The entrance to St. Michael's Hospital on Queen Street is plastered with COVID-19 Assessment Centre signage as a security guard stands out front and a nurse pokes her head out the door to talk to a man asking a question. Kelsey Wilson/Toronto Star

Canada is missing data it will likely need to know when deciding if current COVID-19 stymying measures can be relaxed, experts say — with one researcher at Wilfred Laurier University claiming that policy-makers could soon be “flying blind.”

“Countries like Germany … they’re testing enough people that you can actually infer something from those results,” WLU associate professor Mark Humphries, whose research has examined the politics of public health related to the 1918 influenza pandemic, told iPolitics in an interview this week.

“Without that (broad) information, you’re essentially flying blind. That’s my real fear about the numbers in Canada. We don’t know if the numbers are too high. We don’t know if they’re too low, because the data’s not good. And that’s a real problem,” he said.

EXPLAINER: Why Canada’s COVID-19 data is not yet showing the full picture

Testing has varied across the country since the COVID-19 pandemic hit Canada, and as of Tuesday, struggles ramping up testing in Ontario were still evident in the national epidemiological summary — showing that the most populous province had conducted the second least number of COVID-19 tests per million people, at 7,908 tests per million. (The only jurisdiction with a lower listed figure was Nunavut, the territory that as of Tuesday had zero probable or confirmed cases of the disease.)

Ontario’s most recent online data update on Wednesday morning showed that, since Tuesday, 6,010 more tests had been conducted. On Tuesday, 4,429 cases were considered ‘under investigation’ for COVID-19 — denoting test results that hadn’t yet come back — up from the 2,107 cases listed on Tuesday. The provincial PC government, which announced a COVID-19 testing strategy last week, had expressed an expectation that they’d be processing 8,000 tests per day by today, then 14,000 per day by April 29.

(A footnote beneath the daily Ontario data was also altered from this Tuesday to Wednesday, with testing numbers going from representing “all persons with tests performed”— with a note that a minimum of two specimens were recommended for hospitalized individuals — to total tests, rather than persons tested.)

The current testing regime in the province identifies ‘priority groups,’ including hospital inpatients; long-term care and retirement home residents; healthcare workers; remote, isolated, rural and Indigenous communities; congregate living centres; vulnerable individuals and designated essential workers.

Humphries pointed to problems within that kind of testing strategy, arguing that it hindered policy-makers’ view of what the global pandemic looks like in Canada’s population at large. “If you want to try and project, what’s it going to be like in Canada in six weeks, where are we going to be at? You can’t use that data to do that, because it doesn’t tell you anything about the population in general, it tells you about very specific subsets of the population — that are not random and are not representative,” he claimed.

As of Tuesday’s national update, Ontario had conducted fewer tests than Quebec without even accounting for population differences — conducting 115,189 tests to Quebec’s 137,451. Statistics Canada’s latest data puts Quebec’s population in 2020 at 8,537,674, just over half of Ontario’s 14,711,827.

Some experts — like Ben Bolker, a mathematical biologist and epidemic modeller at McMaster University — say the current data still gives a “reasonably good idea” of the degree to which the curve is being bent, given that it makes apparent to policy-makers the number of patients in need of hospital or intensive care. But Bolker, too, said governments would likely need more data to decide when it will be safe to begin lifting distancing measures.

“Re-opening is either going to depend on a lot of guesses, or a lot of information that we don’t really have right now,” Bolker said, voicing a need for broader testing and also serological tests, which check samples of blood serum for antibodies. “There are some strategies for opening that we can do with the data we have. But more data would make those strategies a lot more robust and a lot more reliable.”

READ MORE: Only 10% of Ontario households reporting key COVID-19 symptoms have been tested: poll

Currently, the federal government says it’s reviewing devices using serological technology, but notes that the World Health Organization hasn’t recommended them for clinical diagnoses. “Serological tests do not detect the virus itself. Instead, they detect the antibodies produced in response to an infection. It can take time (days to weeks) after an initial infection for antibodies to be produced. Antibodies also remain present for variable amounts of time after a viral infection is over. Research into serological testing is ongoing within Canada and worldwide,” the government says.

