Broaden COVID-19 Testing Criteria

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We are physicians across Canada on the frontlines of the COVID-19 outbreak. We are writing as we are gravely concerned by the new guidance for Toronto Region COVID-19 Assessment Centers released to us today. We ask for the testing criteria for Toronto centers to be broadened in accordance with WHO guidance and in equity with other provincial centers.

Every Canadian with COVID-19 is at risk for transmitting the disease to large groups of people. Today’s criteria to only test an extremely limited group in Toronto leads to an algorithm that has major logical and epidemiological flaws. While national travel remains unrestricted, Canadians are being positioned to experience adverse health outcomes of the pandemic should we not change test criteria immediately.

There is no single type of individual with COVID-19 who poses higher risk to large groups. Please consider the case of Patient 31 and other “super-spreaders” in Seoul, South Korea who would not have met your screening criteria. These individuals went on to infect thousands of others leading to probably hundreds of deaths. As long as people continue to attend public places such as malls, grocery stores, and places of worship; ride the transit or take air travel; and engage in every other contact imaginable under anything except strict house arrest under martial law, every person who lives in or comes to Toronto is at risk of transmitting COVID-19 to large groups of people across the nation.

There is no shortage of test supplies. We are willing to staff the assessment centers as the population requires. The assessments centers are the safest place for all providers to engage in testing for COVID-19. The most effective way to prevent infections and save lives and scarce health resources is to break every single chain of COVID-19 community transmission. And to do that, we must test and isolate. We cannot fight a fire blindfolded, and we cannot contain the virus in an urban center like Toronto if we don’t know who is infected. We have every opportunity at hand to rapidly diagnose the mild infections and save lives and resources. To rely on the fragile premise that those who live in Toronto with mild symptoms will properly self-isolate in our dense urban community on an honour system is dangerous.

We call your attention to the World Health Organizations March 16th clear and simple message for all countries:

“Test. Test. Test. Test every suspected COVID-19 case. If they test positive, isolate them and find out who they have been close in contact with up to 2 days before they developed symptoms and test those people too.”

Other assessment centers in the province are screening widely, and these communities have a better chance of breaking transmission chains. Our patients are listening to us here on the ground, and they take us seriously when we tell them they are COVID-19 positive and must isolate. Our ICUs in Toronto are slowly filling up with COVID-19. Your stringent criteria will doom Toronto, and thereby the entire nation, to a health crisis we could have avoided with rapid widespread screening. We ask you to immediately broaden the criteria so that we can use the assessment centers for what they were intended to do: Save lives.