Protecting Ontarians through Enhanced Testing May 29, 2020 Why Test? Ontario’s testing plan is designed to achieve three goals. To accomplish these goals, we need to make sure testing is accessible, available, timely and of high quality. Goal 1: Increase testing to identify anyone with COVID-19 and spread in community Goal 2: Aggressively track and trace contacts to contain spread Goal 3: Populations surveillance: provide an ongoing evidence base to inform decision-making 2 Types of testing for COVID-19 Molecular (PCR) What question does it answer? Do I currently have COVID-19? (current diagnosis) Serology Have I had COVID-19? (retrospective exposure) How does a sample get collected? Nose and/or throat swab Blood (serum) sample What is being detected in the test? The COVID-19 virus An individual’s antibodies When does this test matter? Early in the disease cycle (Ideally day 2-4 after infection) Late in the disease cycle (Ideally day 14+ after infection) Note: Both molecular (PCR) and serology testing can be performed in a laboratory (high throughput/tests per hour with slower turnaround of sample collection to result) or at point of care (low throughput, faster turnaround). There are no point of care tests for serology with Health Canada approval today. 3 Presentation Name 3 Three Branches of Testing ▪ Individuals are tested in a variety of settings, including in assessment centres. New approaches are regularly being designed to make testing more accessible. ▪ Ontario now has the most expansive guidelines in the country, including testing asymptomatic individuals concerned they may have been exposed to the virus. ▪ Ontario is further reducing barriers to testing by advertising assessment centres online. ▪ Public health units remain focused on case and contact management in containing and managing an outbreak. Ontario will support these efforts with its agile and rapid response capacity, including mobile testing. 4 ▪ Plans are already in place in conjunction with employers to support enhanced testing for hospital workers, first responders, retirement homes and longterm care homes. ▪ The province is also looking to expand testing to additional essential workplaces and is working collaboratively with sector leaders, including auto manufacturers, major retailers and other food suppliers. Assessment Centre Testing Outbreak Management Targeted Campaigns System Snapshot Accomplishments to Date Testing for COVID-19 is one part of an extensive provincial plan to protect Ontarians throughout this outbreak. Ontario has completed over 660,000 tests to date Ontario is leading large provinces in daily tests completed Capacity to conduct more than 20,000 tests daily 131 assessment centres providing access to testing Over 20 Labs in the network to manage increased volume Evolved testing guidance to support our response to the pandemic 6 Testing Volumes At A Glance Daily Volume of Tests Processed (May 28th) 662,162 (+2.67%) Tests Completed as of May 28th Diversified testing platform Managing a complex logistical landscape End to End Daily Turn Around Times (May 28th) 3-Day Rolling Average (May 24th to May 26th) • 54.5% of test results completed by the next day • 82.0% of test results complete within two days 7 Testing Volumes at a Glance Ontario ranks third overall for total persons tested per 100,000 population (4,280) 8 Moving Forward: Ontario?s Strategy to Expand Testing Moving Forward: The Plan Working alongside Ontario Health, Public Health Ontario, assessment centres and public health units, the province is building a comprehensive post-peak plan to enhance surveillance and testing across the province. Identify, contain and monitor new cases and monitor spread of COVID-19 Expand testing to support public confidence and reopening the economy Ensure testing is accessible, available and widespread Learn from each testing phase – Plan, Do, Study, Act 10 Evolution of the Testing Strategy • Ontario has taken action on all fronts to respond to the evolving global pandemic. • As Ontario exits the epidemic peak and gradually reopens the province, we are shifting the focus to enhance our testing approach for Ontarians. • Effective May 24, testing has been broadened to include: 1. Symptomatic testing: • 2. 11 All people with at least one symptom of COVID-19, even for mild symptoms. Asymptomatic, risk-based testing: • People who are concerned that they have been exposed to COVID-19. • People who are at risk of exposure to COVID-19 through their employment, including essential workers (e.g., health care workers and their families, grocery store employees). Case and Contact Management: Current Status 89.4% of new cases reached within 24 hours No Ontarian who is symptomatic or who is concerned they have been exposed to COVID-19 will be declined a test at an assessment centre (either through appointment or walk-in, per the processes of each individual assessment centre) 12 Testing Calendar: Initiated and Being Planned Monday Tuesday Wednesday Thursday Friday Saturday Sunday 25 26 27 28 29 30 31 5 6 7 Ongoing symptomatic and asymptomatic testing at assessment centres Long-Term Care Homes (monitoring and testing of all staff) Retirement Homes (testing all residents and staff in homes with outbreaks) LCBO (staff directed to local assessment centres) Toronto First Responders and Families (police, fire, EMS, paramedics) Hospital Workers at select hospitals across Ontario Select Adult Correctional Facilities 1 2 3 4 Ongoing symptomatic and asymptomatic testing at assessment centres Long-Term Care Homes (monitoring and testing of all staff) Retirement Homes (planning and initiating testing of all