People wait in line at the Women's College COVID-19 testing facility in Toronto, Sept. 18, 2020.CARLOS OSORIO/Reuters
Ontario is relying on antiquated systems to route coronavirus test samples to labs across the province, adding to the lengthy turnaround times for processing results, health care experts say.
Some nursing homes with outbreaks of COVID-19 are also experiencing long lag times between the date samples are collected and when they are received at a lab, resulting in further delays, according to statistics provided to The Globe and Mail.
Labs across the province have been calling on the government to modernize Ontario’s public health laboratory system for 25 years, long before the pandemic began in March, said Tony Mazzulli, microbiologist-in-chief for University Health Network (UHN) and Sinai Health System. The province needs updated information technology systems for both timely delivery of swabs to labs and quick production of results, Dr. Mazzulli said.
“Eight months later,” he said, “we are no further ahead.”
Delays getting testing results are preventing nursing homes from quickly identifying infected residents and staff, and controlling the spread of the virus, just as a growing number of facilities are declaring outbreaks. The number of long-term care homes with outbreaks in Ontario has quadrupled over the past month to 80, and 62 residents have died.
Paul Roumeliotis, Medical Officer of Health for the Eastern Ontario Health Unit, told reporters it takes three days to get test results back for nursing homes in his region with an outbreak of COVID-19. That’s an improvement of a five-to-seven-day turnaround a week ago, he said.
Four institutions in the region have outbreaks, including Prescott and Russell Residence, a 146-bed nursing home in Hawkesbury, where one resident has died and another 15 are sickened with the virus.
Dr. Roumeliotis said all the swabs are sent to labs in Ottawa, one of the province’s hot spots for the virus. “We’re overwhelming the Ottawa labs,” he said.
Several nursing homes in Ottawa have outbreaks of the virus. The hardest-hit is West End Villa, where 19 residents have died since an outbreak was declared on Aug. 30.
Turnaround times for tests on residents and staff at the home ranged from two to six days between Sept. 5 and Oct. 6, according to data Ottawa Public Health provided to The Globe.
Much of the delay took place even before the labs received the samples. Those collected on Sept. 23, for example, were not received at the lab until Sept. 28. The lab processed the samples the following day. It also took six days to turn around samples collected on Sept. 24, which were not received at the lab until Sept. 28.
West End Villa is owned by private, for-profit chain operator Extendicare. The company said Ottawa Public Health dispatched a “third-party logistics provider” to pick up the specimens the same day the tests were done on Sept. 23 and Sept. 24 and transport them to the lab.
“We are deeply troubled to learn that there may have been a significant delay between when the tests were picked up from the home and when they were recorded in the lab’s information system,” Extendicare said in a statement.
Four different labs in Ottawa and Toronto processed the tests on residents and staff at West End Villa between Sept. 5 and Sept. 24, the data show.
Consulting firm KPMG co-ordinates the province’s network of labs, consisting of a central facility in downtown Toronto and 11 regional ones, under a contract with the Ontario government. When the volume of work is high at any one lab, KPMG uses a routing model to redistribute the workload by diverting swabs to other labs, including those run by hospitals and the private sector.
A spokeswoman for KPMG declined to comment on Thursday, and referred questions to Ontario Health, the agency that oversees the delivery of health care in the province.
Ontario Health spokeswoman Jennifer Schipper said the agency is working on automating some processes. Most of the test requisitions are paper based and, as a result, there is no central IT system that dispatches swabs to a lab, she said. “The provincial lab network is constantly working to improve its routing model to help further improve provincial turnaround times,” she said.
Dr. Mazzulli runs Canada’s largest hospital lab. When other labs in the province get backed up, some of the overflow from as far away as Thunder Bay and Muskoka arrives in his microbiology lab at Mount Sinai Hospital, a shared service with the UHN hospitals.
The Mount Sinai lab also processes swabs for several long-term care homes in Toronto. For those with outbreaks, the lab attaches a hot-pink sticker to the swab, indicating they should be given priority. It takes 4.5 to five hours to process a test in his lab and half that time for those with a pink sticker.
Mario Possamai, a senior adviser on the SARS commission led by Justice Archie Campbell, said the inquiry into the outbreak that killed 44 people in Canada in 2003, chronicled problems with Ontario’s public labs. But he thought the problem had been addressed.
“I have been shocked by our lack of preparedness on the laboratory-testing front,” he said.
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