So back at the end of September, when the testing numbers surged in Ontario and labs started backing up and samples basically stopped moving out with any kind of speed I found myself looking at that backlog and not really having any idea what it meant. https://nationalpost.com/news/canada/inside-ontarios-overwhelmed-labs-how-lingering-issues-and-mistakes-caused-massive-covid-19-testing-backlog

It was clear by the beginning of October that Ontario was conducting far more COVID tests every day than the labs could process and it was obvious that this was a big problem, but I couldn't wrap my head around what that problem was or what was causing it.

So I spent a few weeks talking to every senior lab person who would take my call, including @vanessagallen, Tony Mazzulli, Kevin Katz and a whole host of others from across the public, private and hospital lab systems to try figure out what was happening and why.

On one level the answer was simple. It was a pure volume issue. The testing centres ramped up far quicker than the labs did, or could, and for too long Ontario was testing way too many people who didn't really need tests.

The more complicated question is: why? Why weren't the labs ready to process more samples when the fall surge came? Everyone across the system knew it was coming. So why did it seem like such a surprise?

Now that, it turned out, was way trickier. Part of it was supplies. At some point or another over the past seven months, there have been shortages every single thing you need to conduct and analyze a COVID test.

Part of it was human resources. For decades Ontario has known that it does train enough licensed laboratory technologists. The former head of Ontario's public lab system told me he flagged that issue in the 1990s, in the 2000s and all the way up until he retired six years ago.

But part of it, too, was something critics say has dogged Ontario's COVID response at every step. At the top level, the province was too slow to react.

As @bruce_arthur has reported, many labs knew they needed money to expand months before the funding was approved. At one large hospital laboratory, four analyzers sat in storage during the fall surge because the lab didn't have the physical space for them https://www.thestar.com/opinion/star-columnists/2020/10/03/many-experts-advised-ontario-for-months-to-boost-covid-testing-capacity-sources-say-they-just-didnt-want-to-spend-the-money.html

Chronic issues dogged the system too. Almost two decades after SARS, Ontario's labs still don't share a digital communications network. That means requisitions are still being filled out by hand, on paper.

Public Health Ontario's former chief scientist, @NSCrowcroft, told me the labs have been chronically underfunded and oversubscribed, a situation that has only gotten worse in recent years.

All of that said, the one thing I came away from all this feeling was a sense of awe over what the people on the laboratory front lines have actually managed to do, given all the barriers they've faced.

"I actually think that we have done this at lightening speed," @larissamatukas told me.