Since January 5, it is no longer possible for the general population to go for a PCR test at a screening center to confirm a diagnosis of COVID-19. Four months and a new wave later, the Ministry of Health and Social Services (MSSS) says that there are still no plans to “further expand” access to these tests in screening centers, in ” a concern for the efficient use of available resources, and to identify the most vulnerable clienteles”.
The average of 15,000 daily tests currently carried out with priority clienteles “provides sufficient data to adequately monitor the evolution of the pandemic”, assures the MSSS in an email sent to the To have to. Health care workers, homeless people, members of Indigenous communities, symptomatic staff in the school network and people aged 70 and over with symptoms are among the priority groups.
The MSSS did not want to advance on groups that could be added to the priority clienteles. Symptomatic people who are not in said groups are therefore still advised to use rapid tests.
For public health specialist Roxane Borgès Da Silva, this “paradigm shift” is entirely relevant at a time when Quebec is learning to live with the virus. “Do we need to allocate human resources to mass screening as we did before, in a context of shortage and where it is very expensive, knowing that there are other methods? she asks.
“We have reached a stage where we are very correct with a more “public health” screening tool [comme les tests rapides]a bit like we do with breathalyzers, pregnancy tests or people with diabetes who test their own blood sugar,” she gives as examples.
Quebec has distributed more than 60 million rapid antigen tests in recent months. The MSSS also affirms that the agreement with the Quebec Association of Proprietary Pharmacists (AQPP) has been renewed “to allow distribution to continue as long as deemed necessary”.
“Bridging the Knowledge Gap”
“Having data is the sinews of war when you are in crisis management to know what to expect,” recalls Roxane Borgès Da Silva. However, the introduction of rapid tests and the restricted access to PCR screening tests since the fifth wave have decidedly affected the data on the pandemic in the province, such as the number of confirmed cases, their distribution by age and sex, the active and recovered cases, number of samples, positivity rate and number of outbreaks by setting.
“As of the end of 2021 and the beginning of 2022, these results are no longer representative of the situation for all of Quebec,” reads the website of the Institut national de Quebec Public Health (INSPQ).
However, the challenge remains, since very few Quebecers transmit the results of their rapid tests on the government self-declaration platform. According to the latest CIRANO study from April 21 to 26, only 27.4% of respondents had entered their positive rapid test result there.
For his part, Janusz Kaczorowski, Full Professor and Director of Research in the Department of Family Medicine and Emergency Medicine and at the CRCHUM of the Université de Montréal, believes that certain strategies could be put in place to improve these results. The obligation to enter rapid test results online in order to obtain new boxes, for example, would be a good incentive, according to him.
Consequently, in the absence of open screening and reliable data from rapid tests, surveys are now taking over to estimate pandemic trends.
After Roxane Borgès Da Silva and a team of several CIRANO researchers had surveyed the population to estimate the trends of the pandemic since January, the INSPQ — in partnership with the MSSS — is now preparing to take up the torch.
A monitoring project surveying 30,000 vaccinated Quebec adults and serving to estimate the number of cases in the province has just been launched. “This monitoring project could be renewed in the coming weeks and will serve as a tool for monitoring the evolution of the pandemic”, can we read on the site. The INSPQ still does not know when the first results will be available, according to a spokesperson.
Even if there are certainly sampling biases, a survey method is “very interesting” as an alternative, believes Roxane Borgès Da Silva.
“For PCR tests, we could clearly see in the INSPQ surveys in the fall that people were going to be tested less and less, and this is even more the case with the advent of rapid tests. In this context, to find out what the trend in the incidence of cases is, a survey method makes it possible to fill the lack of knowledge that we have, ”she judges.