What can early Canadian experience screening for COVID-19 teach us about how to prepare for a pandemic?

Canada needs to urgently establish the capacity to assess and test people with symptoms of possible coronavirus disease 2019 (COVID-19) in their homes or in special clinics outside of acute care hospitals, say physicians from eight Toronto hospitals that tested 135 people for COVID-19, in an analysis article published today in the Canadian Medical Association Journal (CMAJ).

"The COVID-19 epidemic is rapidly evolving and a pandemic appears imminent," writes Dr. Jerome Leis, medical director of Infection Prevention and Control at Sunnybrook, with coauthors. "Canada's preparedness for COVID-19 must extend beyond hospitals, as a surge of cases appears inevitable."

The 135 patients who presented for testing at emergency departments between January 20 and February 19, 2020 were young (median age 28) and not very ill (95 per cent did not use emergency medical services to get to the emergency department and 95 per cent were sent home from the emergency department). Only one person tested positive for COVID-19.

Based on this early experience, the authors suggest that most people who should be screened for COVID-19 are not acutely ill and do not need to be assessed in the hospital.

Barriers to community testing include guidance in Ontario that still requires that health care personnel use personal protective equipment that is not routinely available outside of hospitals; lack of role clarity for community providers; limited access to diagnostic testing; and past Canadian experience with severe acute respiratory syndrome (SARS), which may make people assume hospital emergency departments are the best places to be tested.

"These barriers need to be addressed urgently before a pandemic situation leads to emergency departments across the country being overwhelmed, with the knock-on effects of overcrowding, health care worker infection and risks to other acutely ill patients," the authors conclude. The authors note that COVID-19 is spread by droplets and contact, and therefore fit-tested N95 respirators and airborne infection isolation rooms are not required unless an aerosol-generating procedure is being undertaken.

The eight hospitals were The Hospital for Sick Children (SickKids); Michael Garron Hospital; North York General Hospital; Sinai Health System; Sunnybrook Health Sciences Centre; Unity Health; Toronto General Hospital and Toronto Western, University Health Network, Toronto, Ontario.

Media contact for analysis:

Laura Bristow, Communications Advisor, Sunnybrook Health Sciences Centre, 416-480-4040, laura.bristow@sunnybrook.ca

General media contact:

Kim Barnhardt, CMAJ, kim.barnhardt@cmaj.ca