10 signatures reached
To: MPs and MPPs
Expand COVID-19 testing to save lives
Please help relax regulations so that under a state of emergency, research labs can perform COVID-19 testing under the full supervision and control of public testing labs, with all required quality assurance and privacy protection measures. Normally this red tape is important. Right now it is blocking our ability to respond quickly:
An open letter to the Ontario Minister of Health:
Dear Ms Elliott,
We are a group of concerned Canadians regarding the outbreak of SARS COV2. As we are not the first and only country to be facing this challenge, we believe there is much to learn from experiences across the globe.
In evaluating the resources that become limited early on in a country’s battle with this virus, it is clear that beyond healthcare workers there are three major concerns:
1. Testing – this is the first resource to become limited. There are critical
examples in South Korea, Hong Kong, and Taiwan whose testing capabilities have limited the spread of disease despite early exposures [1, 2].
2. Personal protective equipment (PPE)– while this is not a major focus of our purpose, wartime levels of production of these are critical. In Italy, the limits of PPE supply leads to patients not having visitors, and exclusion of
healthcare professionals from caring for patients [3]
3. Ventilators – certainly, the triage of ventilators has been well covered in the news in Italy.
Regarding testing, experience from Italy suggests that “were they to do this again”, increasing testing capabilities would be their first priority [4]. We are already seeing the limits of our testing capacity in Ontario and British Columbia, as patients are only being tested should a result change their in-hospital management.
Unfortunately, this capacity is unacceptable. Considering that SARS COV2 has asymptomatic transmission, limiting testing to this population prevents us from gaining adequate control in the community [5]. We need testing capacity to investigate those at increased risk of infection with SARS COV2, not just those with a presentation of COVID 19.
In South Korea, innovative approaches to testing facilities has allowed the mapping of disease spread to control and limit the effects of an early outbreak [2]. This was replicated in a small community in Italy, where they have stopped the spread of COVID 19 despite the burden of disease in neighboring cities [6]. In Hong Kong, best practice guidelines are followed such that patients who test positive are not discharged from care until they convert to negative testing [7]. It is likely that this practice has contributed to near complete disease control in Hong Kong despite
sharing a border with the original epicentre of this virus.
As provinces continue to fall behind in their testing abilities, there is good news. Due to social distancing and university mandates, many of Canada’s research facilities and researchers sit idle. Those with experience in polymerase chain reaction assays, which are critical in the manual test for SARS COV2, sit at home, eager to contribute.
With increased testing capacity, citizens would be able to be tested under more safe conditions than in a hospital waiting room, like in a drive through as in South Korea and New York State. Testing could eventually map spread throughout the community amongst asymptomatic individuals that lead them into more dedicated quarantine. Furthermore, when symptoms develop and medical attention is required, those known positives could then be directed to COVID 19 dedicated hospitals or emergency departments, limiting spread to non-infected individuals.
Certainly, there are challenges in quality control and utilization of non-public health laboratories for this testing. Under regular circumstances, this may not be possible; however, under the current circumstances we firmly believe that without increased testing capacity, avoiding constraints on PPE and ventilators may not be possible either.
Regards,
Chris Griffiths, BHSc, MD
March 20, 2020
References:
1. Wang, C.J., C.Y. Ng, and R.H. Brook, Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA, 2020.
2. Special Report: Italy and South Korea virus outbreaks reveal disparity in deaths and tactics, in Reuters. 2020.
3. Times, T.N.Y., The Daily - ‘It’s Like a War’.
4. Grasselli, G., A. Pesenti, and M. Cecconi, Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA, 2020.
5. Rothe, C., et al., Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. New England Journal of Medicine, 2020. 382(10): p. 970-971.
6. Tidman, Z., Italian village reports no new coronavirus infections for days after blanket testing, in The Independent. 2020.
7. ECDC, Novel coronavirus (SARS-CoV-2) - Discharge criteria for confirmed COVID-19 cases. 2020, European Centre for Disease Control.