staff ) Hospital Workers at Select Hospitals School Boards Communications to build awareness on testing Community-Based Testing (High COVID Active Communities) Select Adult Correctional Facilities Congregate Care Settings (emergency shelters, residential group homes for adults with developmental disabilities, VAW residential sites) 13 Landscape of Populations and Settings for Testing All of the following populations and settings will be considered and incorporated into the testing plan, working closely with the community, businesses and stakeholders. LongTerm Care Homes Retirement Homes Residents Residents Other Congregate Care Settings Essential Workplaces* Priority Populations (as per May 14 Provincial Testing Guidance)** Adult Correctional Facilities Agri-Food Businesses Hospital Workers Emergency Homelessness Shelters Staff Staff Residential Group Homes for Adults with Developmental Disabilities Violence Against Women Residential Sites • Supply Chains • Food • Consumer Products • Services • Financial Services • Telecom & IT Infrastructure/Service Providers First Nations and Indigenous Communities Individuals in the Health System General Population First Nations Specific Priority Populations Individuals Congregate care settings • Chemo / Cancer Patients Workplaces First Responders & Their Families High COVID Active Communities High Risk Individuals as Identified via Contact Tracing • Dialysis FNIM people living in urban areas • Pre-/posttransplant Sectors include: • Pregnant Persons • Social Services • Agriculture • Maintenance • Transport Services • Manufacturing • Hospital Inpatients • Agriculture & Food Production • • Construction Health Care Workers/Caregivers/Care Providers/First Responders • Resources & Energy • • Justice Additional settings include: • Community Services • Licensed Children’s Residential Sites • Sports • Anti-Human Trafficking Residential Sites • Research Persons Living in Same Household of Health Care Workers/Care Providers/First Responders/Emergency Child Care Centre Workers Indigenous Healing & Wellness Facilities / Shelters • Health Care & Social Services • • Remote/Isolated/Rural/ Indigenous Communities • Labour and Remuneration Media Industries • • Specific Priority Populations Youth Justice Residential Facilities • • Essential Workers • Public Works and Infrastructure • Supportive Housing Providers Requirements that Apply to Businesses • Cross-Border Workers • Homes for Special Care Intervenor Residential Sites • • • • Neonates Adult Mental Health and Addictions Residential 14 Presentation Name Bail Bed Program * Source: Ontario List of Essential Workplaces ** Source: Ontario COVID-19 Provincial Testing Guidance • Education • Environment and resources • Culture and Community • Municipal Affairs • Economy and Growth • Community Safety • Consumer Services and Protection • Health Assessment Centre Testing Expanding Who Gets Tested The primary focus of testing. ▪ Locations: 131 assessment centres across Ontario New Strategy: ▪ Individuals are tested in a variety of settings, including in assessment centres. ▪ New approaches are regularly being designed to make testing more accessible. ▪ Ontario now has the most expansive guidelines in the country, including asymptomatic individuals concerned they may have been exposed to the virus. ▪ Ontario is further reducing barriers to testing by advertising assessment centres online. Assessment Centre Testing Outbreak Management 15 Targeted Campaigns Targeted Campaigns Detecting and Containing Cases Proactive surveillance testing to quickly detect outbreaks and actively monitor for the spread among priority populations. New Strategy: ▪ Supporting testing for individuals and communities who may be at higher risk. ▪ Plans are already in place in conjunction with employers to support enhanced testing for hospital workers, first responders, retirement homes and long-term care homes. ▪ The province is also looking to expand testing to additional essential workplaces and is working collaboratively with sector leaders, including auto manufacturers, major retailers and other food suppliers. ▪ Further proactive surveillance testing will also be conducted in rural, remote and Indigenous communities. Assessment Centre Testing Outbreak Management 16 Targeted Campaigns Outbreak Management Focusing Testing to Ensure Rapid Response Testing conducted in response to the declaration of an outbreak in a specific neighbourhood, region or institutions such as hospitals, long-term care homes and education settings, as well as workplaces. New Strategy: ▪ Public health units remain focused on case and contact management in containing and managing an outbreak. ▪ Ontario will support these efforts with agile and rapid response capacity, including mobile testing. Assessment Centre Testing Outbreak Management 17 Targeted Campaigns COVID-19 Transmission Reproductive (Rt) The average number of new infections that results from each infection. This measures how quickly the virus is transmitted. 18 Three Phases to Ontario’s Use of Testing As Ontario exits the epidemic peak and begins Recovery, we are shifting the focus of our daily testing 1. 2. 3. Find and contain – management of pandemic (January to May) Monitoring and screening - post-peak (June & July) Ongoing suppression (August – onwards) Find & contain Monitoring & screening Ongoing suppression January 19 June August Hospital Capacity Report Daily Trend of Critical Care COVID+ and PUI Census (May 27th) Critical Care Bed Occupancy Rate for Baseline Capacity and Expanded ICU Capacity (May 27th) 20 Source: Critical Care Services Ontario (CCSO) COVID-19 Daily Report (May 27)