Sharing an update from Ottawa’s Medical Officer of Health, Dr. Vera Etches, with COVID-19 updates and addressing questions and concerns related to COVID-19 testing.
Background
From the onset of the pandemic, the Champlain Health Regional Incident Command (CHRIC) and Ottawa Public Health (OPH) have worked collaboratively to implement the Ontario Ministry of Health’s policies on testing priorities across Ottawa.
Resources are limited and, in order to ensure they are used as effectively as possible, the goals of testing for COVID-19 responsively have changed over the course of the pandemic. As information, best practices and directions to protect the public continue to evolve, so too have provincial guidelines.
On April 21, 2020, the Ministry of Health announced a directive for immediate surveillance testing of every resident and staff at each long-term care home (LTCH). OPH, in collaboration with CHRIC and Ottawa Paramedics Services, developed and implemented a plan to facilitate this testing in 21 LTCHs within a 3-week period. CHRIC and OPH also supported surveillance testing in a number of retirement homes.
In May 2020, the Premier of Ontario announced that anyone in the province could get tested for COVID-19 should they feel they need a test, regardless of whether they have symptoms. The Ontario Ministries of Health and Long-Term Care also released new policies for Resuming Visits in Long-Term Care Homes, Reopening Retirement Homes and Resuming Visits in Congregate Living Settings, which, at the time, included the requirement for a negative test within the last two weeks prior to being permitted for both indoor or outdoor visits at these settings. Recently, the Ministry’s visitor requirements have changed requiring that, for indoor visits only, visitors must provide a verbal attestation to home staff that they have tested negative for COVID-19. Attestation of testing is no longer required for outdoor visits.
In addition, on May 26, the Ministry of Health announced the gradual restart of the health care sector.
Local public health units do not have jurisdiction to make changes to provincial testing guidelines and requirements. Nonetheless, to cope with the demand exceeding local capacity, OPH is exploring ways to highlight what populations are most recommended to go for testing because they are at greater risk of COVID19 as well as communicate about the lower value of testing in low risk circumstances.
Testing and tracing alone as a strategy will not stop the transmission of COVID19 in Ottawa. When people stay 2 metres away from others, limit their social gatherings, wear masks indoors, and wash their hands, this slows the transmission of COVID19.
Given the reality of community spread of COVID19, OPH is also focused on ensuring that access to testing is prioritized for people at higher risk of infection. Testing and follow-up of cases and contacts, combined with epidemiology analysis, enables OPH to understand patterns of transmission and target prevention messaging, as well as control outbreaks.
Roles and Responsibilities
Ontario Health is responsible for developing and implementing the provincial COVID-19 testing strategy that, in addition to focusing on asymptomatic residents in higher risk settings, specific essential workplaces, outbreaks and targeted campaigns, also includes providing testing for any resident who feels they need a test, even if they are not experiencing symptoms.
Protecting Ontarians through Enhanced Testing outlines the Ontario Health testing plan. Questions related to this provincial strategy can be submitted to Ontario Health through an online form.
In the Ottawa context, the Champlain COVID-19 Response Committee (CCRC), under the direction of Ontario Health, is responsible for developing and implementing a regional testing strategy that aligns with the provincial policy approach to COVID-19 testing.
The CCRC has the lead operational responsibility to provide local testing for COVID-19. As such, it staffs, operates and manages the Assessment Centre and the two (2) COVID Care Clinics through local hospitals. CCRC is also responsible for operationalizing targeted testing campaigns, under the direction of Ontario Health. Accordingly, any questions related to the Assessment Centre or Care Clinic sites – the policies or protocols at the sites, professional conduct of staff at the sites, the type of tests administered, wait times, availability of test results, hours of operation, maintenance, line management/volume, or any other aspect of the testing sites – should be directed to testinginquiries@toh.ca.
Ontario Health’s testing plan has three pillars of which, in the Ottawa setting, CCRC is responsible for two (assessment centres and targeted campaigns), whereas OPH is responsible to inform targeted campaigns and indicate who requires testing (outbreak management):
| Initiative | Lead for strategy | Details of management |
| Assessment Centre Testing | CCRC | In Ottawa, CCRC manages the Brewer Arena Assessment Centre and the two COVID-19 Care Clinics (595 Moodie Drive and 1485 Heron Road), as well as mobile testing for certain populations in partnership with the LHIN, Ottawa Inner City Health and Community Paramedics. |
| Targeted Campaigns | CCRC & OPH | OPH monitors cases to detect community cases, including spread among priority populations and in congregate living settings, and directs where targeted campaigns are required.CCRC operationalizes targeted testing campaigns |
| Outbreak Management | OPH | OPH investigates confirmed COVID-19 cases and ensures that those who need testing are able to access it through health sector partners. |
As part of its role in outbreak management, OPH also works with institutions to ensure Infection Prevention and Control (IPAC) measures are implemented to control subsequent spread.
