Illustration by Salini Perera
This summer Ian Brown explores how Canadians are reclaiming their lives from quarantine, whether it’s the thrill of a haircut, the risk of a hug or a chance – finally! – to jump in a pool again.
The most popular outing of the pandemic summer of 2020 isn’t a bike ride or the beach, the hair salon or the golf course. The hot thing to do in the summer of 2020 as we emerge from pandemic lockdown is get tested for COVID-19. Now that 4,635,105 of us have done so, the pattern of pre-result anxiety is well-established.
It begins with planning: How long will I have to wait in line for a test? Then physical worry: How much does it hurt? A longer but milder stretch of nervousness then ensues, while you wait for the results: Do I have it? Where will I quarantine if I do? Could I be a goner nine days from now? All of which ends in a brief splurge of relief, in 97.5 per cent of cases, when the test reveals you’re clear. It’s only a snapshot of a moment; you could still catch COVID-19 when you stop for gas on your way home. But at least it’s some kind of answer.
I know the pattern of test worry because I’m discussing it with Joan Gauthier, the woman behind me in line at Women’s College Hospital in downtown Toronto. I want to be tested specifically because I’m sharing a car on a vacation to Montreal; and more generally because I want to know if my distancing techniques are working. But Joan has notched four tests, so she can visit her husband, David, in his long-term care home where he’s succumbing to Parkinson’s faster than she likes.
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Joan is 88, forthright and well-informed. She speaks in precise sentences. David moved into long-term care four weeks before lockdown last March, whereupon Joan didn’t see him in person for four months. Now that visits are allowed again, provided she has been tested, she makes her way to the hospital from her lakeside condo every second Wednesday morning. This is something we do now to be with people we love.
The one part of the experience she doesn’t like is the 10-inch plastic wand up her nose, if the nurse is the type who counts to five out loud while she probes. “That makes it seem longer,” Joan says.
Last spring, in the dark early days of lockdown, tests were available only to those literally gasping for breath. Now anyone who wants a test can get one almost anywhere in the country – a development that troubles some epidemiologists as much as it pleases others. Tests are essential to understand the spread of the virus. They are also fancy props in the theatre of the pandemic. One thing is certain: No one predicted COVID-19 tests would be the source of a moral quagmire.
At the outset of the pandemic in March, the Women’s College Hospital’s COVID-19 assessment centre conducted a few hundred tests a week.
These days it swabs 450 schnozzes a day. The hospital’s walk-in clinic has conducted 14,000 tests; its fast-track cousin, which requires online registration and phone screening, has processed 17,000 more. Another 4,500 patients have been tested by the hospital’s mobile unit at a long-term care home and 25 homeless shelters.
Wednesdays and Thursdays are busiest, in time for the weekends. After a 15-minute physically distanced wait in line outside, a nurse in full protective armour with her name, Eunice, written in magic marker on her face shield, invites me into a sealed-off space in the vestibule between the (open) outer and (closed) inner doors to the hospital: technically, we’re still outside, therefore non-contaminating. Eunice smiles and asks me to tip my head back.
The white plastic wand goes in. It goes in quite a long way. I can’t say it hurts, or even stings; it’s just momentarily uncomfortable. Describing the feeling has become a competitive amateur sport in Canada: one woman I know likens it to “a twirly Pap smear,” while another says it’s “like a fly flew up your nose.” The whole process takes three minutes, tops.
In fact, administering the test requires special training, to make sure the swab is inserted aggressively enough to reach prime COVID-gathering swampland in the nasopharyngeal cavity. Some nurses won’t do them. “We advance until we meet resistance,” Dr. Tania Di Renna, a no-nonsense anesthesiologist who is also deputy director of the hospital’s assessment centre, tells me one afternoon. Then the tester twirls the tip of the wand. “It’s not hard to do,” Dr. Di Renna insists. “We just don’t like to make people uncomfortable over and over and over again.”
The work is relentless: “These are people working in full PPE, every day, all day, since March,” Dr. Di Renna adds: eight-hour shifts, with an hour for lunch. “If you don PPE, you can’t drink water. You can’t go to the bathroom. Because then you have to doff, and that takes 10 minutes.” Don, doff: medieval words, the language of armour.
All this, which so far has cost Ontarians $160-million, to reassure approximately 98 out of 100 testees that they don’t have COVID-19, and to reveal to the remaining two that they sadly do.
