Provincial Testing Strategy Update Technical Media Briefing January 6th, 2022 Ministry of Health Ontario’s COVID-19 Testing Strategy  Ontario’s testing strategy includes lab-based PCR testing, rapid molecular testing, and rapid antigen testing.  In Fall 2020, Ontario committed to build diagnostic testing capacity for up to 78,000 PCR tests per day—its per capita share of the federal national testing commitment. Ontario exceeded this target as of Winter 2021 and continues to be able to process over 100,000 tests per day through its provincial lab network.  In addition, Ontario has been a national leader in the deployment of rapid antigen tests (RATs), which have played an important role in keeping high risk settings and workplaces safe.  Despite high-volume testing capacity, the highly-transmissible Omicron variant has put strain on Ontario’s testing network, as it has for many jurisdictions.  As a result, Ontario’s testing strategy is evolving to meet Omicron-related demand to ensure timely testing is available for those living and working in the highest-risk settings, protecting our most vulnerable and keeping critical services running. Key Achievements:  Over 21.5M lab-based PCR tests processed to date .  Over 900 testing locations available, with ability to collect over 80,000 specimens/day.  A provincial lab network that includes more than 40 independent, hospital, public health and community laboratories, with the ability to process over 100K PCR tests per day.  Over 617K rapid molecular tests sent to 359 sites , including rural, remote and Indigenous communities.  Over 54M RATs deployed to over 53K sites . Prioritizing and Protecting Diagnostic Testing  Due to the highly transmissible Omicron variant, Ontario's diagnostic network is facing unprecedented demand. This has led to longer waits for appointments and turnaround times for results at many locations.  Ontario is taking the following actions to protect the testing network for those with the highest need, while maximizing all available resources. Prioritizing diagnostic testing for the most at-risk • Revised PCR eligibility (as of December 30th) to protect our most vulnerable and maintain the stability of critical workforces, in consultation with the Chief Medical Officer of Health. • This is in line with best practices from other jurisdictions dealing with Omicron surges. • Continuing to consult with key stakeholders to ensure all priority groups requiring PCR testing are included and to refine PCR eligibility as needed. • Close monitoring of turnaround times for results (as of Jan 5., 70% tests are complete within two days). Maximizing diagnostic testing capacity • Maintaining existing assessment centres and community testing sites, including 270 locations. • Increased mobile testing for additional testing capacity and outbreak response; 22 deployments currently active. • Increased operating hours and locations of community lab specimen collection centres providing public COVID-19 specimen collection services (e.g., LifeLabs, Dynacare, Medical Laboratories of Windsor). • Added over 600 new pharmacy testing sites since November 18. • Continue to test for and monitor COVID-19 variants of concern (VOCs) in Ontario. Expanded Use of Rapid Antigen Tests • RATs are now recommended for the following:  For “test-to-work” purposes to meet critical workforce needs in the highest risk settings • Test-to-work is a strategy to support work-self isolation in critical work shortages, in which staff are able to return to work when they would otherwise be on self-isolation at home (for example, after exposure to someone with COVID￾19).  For people without symptoms as screening • Frequent, repeated rapid antigen testing of people who are asymptomatic and without known exposure to someone with COVID-19, with the goal of identifying cases that are pre-symptomatic or asymptomatic. • Includes healthcare workers subject to Directive 6, which requires unvaccinated staff in high-risk settings to undertake regular rapid antigen testing, now at an increased frequency of a minimum of twice weekly. X Not recommended for one-off use (e.g., before social events) due to the risk of false negatives.  For people with symptoms • A positive RAT is highly indicative that a symptomatic individual has COVID-19, and the individual and their household are required to self-isolate. • If two consecutive RATs, separated by 24-48 hours, are both negative, the symptomatic individual is less likely to be infected, and the individual is advised to self-isolate until symptoms are improving for at least 24 hours (or 48 hours if gastrointestinal symptoms). • Positive RATs do not require confirmatory PCR/rapid molecular testing or reporting to public health. 4 With the diagnostic testing network under significant pressure, Ontario’s testing strategy has shifted toward enhanced use of RATs to effectively respond to the new Omicron context. 