Humphries also voiced support for serological testing, saying that such tests could reveal individuals who might have already contracted the virus and since recovered, which could be used to assess the timing of relaxing COVID-19 measures. He expressed a worry that Canada will lag behind other countries in introducing serological tests, as it focuses on ramping up existing tests.

“If Ontario is projecting, for example, that they want to have 16,000 (existing) tests a day by the beginning of May, by the beginning of May many countries will already be doing serological testing and places like France, if we are to believe what (French President Emmanuel) Macron said the other day, will already be reducing their lockdowns,” Humphries said. Macron, per reporting from Politico, has expressed a desire to begin lifting restrictions after May 11, including the re-opening of schools.

“If other countries are in a position to reduce their lockdowns, and begin to lift restrictions and we are still trying to figure out testing in a month, that begins to paint a really grim picture for how Canada reintegrates itself into a global economy,” Humphries claimed. He also noted the impacts of a longer lockdown on other matters, like people with possibly serious medical situations eschewing ER visits due to fear of contracting the virus, and the repercussions of closed schools on child development.

But other experts are wary of painting serological testing as the gold standard. Susan Bondy, an epidemiologist with the University of Toronto’s Dalla Lana School of Public Health, noted that there were still questions about COVID-19’s virology that had yet to be answered — like the degree to which patients produce antibodies from it, and how effective they are in preventing recurring cases.

“The basic science on the serological test development is so novel, it’s so new, I don’t think we know enough about it to say what people should be manufacturing right now,” Bondy said this week. “I’m glad I’m not a politician,” she later quipped, expressing sympathy for Canada’s policy-makers amid the current crisis.

The eventual decisions that will need to be made about lifting restrictions wouldn’t be a matter of “green light, red light,” Bondy predicted. It would be a matter of incremental steps instead, and managing risk so that it stayed low while restarting economic activity. She agreed with Humphries that the data Canadian jurisdictions currently had about the virus’ spread was from a non-random and non-representative subset of the population.

But while she conceded that random testing or lowered thresholds for testing in Canada could be useful to paint a clearer picture — including testing for antibodies, once confidence was assured in those tests’ reliability — she questioned the “cost-benefit” of testing individuals who, for example, were staying home alone.

“You want to catch the canary that’s anywhere near a vulnerable population, so possibly instead of first going to simple random sampling of the underlying population — which is something you should do later — if you have a limited capacity to test, I would say put moats around highly-vulnerable communities like nursing homes, northern communities,” Bondy said. “You want to find what isn’t seen yet that could possibly create a lot of harm. And that’s not necessarily a random process, it’s a strategic process … looking where, if we’re missing it, it would be catastrophic.”

(Canada’s top public health officer, Theresa Tam, has said that — as of Monday midday — close to half of the country’s COVID-19 deaths were in long-term care, as reported by the Toronto Star.)

Some organizations, like Statistics Canada and polling firms like Forum Research and Mainstreet Research, have been attempting to fill some gaps in data about COVID-19 in the broader population through surveys. Forum and Mainstreet’s survey, as reported by iPolitics today, canvassed Ontario households to see how many included individuals showing possible COVID-19 symptoms. StatsCan, meanwhile, has probed at issues like anxiety related to the novel virus, and fear of violence in Canadian homes.

Bondy pointed to the work of Statistics Canada as a possible aid to existing data. “It’s increasingly looking for unreported disease, and things like that to see if there are other signals,” she said.

Humphries cautioned that the issues with testing were based on issues that pre-dated COVID-19, or any particular administration. “This isn’t a creation of one government or one missed opportunity today, it’s a result of a lack of investment in this type of capacity over time. And it’s not unique to Canada,” he noted.

Bondy told iPolitics that, for now, “the most crude metrics” are currently the ones being used to set public policy — namely, data like death counts and intensive care capacity. “The more subtle stuff becomes more important in time,” she said. In the absence of broader data, Bolker said there were possible workarounds, like a test-and-see approach where some services are re-opened, then case numbers are watched closely for any substantial spikes, and policy is adjusted. “You can do it by the seat of your pants and essentially open things and see what happens, and hope you can see the increasing curve in time to do something about it,” he said.

“But broad-based testing seems like a no-brainer — because there are plenty of logistical and technical and financial obstacles, but the cost of doing it? It will buy us way more than it will cost.”