Lastly, the prospect of additional testing sites and testing site options is a partnership between OPH and CCRC. Given the limited capacity for mobile testing operated by our healthcare partners, OPH is prioritizing testing based on investigation of clusters of cases in neighbourhoods or communities. Please see below for a summary of recent initiatives.
It is also important to note that, for individuals with barriers to testing, such as mobility issues, there is a mobile option available by referral from a healthcare provider.
Update
As stated above, OPH is focused on ensuring that access to testing is prioritized for people at higher risk of infection. Below is a summary of some of the testing initiatives aimed at addressing this.
Emergency Shelters and Vulnerable Populations
OPH, in partnership with Ottawa Inner City Health and Ottawa Paramedic Services, ensured access to COVID-19 testing for the chronically homeless, emergency shelters, and other congregate settings. Through this initiative, over 2000 individuals at 24 congregate settings were provided with access to COVID-19 testing and received COVIDWise information between May 1st and July 22nd.
Mobile Clinic Pilot – July 11, 2020 in Ogilvie North Park
In response to concerns about access to testing for low-income residents in some east end communities, a pop-up COVID-19 assessment clinic was held on July 11, 2020 in Ogilvie North Park.
This clinic was a partnership between Ottawa ACORN, the Ottawa Hospital, the Sandy Hill Community Health Centre, the Children’s Hospital of Eastern Ontario (CHEO), Ottawa Inner City Health and the Ottawa Paramedic Service.
The location was chosen because of its proximity to two Donald Street apartment towers that house a high concentration of newcomers, low-income tenants, people with disabilities and people who don’t speak English as their first language.
Approximately 120 people attended this 1-day pop-up mobile clinic.
Outreach Testing in four (4) Ottawa Communities – July 16 to19, 2020
Through ongoing surveillance, OPH identified suspected clusters of COVID-19 cases in four (4) Ottawa residential communities – Craig Henry, Heatherington, Herongate and Prince of Wales. In order to make it easier for residents of these communities to get tested, OPH worked with the Champlain Health Region Incident Command (CHRIC), healthcare and community partners to bring mobile testing to these communities between Thursday July 16 and Sunday July 19.
Residents living in proximity to the suspected clusters received a letter and flyer, hand delivered to their homes, to inform them of this testing opportunity and to encourage them to attend the mobile clinics to get tested. This information was shared with local health centres serving these communities and with the local community associations so that they could also promote these testing opportunities. Lastly, the information was shared with the ward Councillors and the local Members of Provincial Parliament representing these communities, for their awareness.
Approximately 287 people were tested at the Craig Henry location, 128 people were tested at the Heatherington location, 268 people were tested at the Herongate location and 188 people were tested at the Prince of Wales location.
The mobile testing at these four locations resulted in very few positive tests (less than 0.5% across the four sites).
Lessons learned and go-forward strategy:
- Deploying rapid mobile testing in disproportionately affected communities is not resulting in the detection of a large volume of new cases. This is likely due to barriers other than direct access to testing, such as perception of the threat of COVID-19, understanding of the reasons for testing, and concerns about how one will be viewed in their community if they are seen presenting for testing. This speaks to the importance of focusing on health promotion and prevention messaging, as well as working with community leaders and partners to prevent virus transmission in the community.
- OPH is working with partners to find new ways to better reach these communities with COVIDWise messaging and to better understand what supports they need.
Addressing the Needs of African-Caribbean and Black (ACB) and Ethno-cultural Communities
In mid-May, Public Health Ontario released a report that showed an over-representation of African-Caribbean and Black (ACB) and ethnocultural communities in our positive COVID-19 cases and deaths. A review of the social determinants of health (SDH) data collection in Ottawa since May 8, 2020 further validated this concern. The response to this situation has included:
- Actions by both the Human Needs Task Force (HNTF) and OPH in connection with the ACB and ethnocultural communities in Ottawa.
- Engagement of partners to determine/validate community needs. This was done through meetings and a questionnaire to get partners’ perspective of what is happening in the community. This has provided some insight into the specific needs of these communities and the barriers for them to access testing and, more importantly, the barriers for members of these communities to understand and implement the strategies to protect themselves and their families.
- Continuing work with the HNTF and community partners on a strategy and options to specifically address inequities related to COVID-19 outcomes.
Looking Ahead to School Re-openings
OPH is also working closely with Ottawa’s four school boards on their re-opening strategies. Over 200,000 children and youth have been home since March 16, 2020. September will hopefully see many of these students back in school. OPH will work with the local school boards and testing partners to develop appropriate testing strategies to quickly respond in the event of any cases linked to schools.
In my latest COVID-19 update, I shared details from the Ontario government about their plans to safely reopen schools in September. As further information becomes available, I’ll be sure to share it with our community. As always, please reach out should you have any further questions or concerns: Jenna.Sudds@ottawa.ca