When the province announced it was going to move toward appointment-based COVID-19 testing only beginning October 6, concern broke out immediately.

"People who don't have phones need the same access to testing and treatment in a timely and dignified manner. We know at NorWest, about four per cent of our rostered clients don't have a phone. And of all the clients we see, even if they don't come here for primary care, about 4500 people don't have their own phone," said Jennifer Lawrance, director of health services for NorWest Community Health Centres.

That makes up roughly one-third of all the people that use one health service or another at NorWest, including the safe consumption site Path 525 and the rapid access addictions clinic.

And according to Lawrance, there isn't a strategy or support from the provincial government about how to make sure people who may otherwise fall through the cracks can access COVID-19 testing. That means it has fallen to healthcare organizations in the city and district to come together and make develop a testing plan.

"To be frank, it's frustrating that this isn't coming down from the province. There's a real appetite within the city to make that happen and I think one thing about Thunder Bay is we're great at working together to make things happen. People don't worry about silos or mandates so much," added Lawrance.

That's where the City of Thunder Bay Testing Strategy working group comes in.

It's a group, organized by the North West Local Health Integration Network and including 21 representatives from healthcare organizations in the city, that meets regularly to plan and coordinate a testing strategy for the city.

But the network of agencies didn't always exist.

At the outset of the pandemic, the Thunder Bay District Health Unit (TBDHU), the Thunder Bay Regional Health Sciences Centre and Superior North EMS held regular, informal meetings to set up the COVID assessment centre at the hospital and build testing capacity, explained Superior North's COVID-19 task force commander Shane Muir.

"To begin with, it was kind of an informal arrangement. And to be honest with you, the roll out of assessments happened so fast there wasn't the time to do planning. Everybody was just kind of get operations [running] as quickly as possible. So we established our assessment centre and we established it as an option for everybody," said Muir.

Once the assessment centre was set up, EMS turned its attention to high-risk populations.

"We've been focusing mostly on people who have a hard time getting out of their homes and mobility, transportation issues and pediatric patients. We just find that when we do those assessments and testing in the home, we just get a much better outcome," Muir said.

But over the last few months, provincial directives for testing have been in constant flux and additional agencies got the capacity to test, including NorWest which does allow for some walk-in tests to occur if individuals have accessibility issues otherwise.

Then on September 10, Northern Supply Chains (NSC), a shared service based at the Thunder Bay regional hospital since 2011, was tapped by Ontario Health to coordinate orders for COVID testing kits for all eligible healthcare providers across the Ontario Health North region ----- which numbers more than 600 organizations.

The supply chain service, which was also supporting deliveries of critical supplies like respirators, gowns and face shields since March, has a simple online platform organizations can log in to, input the number of test kits and other supplies they want to order, answer a few basic questions and submit their order, with the supplies arriving often within the week according to NSC director Michael Giardetti.

Both NSC and Public Health Ontario have their own processes to review and assess the requests to ensure their reasonableness, but there is no communication from the provincial level about who is ordering how many tests, which further creates the need for the municipal working group, said Lawrance.

According to the EMS' Shane Muir, with the growing number of organizations that have access to and can conduct testing in the city, including the creation of the school-focused assessment centre at Confederation College, the working group isn't as worried about ramping up testing capacity. They're focusing on determining just how many tests should be conducted so as not to overwhelm the public health lab in Thunder Bay.

"We are trying to really work within that laboratory capacity and as well as the rest of the municipality and district and the system, because we don't want to have too many tests coming in at once. So this is direction that's new from the ministry that's come down to us from Ontario Health," he said.

In a written statement to CBC News, spokespeople from Ontario Health said, "work to increase capacity in Thunder Bay and the rest of Northern Ontario is primarily focused on recruiting more health human resources and adding technology, particularly new testing platforms."

However, as the case count in Ontario continues to climb, Ontario Health would not say how many daily tests the laboratory in Thunder Bay can process, nor what the desired target is.

When the public health lab in Thunder Bay is overwhelmed, tests are sent to labs either in Toronto or Winnipeg for processing.