COVID-19 case counts will drop artificially as testing moves to appointment only, experts warn

Artificially lower case counts will result this week when the Ontario government makes COVID-19 testing by appointment only, say infectious disease experts.

Dr. Sumon Chakrabarti, an infectious disease specialist at Trillium Health Partners in Mississauga, said case counts this week will be "unreliable" in Ontario because the provincial government is making testing for COVID-19 available by appointment only as of Tuesday.

Saturday was the last day for walk-in testing across the province, which means people who want to get tested have to book an appointment by phone or online. 

Some assessment centres at Toronto hospitals, including Mount Sinai Hospital, Michael Garron Hospital, the University Health Network and Unity Health Toronto, are booking appointments online. A few of the centres are booked solid for Tuesday and Wednesday already.

"One thing to take away from this is you might notice that the number of cases of positives are going to artificially be decreased in the coming days," Chakrabarti said in an interview with CBC Toronto on Sunday.

"We have to keep in mind that is because of what's happening with the testing. It's still important in the background — we've seen a sustained rise in cases. And these numbers are going to be unreliable. We still need to do something to bring this under control."

According to the province, none of the assessment centres were supposed to be taking walk-ins on Sunday and Monday. On Sunday, some were closed, while others were open for already booked appointments.

Chakrabarti said the transition to testing by appointment only will affect case counts because it is likely that fewer people will be tested while the move takes place, but he insisted there is still a lot of testing being done.

"You want to be able to look at the overall trend," he added.

On Friday, Premier Doug Ford announced that the province will move to "appointment-based testing" to provide certainty to residents about when they can receive a test during the winter months, to allow assessment centres to conduct deep cleaning, and to allow the province's network of labs to process a backlog of tests.

The move comes as the government has endured criticism over long lines at assessment centre and a rapid rise in the number of cases.

"We have made some tough but necessary decisions always based on the best medical advice and scientific evidence available," Ford said.

Changes could 'really start to skew the picture,' doctor says

Dr. Andrew Boozary, a primary care physician and executive director of Population Health and Social Medicine at the University Health Network, said case counts may not accurately reflect the number of positive cases in Ontario because people might have trouble booking appointments.

Case numbers may also be affected by the fact that there is a backlog of unprocessed tests and Toronto Public Health has decided to suspend contact tracing, starting on Saturday, he said.

"Because of the backlog, because of the challenges now with contact tracing and the challenges in accessing testing, there's no doubt going to be an effect on what the numbers and daily cases reports look like," Boozary said on Sunday. 

"And I think that's the major challenge, is when you've got a testing system that is in great peril and under huge amounts of stress and is not able to capture as much as we'd all hope it would, in terms of where the positive cases are, how we can ensure that people are getting the support they need and being able to isolate safely, it can really start to skew the picture."

Boozary said the new appointment-based model may be difficult for low-income people to access because they might not have internet access to book appointments, or sick days that would enable them to take time off work for one specific appointment time.

Waiting for an appointment could mean positive cases are not isolating, he added.

Humber River Hospital to test 180 fewer people a day

At least one Toronto hospital has reported receiving 150 calls about appointments in just half a day.

Ruben Rodriguez, manager of the COVID-19 assessment centres of Humber River Hospital, said the hospital's two assessment centres will be testing 180 fewer people a day, compared to when it provided walk-in services, but it plans to extend hours. The two assessment centres used to test about 500 people a day.

Rodriguez said the new pre-appointment screening will ensure only those who meet testing guidelines will receive a test. 

"The number of tests we will do right now aligns with the true individuals who need a test," he said.

Humber River Hospital is supportive of the move to test by appointment only because it means people do not have to wait in the cold for hours, he said.

Mobile, pop-up testing centres to continue, province says

According to the Ontario government, the change to appointment-only testing will enable testing centres to better screen patients online to ensure they meet the testing guidelines.

In a news release on Friday, the government said mobile testing and pop-up testing centres will continue to ensure that the province can reach vulnerable populations in neighbourhoods where case counts are high and in long-term care homes where hundreds of deaths occurred in the spring.

The government said it also wants to expand the number of pharmacies where people with no symptoms can get tested.

And it said it hopes to increase capacity to 50,000 tests per day by mid-October and 68,000 tests per day by mid- November and to introduce new testing methods once they are approved by Health Canada.