An open letter to the Ontario Minister of Health:
Dear Ms Elliott,
We are a group of concerned Canadians regarding the outbreak of SARS COV2. As we are not the first and only country to be facing this challenge, we believe there is much to learn from experiences across the globe.
In evaluating the resources that become limited early on in a country’s battle with this virus, it is clear that beyond healthcare workers there are three major concerns:
1. Testing – this is the first resource to become limited. There are critical
examples in South Korea, Hong Kong, and Taiwan whose testing capabilities have limited the spread of disease despite early exposures [1, 2].
2. Personal protective equipment (PPE)– while this is not a major focus of our purpose, wartime levels of production of these are critical. In Italy, the limits of PPE supply leads to patients not having visitors, and exclusion of
healthcare professionals from caring for patients [3]
3. Ventilators – certainly, the triage of ventilators has been well covered in the news in Italy.
Regarding testing, experience from Italy suggests that “were they to do this again”, increasing testing capabilities would be their first priority [4]. We are already seeing the limits of our testing capacity in Ontario and British Columbia, as patients are only being tested should a result change their in-hospital management.
Unfortunately, this capacity is unacceptable. Considering that SARS COV2 has asymptomatic transmission, limiting testing to this population prevents us from gaining adequate control in the community [5]. We need testing capacity to investigate those at increased risk of infection with SARS COV2, not just those with a presentation of COVID 19.
In South Korea, innovative approaches to testing facilities has allowed the mapping of disease spread to control and limit the effects of an early outbreak [2]. This was replicated in a small community in Italy, where they have stopped the spread of COVID 19 despite the burden of disease in neighboring cities [6]. In Hong Kong, best practice guidelines are followed such that patients who test positive are not discharged from care until they convert to negative testing [7]. It is likely that this practice has contributed to near complete disease control in Hong Kong despite
sharing a border with the original epicentre of this virus.
As provinces continue to fall behind in their testing abilities, there is good news. Due to social distancing and university mandates, many of Canada’s research facilities and researchers sit idle. Those with experience in polymerase chain reaction assays, which are critical in the manual test for SARS COV2, sit at home, eager to contribute.
With increased testing capacity, citizens would be able to be tested under more safe conditions than in a hospital waiting room, like in a drive through as in South Korea and New York State. Testing could eventually map spread throughout the community amongst asymptomatic individuals that lead them into more dedicated quarantine. Furthermore, when symptoms develop and medical attention is required, those known positives could then be directed to COVID 19 dedicated hospitals or emergency departments, limiting spread to non-infected individuals.
Certainly, there are challenges in quality control and utilization of non-public health laboratories for this testing. Under regular circumstances, this may not be possible; however, under the current circumstances we firmly believe that without increased testing capacity, avoiding constraints on PPE and ventilators may not be possible either.
Regards,
Chris Griffiths, BHSc, MD
March 20, 2020
References:
1. Wang, C.J., C.Y. Ng, and R.H. Brook, Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA, 2020.
2. Special Report: Italy and South Korea virus outbreaks reveal disparity in deaths and tactics, in Reuters. 2020.
3. Times, T.N.Y., The Daily - ‘It’s Like a War’.
4. Grasselli, G., A. Pesenti, and M. Cecconi, Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA, 2020.
5. Rothe, C., et al., Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. New England Journal of Medicine, 2020. 382(10): p. 970-971.
6. Tidman, Z., Italian village reports no new coronavirus infections for days after blanket testing, in The Independent. 2020.
7. ECDC, Novel coronavirus (SARS-CoV-2) - Discharge criteria for confirmed COVID-19 cases. 2020, European Centre for Disease Control.
Why is this important?
We are entering the very rapid rising part of the epidemic curve. Social distancing measures needed to control this in the absence of increased testing capacity will be extreme. We are a week or so away from large numbers of COVID-19 cases entering our ERs and ICUs. Based on what has happened around the world, we know that ICUs will be overwhelmed, and our doctors will have to make decisions about who gets a ventilator, "which" person's life is worth more than another's. We do not want these decisions to have to be made. We need to reduce red tape for diagnostic testing so that highly skilled scientists from outside public health labs can contribute labour and resources.