Dangerous distractions? - a view from primary care about @fordnation Ontario's COVID19 latest testing strategy. A thread ...

At the onset of COVID-19 in Ontario, testing strategies had to contend with supply limitations (swabs, reagents, lab capacity), confusing labyrinths for obtaining results and rapidly changing public health directives.

Hamilton’s response was an integrated table with partners from public health, @STJOESHAMILTON, @HamHealthSci, @cityofhamilton and @hfam. We have met 38 times to prioritize and improvise: how do we obtain the highest possible yield from testing as the pandemic progresses?

The landscape continues to change. More than ever, it's apparent that demand for testing in Ontario is now being driven by two forces. One which may be harming the other.

Best worldwide drivers for testing are informed by science and public health. In Ontario, avoiding a future lockdown relies on rapid testing and contact tracing of the symptomatic, close contacts of the infected and essential workers at high risk of occupational exposure.

(there are other important testing strategies for congregate settings and settings which are in outbreak).

Unfortunately, as the number of new COVID cases diminish and we experience the lifting of lockdown there are also a series of drivers which are encouraging people to test in ways that are NOT helpful for preventing future lockdowns and may, in fact, be causing unintentional harm.

These include the requirement that people who wish to visit a long-term care facility need proof of a negative test within a two-week period, employers asking for workplace testing to ensure a “safe environment” or people at low risk who find reassurance with serial testing.

When “freeform” testing is done for (unscientific) psychological reassurance or political popularity, there are several unintentional harms. One is the risk that people overvalue a negative test which only has significance for a single point in time.

We know the most important measures for preventing COVID are appropriate physical distancing, public masking while in close proximity, and great hand hygiene. (these are the measures which all workplaces are required to follow, as well).

There are increasing calls for people interacting in a variety of settings to have “proof of a negative test”.

A person who tests negative 5 days before their scheduled x-ray or colonoscopy is not a “safer” patient than a person who was not tested.

“Safety” comes from infection control procedures at the facility – active screening, appropriate use of physical distancing, masks, hand hygiene and PPE. Medical settings: consider the harms you are causing by insisting on “single point in time” pre-testing of your patients.

Another significant risk is “system distraction”. Low value and low yield testing demands lab, staffing and public health resources. This puts rapid testing of high priority groups at risk.

Even 24 hours of system delay can make a huge difference to the timely identification of cases and their at-risk contacts essential for the containment of new COVID infections and reduction in the risk of community spread.

It’s vital that all workplaces place primary emphasis on infection control as the central practice for protecting staff and clients – and not to rely or insist on low value testing. The current suggestion to screen all people visiting nursing homes should also be revisited.

Our shared goal of preventing future lockdowns is best served by a laser-like focus on the core elements of priority testing, rapid contact tracing and case management. Public health in partnership with primary care! @McMasterFamMed @OntarioCollege

The result of a test done without reference to symptoms, contact tracing or exposure to risk becomes obsolete even as one drives away from the crowded testing centre, leaving in its wake false assurance, wasted resources and diversion from interventions that matter.