Use Rapid Tests to Bring Covid Under Control in Canada

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We need to use Rapid Testing, like Slovakia, to bring Covid-19 cases under control quickly.  Make this lockdown the last lockdown.

I am an emergency doctor in Toronto with an urgent plea to all Canadians to seriously consider an alternative to our current politics in Canada. 

Covid-19 cases are rising rapidly, especially in large parts of Western Canada, Qhebec and the GTA.  It is far past time to look at other countries that are doing much better than we are.  In all of two weeks, the Eastern European nation of Slovakia has slowed the spread of cases to a crawl by combining a short lockdown with rapid testing of the entire population.

The tools we have now are not working.  Targeted closures are effective but cases are still rising, though slower in Ontario and Quebec than other provinces that did not take these precautions.   A blunt full lockdown will not be effective on its own for very long; Brampton, the hardest hit city in Ontario, has hundreds of transport, industrial and food processing businesses critical to supplying the country.  Truckers, who are exempt from 14-day quarantine rules, are constantly moving back and forth from the US and will simply reseed the infection again.  Many are workers without job security, and the delay in the Federal sick leave benefits bill means they have no support if they isolate at home.  Crucially, locking down would halt critical food shipments and Amazon warehouses would shut down, contributing to crippling of the economy.   

It is also unfeasible and unethical to let the virus tear through the community; our health system, already running at capacity, will be easily overwhelmed and tens of thousands of healthy Canadians will die preventable deaths. Canada’s case fatality rate is 50% higher than average of peer countries, with Ontario’s additionally exceeding that of the UK. To date, 13 LTCs in Ontario have outbreaks with 100 cases, and total death count of 323 ; this will only grow. 

Rapid testing offers a way out of this mess.  These are cheap, $5 tests that you can do in your home.  They are just sensitive enough to tell you if you are in that crucial window when you are infectious to other people;  super-accurate PCR tests, which is what we’re using now, will pick up very early infections even when they aren’t in that crucial infectious window.  The advantage of rapid tests is they are far faster, easier to deploy and can be mailed out to Ontarians by the millions.

In the last few weeks, Europe has been reporting shocking numbers of cases and deaths, but one country is bucking that trend.  In just two weekends, Slovakia tested every resident between the ages of 10 and 65.  They locked down the country for two weeks; those that tested negative were given a special pass to move freely.  They mobilized every resource, including the military and polling centres in schools, and created thousands of testing teams.  They found that 1% of the population was infected, and isolated them for ten days.   They brought down their R0, a measure of virus reproduction, from 1.47 to 0.62, and they are the only country in the world now reporting a decrease in cases.   

We could easily apply the same techniques here.  We could even time our 2 week lockdown for just after Christmas, when most people are at home anyway.  Once cases plummet to a low enough point, a goal we in health care are calling ‘CovidZero’, we can restart contact tracing, and try to live life like our brethren in Atlantic Canada, where shops, restaurants and gyms are open, normal life continues, and that omnipresent fear isn’t there.  

Prof Michael Mina at Harvard makes a very strong case for rapid tests. His idea is even more radical, mail tests to every household, and have each person test and self isolate on their own initiative.   Even if half of all households do so, it will dramatically affect infection rates

There are some barriers though; these tests need to be approved by Health Canada, which they have been slow to do; Slovakia used two tests made in South Korea (Rapigen, SD Biosensor) - both have been ‘under review’ with Health Canada for months.  Organizing the logistics for such a large operation would require the close cooperation of the federal and provincial governments, something we still aren’t seeing today.   Ideally we would involve our most effective national institutions, the Canadian Forces and Elections Canada.

Doing nothing means we live with increasing cycles of lockdowns, reopenings, disrupted holidays, distant family and constantly living in fear, which exacts its own toll.    In fact, I would challenge our provincial premiers to just purchase these tests and try anyway, dare our federal government to stop him.  

There really is no good alternative at this point. 

Please sign this petition, lobby your local, provincial and federal leaders!