55.7M* Total antigen tests received by Ontario to date 34.21M through the Federal Government 20.79M through Ontario’s direct procurements SUPPLY FORECAST 54.3M deployed to date 380k remaining in inventory (Note, this amount is as of Jan 3rd only and changes daily based on inbounds and outbounds) Rapid Antigen Screening: By the Numbers *As of Jan 3 DEPLOYMENT BREAKDOWN 7.30M Tests deployed to 128 Chambers of Commerce 54.3M rapid antigen tests deployed by the province to a total of 53,730 sites^ 4.43M tests distributed by Chambers to 38,050 small to medium sized businesses 5.7M Tests deployed to Essential Industries 22.61M Tests deployed to Health and Congregate Care Reported numbers are captured via recent entries to the MOH reporting tool, Some Chambers report directly to MEDJCT and are captured in the total numbers deployed above. *As of Jan 3 17.48M Tests deployed to Education and child-care 1.2M Tests already distributed through Holiday Pop￾Up Initiative * Includes tests shipped directly to school boards from manufacturer, facilitated by MGCS. Ontario leads the country in the distribution of RATs, having deployed over 54M tests to date to over 53,000 sites; 47M more than any other province or territory. • Initial distribution of RATs began in Ontario in November 2020, and was quickly expanded to provincially￾scaled deployment through the establishment of the Provincial Antigen Screening Program (PASP) in January 2021. • Through the PASP, Ontario has widely deployed ~1M tests per week over the last year as an additional layer of safety for any organization that is permitted to be open and who has employees working on￾site, including all sectors subject to provincial vaccination policies for the purpose of testing unvaccinated staff. • 11M RATs were also distributed to all publicly-funded schools in Ontario, as well as participating First Nation, ahead of the December break as an added layer of protection over the holiday season, which was particularly critical in the context of Omicron. • Ontario tracks the deployment of rapid tests closely; 99% of the 54M rapid tests deployed across the province have been used. Provincial Antigen Screening Program Rapid Antigen Test Deployment in Canada Province/Territory Total RATs deployed* Ontario 54.3M Saskatchewan 7.27M Quebec 6.55M Alberta 5.83M New Brunswick 3.44M Nova Scotia 2.15M British Columbia 1.17M Manitoba 0.42M Newfoundland and Labrador 0.304M Prince Edward Island 0.114M Nunavut 0.014M Northwest Territories 0.008M Yukon No reported deployment * Ontario’s total includes RATs that were both federally allocated and provincially procured. The totals noted for the other provinces and territories include only federally allocated RATs. Mitigating Temporary Supply Constraints • Demand for RATs in Ontario is expected to increase from ~1M per week to over 18M per week through January as a result of changes to PCR testing eligibility and enhanced use cases for RATs (i.e. symptomatic, test to work). • At the same time, Ontario is experiencing temporary supply constraints, including delays in shipments of RATs from the federal government, which are impacting the province’s ability to meet this increased demand. • For December, Ontario anticipated receiving 15.5M RATs from the federal government; ~3.4M were received; the federal government has confirmed they will not be providing the remaining ~12M tests. • For January, Ontario requested an allocation of 68.6M RATs from the federal government. • The federal government committed to providing 54.3M RATs to Ontario; confirmation of the remaining portion of Ontario’s allocation (~14M) is still pending. • Of the 54.3M RATs the federal government committed to provide to Ontario in January, 0.15M have been delivered, and ~9M have been scheduled for delivery. Delivery dates for the remaining ~45M tests have yet to be scheduled. • To mitigate these supply constraints and meet the increased demand for RATs across the province, Ontario procured an additional 65M RATs in December and January to ensure continued access. • This is in addition to 20M RATs previously procured by Ontario, including 11M provided to school children before the winter break, which brings Ontario’s total provincial procurements to 85M. Ontario is currently experiencing significantly increased demand for RATs in the context of Omicron, while also managing temporarily constrained supply. Prioritizing Rapid Antigen Tests for our Highest-Risk Sectors • Despite current supply constraints, the province continues to deploy as many RATs per day as possible. • Distribution is currently being prioritized for our most vulnerable sectors, identified in consultation with the Chief Medical Officer of Health, with the goal of preserving critical health human resource capacity and protecting individuals working and living in the highest risk settings (i.e., elderly, immunocompromised etc.). • Over 700,000 RATs were deployed to high priority sectors on January 5th alone, and an additional 1.7M tests are planned for distribution before the end of the week, which is the majority of the provincial inventory available. • As provincial supply stabilizes over the month with incoming procurements and federal allocations, the government will look to expand access within this prioritization framework. In light of temporary supply constraints, Ontario is prioritizing RATs for the highest-risk sectors. RAT Prioritization Use for RATs High Priority Settings (i.e. long-term care and retirement homes, hospitals, paramedics, shelters and other congregate care settings, as well as First Nation and Indigenous communities and organizations) • Test to work • Screen testing Education • Symptomatic testing as priority • Screen testing Sectors with mandatory vaccination policies/testing mandates • Screen testing Public Access (pending supply) Current focus Next Steps  Continued efforts to work both federally and provincially to ensure rapid antigen tests are available for Ontarians and deployed quickly once received.  Broader distribution of rapid antigen tests as supply allows.  Updates to reporting process. 10