COVID-19 Testing Strategy for Ontario
Timely high-quality COVID-19 testing is a critical component of our pandemic response in addition to infection prevention measures.
- Testing is the only way to confirm if someone has COVID-19.
- The rate of infection (percentage of tests that are positive for COVID-19) shows if the virus is spreading in the community and where the hotspots are.
- This information helps public health officials make recommendations to reduce further spread.
Ontario Health, the provincial government, Public Health Ontario and health system partners are working together to ensure that anyone who needs a test can get a test. This work is in accordance with the testing guidance by the Chief Medical Officer of Health that considers evidence-based recommendations from a Testing Strategy Expert Panel via Public Health Ontario.
The guidance covers who to test, what tests to use and where tests should be done.
Ontario Health’s role in testing is coordination, specifically specimen collection, transportation / routing, lab analysis and reporting. All of our work is aligned with the Ministry of Health’s most up-to-date evidence-based guidance.
Ontario Health helps to secure testing supplies (swabs, reagents, etc.) for the public health system and distributes them to assessment centres, hospitals, long-term care homes, etc., in alignment with Ontario Health’s regional work in planning and supporting COVID-19 testing.
In response to COVID-19, Ontario has:
- Completed more than 9 million tests from March to Jan. 2021 (more than 5 million completed from Sept. 24 to Jan. 21, 2021)
- Opened 171 assessment centres
- Expanded testing up to 213 pharmacies
- Expanded test processing and analysis to a network of 40+ labs
- Increased testing to 60,594 tests per 100,000 population
- Established a distribution network of couriers and Ornge to deliver specimens to labs
*Data as of January 22, 2021
For more information
- Ministry of Health’s COVID-19 Provincial Testing Guidance Update (Nov. 20, 2020)
- Ontario’s COVID-19 Case Data (updated daily): Includes case status, demographics and testing
- COVID-19 Testing Locations
- Ontario Health testing updates to the health system
The COVID-19 Testing Network
Ontario has built a network of partners to manage every step of COVID-19 specimen collection, transportation / routing of specimens, laboratory analysis and reporting.
Specimen collection began with the opening of assessment centres designed specifically for COVID-19 testing. This approach helps manage risk and divert the flow of potential COVID-positive patients from hospital emergency departments, freeing those resources for other urgent patient care.
In addition, a partnership between pharmacies and the Ontario government has expanded access to convenient and timely testing according to the testing guidelines for a specific list of asymptomatic individuals.
COVID-19 testing locations now include more than 171 assessment centres and up to 213 pharmacies.
Plus mobile testing or pop-up facilities are set up in areas where there is need for additional testing or to reach a specific or vulnerable population. Mobile testing sites are developed with the help of local partners and Public Health Units and are operated by various community partners, often in partnership with assessment centres.
Transportation / Routing, Laboratory Analysis and Reporting
To efficiently analyze the tests, Ontario Health and its partners quickly established a Provincial Diagnostic Network of more than 40 independent, hospital, public health and community laboratories. This network of labs coordinates the processing and analysis of COVID-19 tests, enabling specimens to be efficiently routed to labs that have testing capacity so they can be analyzed as quickly as possible.
Specimens are collected and delivered to a lab via a specifically designated network of couriers and Ornge, Ontario’s air ambulance service and medical transport, to ensure timely turnaround times.
After the specimen is analyzed, the result is entered into the Ontario Laboratories Information System (OLIS). Data in OLIS is used by the Ministry of Health to track and report the spread of COVID-19, to inform government decisions, and deploy appropriate resources and response. Public Health Units also use OLIS data to look at where testing is needed within their communities and advise on local public health prevention measures and strategies.
All positive tests are communicated to the facility where the swab was taken (i.e., assessment centre, pharmacy, etc.) and to the person’s local public health unit. The public health unit then follows up with the individual with instructions on how to self-isolate and interviews them for contact tracing.
If the individual provided their health card number at the time of testing, they can access their test result through the COVID-19 Test Result Viewer. A person with a positive result who also uses the COVID-19 mobile app can request a one-time key code to notify other app users of a potential exposure to the virus.
Test results may also be available through the patient portals at some hospitals. These portals do not provide a key code for the COVID-19 mobile app, however.
The province aims to have 80 per cent of individuals receive their test results within 2 days.
