Quebec vows to dramatically boost COVID-19 testing, as deconfinement begins

As Quebec rolls out a plan to reopen elementary schools and some sectors of the economy, the provincial government says it will be able ramp up COVID-19 testing from roughly 5,000 to 20,000 tests a day.

The provincial Health Ministry says it has reached a rate of between 6,000 and 7,000 tests a day.

However, according to figures from the INSPQ, Quebec's public health research institute, more people were tested last week than in any week since the pandemic began. On average, that amounted to 4,575 tests each day.

Still, a spokesperson for the Health Ministry and Dr. Horacio Arruda, Quebec's public health director, both said the province already has the capacity to ramp up rapidly to 15,000 daily tests almost immediately.

"We are one of the places that is testing the most in the world," said Premier François Legault Monday. "We're testing three times more than Ontario."

Quebec has done a total of just under 200,000 tests, which works out to 23 tests per 1,000 people, according to the latest data from the INSPQ.

The way each country quantifies testing varies, but according to a University of Oxford-based data project, the Canadian average is just under 19 tests per 1,000 people, while Germany and Italy are pegged at 25 and 29 tests per 1,000 people, respectively. 

'We don't want to go back to square one'

Quebec will need much more data than it has right now to avoid a spike in infections that could overwhelm the health-care system, according to Dr. Nima Machouf, an epidemiologist and instructor in the school of public health at Université de Montréal.

"I don't know what the threshold is that we need to hit, to be confident that we are finding all of the positive cases," said Machouf. "But 3,000, 4,000, 5,000 tests a day are not at all enough."

She said 15,000 tests a day would be "excellent," by comparison.

"The danger is to have another wave of the epidemic," she said. "We stayed home for five weeks, and it was a very tough situation for a lot of people, so we don't want to go back to square one."

Machouf said testing efforts should be concentrated in the greater Montreal area, the epicentre of the pandemic in Quebec.

She also said mobile testing sites in schools and workplaces could be a good strategy to give the public better access to testing and to more easily track outbreaks when and where they occur.

Things could 'catch fire again'

Legault has suggested Quebec will change its testing strategy in the coming weeks, moving toward more "random sampling" of the population rather than focusing primarily on residents of long-term care homes and medical personnel.

Arruda said some of that random testing could be done at schools, grocery stores or other places where people gather.

"We will have a strategy that will be a balance between the quantity of tests we have available and the representativity of the data," he said. 

But some experts are not convinced that Quebec will be able to ramp up testing so quickly. 

"If we remove confinement, and we're not able to test widely, things will catch fire again, and there will be more infections," said Dr. Cécile Tremblay, an infectious disease specialist at the Centre hospitalier de l'Université de Montréal.

"We have to test more widely, but right now, we don't have what we need to do it."

Quebec, like many jurisdictions, has faced shortages of the chemical reagents needed for testing, while thousands of testing swabs arrived in Quebec potentially contaminated.

As recently as Friday, the Health Ministry said the availability of swabs was "a major challenge," but Monday, Legault said the province had 109,000 swabs in inventory.

"It's clear we had problems with the availability of reagents and swabs, but that problem has been solved," assured Arruda. 

'Time is very crucial'

In addition to testing more people, getting results fast to be able to react quickly is essential for deconfinement to work, Machouf said. 

The Quebec government has ordered 100 rapid testing devices and 200,000 test kits from Spartan, an Ontario company. According to the company, the Health Canada-approved tests can give a result in approximately 30 minutes. 

That could drastically cut down on the number of contacts that need to be traced if someone tests positive for COVID-19 following deconfinement, Machouf said. 

"Time is very crucial in the control of an epidemic where the capacity of the virus to spread is very high," she said. "The capacity of each infected person to spread the virus to other people is much higher than what we thought at the beginning." 

Research from the Center for Disease Control looking at data from Wuhan, China, suggests that rather than infecting two to three people, each infected person has the capacity to spread the virus to five or six people. 

The rapid tests from Spartan are what will allow Quebec to increase its capacity to 20,000 or even 30,000 tests a day, Arruda said Monday.

However, those tests are not yet available in Quebec. The company could not give a firm delivery date when contacted by Radio-Canada. The Quebec Health Ministry said it was expecting the tests by the end of May — by which time elementary students are to already be back at school. 

Over the longer term, Machouf said, even if Quebec succeeds in deconfining safely, the province will have to keep a watchful eye on how the virus is progressing elsewhere in the world.

Machouf said testing all travellers arriving at airports and borders could become a necessary reality, once travel restrictions are lifted.

"Quebec is one thing, but the whole world is another. South of us, there will soon be one million people who are infected," she said. "We will soon be at three million cases around the world."

"We have to make sure this deconfinement lasts."