From the moment the Omicron surge, which was infecting thousands a day, emerged, the government restricted access to PCR testing. And daily reports on the COVID-19 situation only mentioned hospitalizations and deaths. The number of new positive cases has disappeared. One has to wonder if the state still maintains sufficient surveillance.
Santé Québec publishes a daily report on the situation, in which it is specified that since “access to screening centers is restricted to priority clienteles, the number of cases identified […] is not representative of the situation for the whole of Quebec”.
Access to nucleic acid amplification tests (NAATs, or PCR in English) was indeed restricted on December 20, 2021. Only essential workers (police, firefighters, school and child care and health sector personnel health) are entitled to it. In such a context, it has thus become much more difficult to draw an accurate portrait of the number of positive cases in circulation.
The extent of contamination within the Quebec population is currently estimated mainly from the voluntary declaration of the results of rapid tests, the monitoring of absences from schools, as well as from analyzes of the presence of the virus in wastewater from the cities of Montreal, Quebec, Laval and Gatineau.
Wastewater monitoring, however, can only determine temporal trends in the circulation of the virus within the population. Wastewater, on the other hand, has the advantage of including viruses excreted by “asymptomatic people or people who have not been tested”, underlines one of the coordinators of the wastewater analysis project, Dominic Frigon, of the McGill University.
The Ministry of Health and Social Services (MSSS) assures that “the surveillance systems [de la COVID-19] are always the same”. A tool has also been added to the vigilance network with the provincial wastewater monitoring program, specifies Robert Maranda, spokesperson for the ministry.
At the Laboratoire de santé publique du Québec (LSPQ), we are told that the monitoring of variants in circulation has not weakened despite the restriction of access to NAAT tests, quite the contrary. “We have implemented a new process that allows us to have sequencing results much faster. Only ten days elapse, compared to two to three weeks previously, between the sampling and the identification of the variant present in the sample”, specifies Inès Levade, scientific adviser at the LSPQ and coordinator of the Expert Committee on genomic monitoring of SARS-CoV-2.
Fog
Nevertheless, several experts believe that a more precise portrait of the situation would be necessary. “Advancing in the fog like this [comme au Québec] in crisis management, it’s really a very bad strategy, because we are not able to prevent, we do not know what is coming, and that can raise enormous stakes. It is true that these variants [qui circulent en ce moment] seem much less harmful. But infected people must comply with isolation and containment measures which can have a strong impact on society, on all economic sectors,” notes the professor at the School of Public Health at the University of Montreal. , Roxane Borges Da Silva.
The latter was able to experience this week the exemplary performance of the COVID screening and tracing system in France. Her son had access to a NAAT test following a positive rapid test and, in addition to receiving the positive result by text message, a public health investigator took the initiative to contact the airline to that she warns passengers who have traveled near the young boy so that they can take a screening test.
In Quebec, the Regional Public Health Department is currently carrying out “a shortened investigation of most cases having had access to NAATs that are declared to it, according to capacities and priorities. And in the context of an outbreak in a living environment for seniors, it carries out further investigations, ”says Marianne Paquette, media relations advisor.
Expanding access to PCR tests to the entire population would provide a better idea of the state of the pandemic, says Nathalie Grandvaux, researcher at the CHUM Research Center on Respiratory Viral Infections. Even if several people are infected, the number of screening tests to be carried out would not be unreasonable for the moment, she argues.
“It would not be necessary to authorize access to NAAT tests to people who are simply exposed. But these tests, combined with sewage monitoring, would give us a more accurate picture of what is happening with community transmission. And such a portrait would be important for reasons of hospital and community resource management (CLSC, CHSLD). It is difficult to manage resources, to assign nurses and respiratory therapists to the services that need them the most, when we do not know what will arrive at our door, “adds the Dr Don Vinh, microbiologist-infectiologist at the MUHC.
In a press briefing on Wednesday, the national director of public health, Dr.r Luc Boileau, however, closed the door to the idea of making NAAT tests accessible to the general population.