The goop from the back of my sinusoidal cavity leaves the assessment centre and heads three blocks south to the Mt. Sinai Hospital/University Health Network microbiology laboratory. During the worldwide test shortage last March, the lab processed 200 COVID-19 samples a day. Today, 60 lab technicians assay 4,500 tests daily, gathered from 24 different Toronto-area hospitals – a temporary plateau. “Clearly, we don’t know what’s going to happen come September, October, when the so-called flu season starts,” Dr. Tony Mazzulli, the director of the Mt. Sinai/UNH microbiology department tells me when I ask about the new school year. “We all expect it’s going to go up as more people get colds, coughs, runny noses. But it’s always a prediction, rather than knowing.”
My swab gets logged and placed in a $150,000 machine that performs a “real-time reverse transcription polymerase chain reaction.” The machine is artificially intelligent but comes with 82 pages of instructions for the lab’s technicians, another commodity still in short supply across the country. The machine needs four hours to find zero COVID-19 in my snot.
“If you were infected today,” Dr. Mazzulli says, “and you came this afternoon to be tested, your test would almost certainly be negative. You have to allow it time to start growing. That usually takes 48, more likely 72 hours.”
The new barrage of testing costs a lot of money and the supply of tests still isn’t secure. “At this very moment,” Dr. Mazzulli says, “two of Mt. Sinai’s five suppliers aren’t supplying tests because they don’t have the raw materials.” At one desperate point last spring the hospital paid a Chinese supplier (none of its test makers are Canadian) $1-million for 200,000 plastic swabs, at $5 a poke – cash, up front. James Yantzi, the Canadian representative of Seegene Inc., a Korean test maker, sells them to U.S. hospitals for anywhere from $150 and $300 a test. Here in Canada, Mt. Sinai pays him up to $20 for each one; swabs and disposable tips are extra. Meanwhile his business has grown fifteen-fold in five months.
But the pandemic always seems to swim ahead of us. In the spring, everyone wanted more testing. Now we’re too paranoid to lay off. Ontario has logged fewer than 100 new COVID cases a day since July 28. Current testing levels in Ontario range between 17,000 tests on a slow day and 35,000 on a nervous one. “I don’t know if there’s an actual Ontario testing target,” Christine Bruce, Mt. Sinai’s administrative director, says. “It certainly hasn’t been shared. Right now, we’re hovering at a 40,000-a-day target, with some predictions of growth to 50,000. But I think the modelling of what we truly are going to need in the fall is still a little bit in flux.” One thing is certain, according to Michael Gardham, the hospital’s medical director of infection control. “The government does not want to be accused of sleep-walking.”
Which is why the news in COVID-testing has a distinctly bipolar feel these days.
Some public-health experts claim we each have a moral obligation to get tested, because that proves we’re all in this together. Others say it is morally reprehensible to indulge people with no symptoms when there’s a shortage of assays.
This week in Canada, the Globe has learned, a group of infectious disease doctors plans to circulate a letter to Canada’s health ministers, calling for a halt to the unrestrained testing of people with no symptoms and no pressing reason to be tested beyond their own nervous whims. The doctors maintain unbridled testing will pull focus from genuinely sick patients, overwork labs and further strain the resources of the public health system.
Michael Gardham doesn’t agree, but thinks the letter writers may have a point. Early in the pandemic, he says, “the criteria necessary to get tested were quite strict. And so that leads to all sorts of potential biases in the information that we are reporting.” Canada was lulled into thinking our main COVID problems were travellers and health-care workers, because that’s mostly who we tested with the tests we had. “I personally believe that our focus on travellers – which was appropriate early on –made us keep focusing on travellers when we should have been focusing on local transmission.” That might have reduced the carnage in long-term care.
So am I wrong to use up a valuable test when I have no symptoms? “Right now,” Dr. Gardham says, “testing asymptomatic people makes a lot less sense than it did two months ago. Because we had a lot more COVID two months ago.” But no one wants to infect someone else, especially the vulnerable. “There’s no single right answer to these questions. We need to be agile and flexible. We need to change as the epidemiology changes.”
That is rational and sensible and true. I just keep thinking of Joan Gauthier, lined up in the heat to be tested so she can visit her ailing husband. He’s a retired professor of philosophy, a Hobbesian realist who believes human beings invent moral values not because we’re high-minded, but because they’re a fancy way of striking a deal between what we want and what we’re willing to do to get it. “I continue to test negative, and I would be very surprised if I did not,” Joan said to me that hot morning. She’s conscientious – wears a mask, washes her hands, avoids crowds. “I don’t pat myself on my back,” she said. “I just feel I have an obligation to keep healthy so I can be some kind of support for my husband.” A pandemic tests your love in the most literal way.
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