Ontario Health is working with health system partners and the Ministry of Health to continue to expand the provincial lab network’s capacity by securing key supplies, technology and lab staff. It is also working to expand its reporting at both the provincial, regional and sub-regional level.
Ontario Health has set up a separate process for congregate settings in outbreak, from the time the specimen is collected, through transportation/routing, to the result being processed and communicated. The goal with this new dedicated process is for test results to be available within 2 days.
Types of Tests
PCR Lab Tests
PCR (also known as polymerase chain reaction) tests show if someone currently has COVID-19. Swabs have to be shipped to one of more than 40 laboratories across Ontario in order to be analyzed. In a lab, technicians can process and analyze about 96 of these tests per machine in 4 to 6 hours. Shown to be highly accurate, the PCR lab test is the gold-standard of COVID-19 testing.
Rapid PCR Tests
Like the PCR lab test, a rapid PCR test looks for virus cells and shows if someone has a current COVID-19 infection. This test can be analyzed at the same site the sample is taken, using a portable analyzer box. Each analyzer box can process 3 to 4 tests per hour.
Rapid testing in Ontario will initially be used to increase access to testing in parts of the province with longer turnaround times for results, such as in rural and remote communities where transportation of specimens takes longer. They also will be used to support early identification and management of outbreaks.
Throughout these initial usages, the rapid PCR test will be carefully evaluated because these are new tests and are less sensitive than lab-based PCR tests. We are evaluating them carefully to ensure they add value.
Rapid Antigen Tests
The antigen test looks for proteins from the COVID-19 virus. Results are available in about 15 to 20 minutes, at the same site the sample is taken. This test may be useful for repeated screening of asymptomatic people in high-risk settings, such as staff, volunteers, residents or visitors in long-term care homes. Antigen tests are not as accurate at PCR tests, however. Consequently, people who receive a positive result with an antigen test, but who are considered low risk (e.g., no symptoms, no exposure to a confirmed case), may require a confirmation PCR test.
Targeted testing with rapid PCR or antigen tests may improve accessibility to testing and help alleviate the burden on labs. However, rapid testing does not replace the gold standard of lab-based PCR testing; these are complementary tools.
A serology test looks for antibodies to COVID-19 in the blood. The results may help determine if a person has been infected with COVID-19 in the past.
However, the accuracy of serology tests has not been proven. It is not yet known whether having these antibodies means that a person is immune to COVID-19. Given gaps in our understanding of the immune response in COVID-19, serology testing has very limited clinical value for individual patients and is currently available in Ontario to specific populations only. For more information see Public Health Ontario Serology Testing Guidance.
Meet Our Experts
There are many partners involved in Ontario’s testing strategy. Below are the people leading this work for Ontario Health:
Michele Henry | Operational Director, Provincial Diagnostic Network
Michele Henry leads the operational oversight and formalization of the Provincial Diagnostic Network.
She is an experienced and skilled leader with over 25 years of laboratory experience, including operations, strategic planning, partnerships and research. She has been responsible for multi-disciplinary teams across multiple laboratory sites and integrated programs across multiple partner organizations regionally, nationally and internationally. Most recently, she served as the Senior Director for the University Health Network Laboratory Medicine Program, a team of over 500 technical, medical /scientific and administrative staff. Michele is very familiar with Ontario Health’s system partners and stakeholders, having been involved in the development of partnerships across community and academic hospitals, complex continuing care and rehab, and private sector laboratories as well as expanded digital networks to enable greater access to subspecialty diagnostics across Ontario.
Dr. Vanessa Allen | Medical Director, Provincial Diagnostic Network
Dr. Allen is responsible for medical leadership of the Provincial Diagnostic Network. This includes providing clinical and scientific advice and recommendations with respect to COVID-19 testing.
She is a medical microbiologist and clinical infectious disease specialist, serving as Chief of Microbiology and Laboratory Science at Public Health Ontario since 2013. She is an attending clinical Infectious Diseases Specialist at Sunnybrook Health Sciences Centre, as well as an Assistant Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. Her public health contributions and research have focused on strategies to combat antimicrobial resistance primarily in the areas of bacterial sexually transmitted infections and enteric pathogens, and the implementation and evaluation of the use of novel methods such as genomics, artificial intelligence and point of care testing to advance infectious disease and public health response.