Provinces start offering in-home testing for novel coronavirus

Theglobeandmail.com
March 11, 2020
Kelly Grant

Canada now has nearly 100 cases of the novel coronavirus and provinces are planning to offer more in-home testing as they try to prevent patients with mild symptoms from overloading the country’s emergency departments.

COVID-19 cases continue to increase, with 15 new cases reported across Canada on Tuesday. Those include two new cases in British Columbia that have no clear link to the source of the disease and indicate exposure within the community.

B.C. and Alberta are already testing patients for the novel coronavirus at home. In Toronto, public-health nurses have been providing limited “clearance” testing in the private residences of patients diagnosed with COVID-19, the disease caused by the new virus, to see whether they’ve recovered.

But in-home coronavirus testing is poised to expand now that Canada’s most populous province intends to offer it more widely.

Ontario’s Ministry of Health sent a memo to health-care organizations on Monday laying out some principles for containing the coronavirus, including making, “services and access to screening more accessible to patients in their homes, to reduce the spread of illness.”

Travis Kann, a spokesman for Ontario Health Minister Christine Elliott, said the in-home testing plan, which is in its early stages, is designed to complement out-of-hospital coronavirus assessment centres to “ease the pressure on hospitals and emergency rooms.”

In parts of Alberta where call volumes are lower, paramedics or public-health nurses conduct tests in people’s homes so they don’t have to visit hospitals or clinics, potentially putting other patients or health-care workers at risk, Alberta’s Chief Medical Health Officer Deena Hinshaw said Tuesday.

Edmonton and Calgary, which have higher call volumes, have set up assessment centres where people can go for testing.

Some B.C. health authorities have also dispatched public-health teams to test the close contacts of confirmed cases in their homes.

Governments and public-health officials have grown increasingly concerned that hospitals won’t have the staff, beds or equipment to care for thousands of patients if the virus sweeps across Canada the way it has across Italy, site of the deadliest outbreak outside of China.

Air Canada announced Tuesday that it was suspending flights between Canada and Italy.

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Canada’s 15 new cases reported Tuesday comprise seven each in B.C. and Alberta and one in Ontario, bringing the total recorded since January to 94.

In B.C., that included two men in the Fraser Health region – one in his 90s, and one in his 40s – who contracted the disease despite having no recent travel history and no clear links to other cases.

“It is these community cases that give us some degree of concern,” Provincial Health Officer Bonnie Henry said Tuesday. “But being able to detect them is really important, because as soon as we detect them, we can start that detailed investigation to find out where they might have come in contact. This helps us uncover where other chains of transmission are in our community.”

The new B.C. cases also include a man in his 90s who had been a passenger on the Grand Princess cruise ship, and two more health-care workers at the Lynn Valley Care Centre in North Vancouver, where an outbreak was declared last weekend and the country’s only COVID-19 death was recorded.

B.C. Health Minister Adrian Dix said the province has opened a new call centre to accommodate calls to the 811 health information line, which have recently tripled to about 3,800 calls a week.

Testing for the new coronavirus has ramped up significantly in the past week, especially in Ontario, B.C. and Alberta, where most of Canada’s cases have been discovered.

The provinces have moved beyond testing only patients who have travelled to conducting what’s known as sentinel surveillance, largely by adding COVID-19 testing to existing influenza screening programs.

Ontario had tested 2,747 patients as of Tuesday, while Alberta had conducted tests in 1,452 cases as of Monday. B.C. had tested 2,008 people as of Friday.

“I definitely think there could be a role for home testing,” said Jerome Leis, medical director of infection prevention and control at Sunnybrook Health Sciences Centre in Toronto.

Dr. Leis also said that virtual screening and off-site coronavirus assessment centres would be necessary to preserve hospital space for the seriously ill, and to help prevent sick patients from spreading the virus to others.

Dr. Leis was one of the co-authors of a study published in the Canadian Medical Association Journal on Friday that found the vast majority of 135 patients tested for the new coronavirus in the emergency departments of eight hospitals in the Greater Toronto Area between Jan. 20 and Feb. 19 were well enough to be sent home right away.

Only one tested positive for COVID-19.

“If [the emergency department] was our only system for caring for these patients, we could rapidly be in a very non-sustainable and frankly, unsafe, situation,” Dr. Leis said.

Toronto Public Health has already performed a limited number of at-home tests for patients who have tested positive for the new virus.

Public-health officials do not consider patients to have recovered from COVID-19 until they have tested negative twice; trained tuberculosis nurses have visited patients at home to collect nasal and throat swabs for clearance testing. Tuberculosis nurses are trained to safely put on and take off protective equipment as they care for patients with highly contagious diseases.

Adrian Sebastian, a registered nurse and manager at Toronto Public Health, said the priorities during home testing are protecting the nurses performing the swabs – all of whom are outfitted in full protective equipment – and safeguarding the privacy of patients.

“The worst thing would be ... someone sees you donning and doffing in the hallway and thinks, ‘Oh my gosh, what’s going on here?’ They hear the news that there’s coronavirus. It’s just going to cause a panic in that building,” Mr. Sebastian said.

Mr. Sebastian was on-site supervising another nurse during the at-home testing of Canada’s second confirmed coronavirus patient, a woman who flew home from China with her husband in January. He was the first patient to be diagnosed with the virus in Canada.

Fortunately, Mr. Sebastian said, the couple had a garage they hadn’t entered since returning home.

“We got them to open their garage, we went into their garage, prepped in the garage and we did our business," he said.