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What caused the September surprise in testing? It’s complicated

Posted: September 27, 2020

(September 26, 2020)

By: Elizabeth Payne, Ottawa Citzen

The long lines and boiling frustration around COVID-19 testing centres in Ottawa have led many to ask why the province wasn’t prepared for a predictable September spike in demand.

Like most questions involving Ontario’s multibillion-dollar health system, the answer is complicated.

Not only has the worst pandemic in a century put Ontario’s health system under unprecedented strain, but the pandemic also arrived as the system was undergoing massive structural change. Critics say the province should have hit the pause button on the partially completed health system reform when the pandemic hit. Failing to do so has made the pandemic response more difficult, they say, and created gaps.

But there is also a less complex answer to the question about what went wrong: No single organization was directly in charge of co-ordinating local testing efforts.

As a result, local hospitals, already stretching their resources trying to work through a backlog in surgeries caused by the pandemic while helping out in overwhelmed long-term care homes, are scrambling to cope with testing demand with limited extra resources and guidance from the province. Many local doctors have helped staff assessment centres.

Working with Ottawa Public Health, hours have been expanded at existing testing centres, new ones are being planned and online booking systems have been set up, albeit slowly and not without glitches, all in response to demand. Public Health Ontario is running some mobile testing in the city.

Meanwhile, paramedics from across Eastern Ontario stepped in with a pop-up drive-thru testing clinic at the Canadian Tire Centre last weekend, aimed at taking some pressure off the city’s testing and assessment centres. The demand was huge as paramedics tested more than 2,700 people.

But a second clinic that had been planned for this weekend will not go ahead, this newspaper has learned, because of concerns that it would overwhelm limited lab capacity in the region.

Regional and province laboratories that process test results are already having difficulty keeping up.

If the testing response looks ad-hoc, that is the way the province has allowed it to develop, NDP health critic France Gélinas charges. She says the provincial government has essentially left communities “to figure it out for themselves” without providing the additional resources needed to ramp up testing to meet demand, further straining local health systems.

NDP leader Andrea Horwath said public health officials anticipated the surge in demand once school returned. Some asked the province for extra money to increase testing and contract tracing, but were denied.

That money was forthcoming this week, when the province announced $1 billion to expand testing and boost case and contact management. It also announced $741 million to clear the backlog of surgeries and medical procedures.

Some members of Ottawa’s board of health were left scratching their heads during a special meeting this week about local testing coordination.

“I am a little bit confused about who is leading testing in our community. Can you clarify?” Stittsville councillor and board of health member Glen Gower asked Cameron Love during the meeting.

Love, who is president and CEO of The Ottawa Hospital, was representing the Champlain COVID-19 Response Committee (CCRC) at the meeting to talk about pandemic response.

Although local hospitals have taken charge of running most testing assessment centres in Ottawa, Love said the response committee, which reports to Ontario Health, was not set up for that purpose.

“The CCRC was set up to deal with hospital services. It was never set up to run testing.” Nor is there another organization in charge of local testing.

“There is not one body that provides testing.”

Love said an incident command to better coordinate and plan testing was needed. Others in the regional health system say a better coordinated, less territorial approach to testing would be more efficient.

Gower was among councillors who were frustrated that there hadn’t been better coordination and communication about testing at a time when people were waiting for tests.

And he said he was worried about “the left hand not knowing what the right hand is doing,” when it came to testing. “How do you plan your resourcing if you don’t know what the province is going to drop in?”

That confusion continued this week as the province announced that some pharmacies would also begin offering COVID-19 testing by appointment, although only to designated asymptomatic patients such as those with high-risk contacts or those needing tests in order to enter long-term care homes.

Meanwhile, the province that has long encouraged any Ontario resident wanting a test to get one adjusted its policy this week, saying people without symptoms should not be tested unless they met the categories designated for testing at pharmacies.

Ottawa’s Chief Medical Officer, Dr. Vera Etches, has complained that the provincial policy is putting a strain on the testing system.

Natalie Mehra of the Ontario Health Coalition, an advocacy group, said the general “incoherence” of Ontario’s pandemic response, especially approaching a second wave, partly reflected the fact that the organizations that were supposed to be in charge of planning — health teams — were not yet fully functioning; in fact many do not yet exist. Meanwhile, the local health integration networks, which were set up for local health coordination under the previous Liberal government, have been decommissioned.

A spokesperson for the Ministry of Health said the health teams in place “have demonstrated remarkable responsiveness to the COVID-19 outbreak in the past several months.”

Among other things, they have helped simplify the purchase of PPE and supported long-term care homes and assessment centres.Twenty-nine of about 50 anticipated teams have now been named.

Mehra said the government had left it to local providers to coordinate much of the pandemic response among themselves, “only stepping in to intervene belatedly and inadequately.

“What I am seeing is incoherence and a lack of coordination.”

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