, particularly when we hear about shortages and we watch what’s going on in the world around us,” she said. “We can only continue to watch, continue to prepare, continue to make sure that we’re doing everything we can, and to ensure that the rest of our community is doing their part too.”

“I know it’s challenging to say it over and over again, but we do have a strategy that’s based on the best use of the test, with all of the limitations the test has itself.”