June 3, 2020
Updated June 4, 2020 at 12h17
COVID-19: no random testing or large-scale view in Quebec
Despite the expansion of the offer of testing, detection capacity is still limited in Quebec, according to a committee of the ministry of Health, who does not recommend that you open these tests to other needs and to “ensure continuity of care and safe environments of care and living environments”. No random testing or large-scale in the population on the horizon, so. Even the systematic screening of health workers returning from an assignment in the hot zone is not recommended.
At the beginning of April, the national director of public health, Dr. Horacio Arruda, said in a press briefing that random testing would “probably be made in some territories” in order to better measure the communal transmission of the virus.
Among the series of interim recommendations just published by the committee of the ministry of Health on the access to tests of nucleic acid amplification, recommendations that will enable directors of public health planning of the new screening strategy that will replace the one for the 1st of may, no does screening of asymptomatic individuals other than in environments that are very targeted.
As a reminder, the screening on a random basis or on a large scale is a strategy that has been used by Iceland and that concluded that half of the carriers of the SARS-CoV-2 had no symptoms. The operation was to understand more precisely the prevalence of the virus in the population and avoid that people propagate it without knowing it.
The number of reported cases of COVID-19 is currently on the decline in Quebec, which has a capacity daily of about 20 000 tests, reminded the committee in his 26-page document. “Québec must continue to invest in this technology to support emerging needs. A horizon of 35 000 tests appeared to be relevant, especially if Québec is facing an upsurge in the number of cases (second wave) with the resumption of economic activities and social”, writes the committee.
But at the present time, the capacities remain limited. According to the committee, “extreme caution in the use of tests outside of these recommendations is currently required”.
Among these recommendations are: maintain the prioritization of access to testing for persons with symptoms compatible with the COVID-19; testing of close contacts and long-term confirmed cases; organising the screening of contacts and asymptomatic carriers in healthcare settings and living environments; to consider, depending on the situation, screening of asymptomatic individuals during an outbreak in the workplace, daycare or school; offer screening to people who would undergo a procedure, immunosuppressive regimen, to transplant patients and their donors; test for admission into units, acute care, pediatrics, psychiatry, or obstetrics; testing for the medical procedures or surgery, which may require intubation or a gastroscopy; and, finally, to offer screening to isolated regions for the implementation of programmes for management of inputs.
“Access to the [testing] conditions of more continuity of care and safe environments of care and living environments. At present, however, the committee may not open up to other needs, even in a clinical setting,” summarizes the committee.
No screening of caregivers
Several applications have not been able to be selected by the committee. Among these, the demands for caregivers, helpers, parents of pediatric patients, workers in transit to remote regions or cold, those same people asymptomatic hosted in some circles of life such as logging camps.
“These situations are at high-risk of overconsumption of the current capacity. The committee recognizes that the relevance of screening for these individuals may be justified, but remember that the [testing] one-off are not a panacea with respect to universal measures and segregation”, stresses the committee.
Many representations have also been held to test in a systematic way the workers in the hot zone or the return of an assignment in a ltc facility outbreak, notes the committee.
“For the committee, the isolation, the universal measures of prevention, including the wearing of personal protective equipment, and self-monitoring of symptoms remains the best approach,” writes the committee, which “discourages the mobility of health workers between facilities or between units qualified hot to the units, warm or cold”.
According to the committee, “the screening of workers at the back of a unit or a hot installation is a very high risk of overuse of the offer” of testing, considering the number of workers in the network.
The committee agrees, however, to study this recommendation “in light of the volumes available”.
The CISSS of the Chaudière-Appalaches will continue its mobile clinics
The CISSS of the Chaudière-Appalaches began on Tuesday to deploy a mobile clinic screening without an appointment. With a capacity of 100 tests per day, this mobile unit has a mandate to proceed with the screening of symptomatic individuals and asymptomatic individuals within the population, explained the CISSS in a press release.
Questioned whether the facility had to pursue this initiative in light of the recommendations of the ministry of Health, the spokesperson Mireille Gaudreau stated that “the mobile clinics continue to reach out to the public more vulnerable.”
“They are there to meet the needs of those symptomatic or asymptomatic, who do not consult usually for health services. The goal of the test in asymptomatic persons is to protect the environments of living, working, or in vulnerable communities (tenants of social HOUSING, homeless, or users of drugs). The goal is to reduce the transmission of the COVID-19 in the community and to ensure the safety of living environments,” says Ms Gaudreau.