Laboratory testing for COVID-19 in Canada is facilitated by an individual’s health care provider, in consultation with their respective provincial public health laboratory (PPHL). The PPHL coordinates the provision of specimens to the National Microbiology Laboratory (NML) for further testing, as necessary (PHAC, 2020h). The guidelines for testing, as well as the settings in which patients are tested and the capacity for testing, are dictated by provincial and territorial (PT) public health authorities and PPHLs (PHAC, 2020h). A positive result must depend on either nucleic acid amplification tests on at least two specific genome targets, or a single positive target with nucleic acid sequencing (PHAC, 2020b).
On March 18, 2020, an interim order was signed by Health Canada to expedite access to COVID-19 diagnostic laboratory test kits and other medical devices (Health Canada, 2020a). The order was designed to provide more flexible approval for the importation and sale of diagnostic tests and, so far, it has allowed easier access to 18 new diagnostic tests (Health Canada, 2020a). During March 2020, many PPHL were certified by the NML to report negative COVID-19 swab results, without awaiting confirmation from NML; subsequently, numerous PPHL have also received validation to report positive swab results without NML confirmation (Newfoundland and Labrador, 2020a).
On April 23, 2020, Prime Minister Justin Trudeau announced a CA$350 million investment to expand national testing and modelling efforts (K. Harris, 2020a). He also announced the creation of a new COVID-19 immunity task force focused on serology testing (ibid). The COVID-19 Immunity Task Force will gather samples from one million Canadians over two years and provide insight into the level of immunity in the general population (K. Harris, 2020a). On April 24, PHAC released a guidance document to manufacturers of serological assays intended to detect antibodies to SARS-CoV-2 (PHAC, 2020v). It outlines recommendations for the minimum testing to be performed for an application to be authorized under the interim order for medical devices (described above). On May 12, 2020, Health Canada authorized the first COVID-19 serological test for use in Canada (Health Canada, 2020e).
Each province and territory (PT) is responsible for determining its own testing criteria and procedures, as well as ensuring adequate supply of testing kits; thus, testing guidelines and capacity have varied across PTs. Many provinces have developed plans to increase the number of tests completed per day and, further, have expanded testing eligibility criteria over the course of the pandemic. For example, after facing much criticism of under-testing and, specifically, lower numbers of tests conducted relative to other provinces, the Government of Ontario announced an expansion of its COVID-19 testing capacity on April 10 (Office of the Premier, 2020b). Further, as part of Ontario’s Action Plan for Protecting Long-term Care Homes, the province began testing asymptomatic residents and staff in select facilities across the province in April 2020 (Ontario, 2020d). On May 14, 2020, the Ontario government further expanded its eligibility for testing to include anyone with symptoms of COVID-19 (Ottawa Public Health, 2020). Further, on May 29, Ontario began rolling out an expanded testing strategy that includes “targeted campaigns” to test workers in communities and sectors experiencing outbreaks (Ontario, 2020g). This included testing asymptomatic individuals from long-term care homes and other shared living spaces, e.g. shelters and group homes, as well as workplaces in priority settings where physical distancing has proven challenging (Ontario, 2020g). However, in May 2020, the province was still not meeting its testing capacity targets; in response, Prime Minister Trudeau stated on May 21 that the federal government would be prepared to provide financial and logistical support to help Ontario and other PTs increase their testing and contact tracing capacity.
On May 16, 2020, Dr. Tam announced that Canada was testing an average of 26,000 to 28,000 people daily (PHAC, 2020y). As of May 27, 2020, 1,528,239 people have been tested for COVID-19 across the country (40.65 tests per 1,000 people) (PHAC, 2020x). Over the week of June 1-7, Canada was testing an average of 33,000 people daily (PHAC, 2020z); as of July 5, Canada had tested an average of 39,000 people per day over the previous week (PHAC, 2020ad). In a recent statement by Dr. Tam, it was reported that labs were testing an average of almost 48,000 people per day with 0.7% testing positive (PHAC, 2020af).
Specific provincial and territorial measures are reported by the North American Observatory on Health Systems and Policies on their dedicated COVID-19 page (https://ihpme.utoronto.ca/research/research-centres-initiatives/nao/covid19/).
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