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Ontario Tech researcher shares perspectives on the next chapter of the fight against COVID-19

Updated questions and answers with epidemiologist Dr. Emma Bartfay of the Faculty of Health Sciences

Epidemiologist Dr. Emma Bartfay is a Professor with Ontario Tech University's Faculty of Health Sciences.
Epidemiologist Dr. Emma Bartfay is a Professor with Ontario Tech University's Faculty of Health Sciences.

Ontario Tech University epidemiologist Dr. Emma Bartfay continues to monitor local, national and global developments with the COVID-19 pandemic. The Faculty of Health Sciences researcher offers her take on the latest developments.

Why has Ontario struggled to test patients for COVID-19 compared to other provinces?

“There are two issues. One is capacity. We know that Ontario has the capacity to test at least 13,000 cases a day. But we are nowhere near it in terms of the numbers of people being tested. Many people are turned away from testing despite having referrals from a health-care provider. It is a matter of fixing the system. This can be done easily, perhaps by relaxing the testing criteria using a broader case definition.

The other issue is ‘how’ the test is done. Currently, the gold standard is the reverse transcription polymerase chain reaction (RT-PCR) method, which in theory can deliver a result in a few hours. But because of bureaucracy, a few hours could turn into days or even weeks. Under the current system, after a swab sample is taken from a patient, it is often sent to a larger city when a centralized laboratory is located for the testing. After the test is done, the result is then sent back to whoever ordered the test. Not counting for any backlog the laboratories may be facing, this back-and-forth can add up to a significant amount of time.

Is there a faster way to conduct all of the tests needed across the system?

“Because of the time lag with the RT-PCR tests, there has been a lot of development in rapid-testing kits. These are similar to point-of-care testing for influenza, where results can be obtained in real-time, within minutes at the testing site. In fact, Health Canada has just approved a made-in-Canada portable rapid test device for COVID-19.

Besides Canada, a number of other countries are also fast-tracking the approval for these testing devices. But at the same time, we need to be cautious because these new technologies need to be demonstrated for scientific accuracy before their widespread adoption for use. Countries like the United Kingdom and Spain are said to have returned many of these rapid-testing kits because they just don’t work. The last thing we want is to have an inaccurate test that delivers high rates of false positives or false negatives.”

Are there other options available for effective and accurate testing?

“I think a more exciting development is the at-home testing kit where people just do it themselves in the comfort of their own homes. Such testing procedures are actually quite common: like the finger-prick test for diabetes, fecal occult blood test for colon cancer screening and the urine test for pregnancy.

There are many advantages if one can successfully develop such technology:

  • It eliminates the need for patients to travel to a clinic/testing centre and thus reduces the risk of spreading the virus to others.
  • Time from test-to-result could be shorter.
  • It may encourage people to undergo testing before they have symptoms. 

To me, the last advantage is the most important. More and more evidence suggests transmission is possible before symptoms appear. If we can detect an infection at such an early stage, it will have a tremendous effect in fighting the disease and limiting further spread.”

How probable is it for someone to be asymptomatic for COVID-19 and not aware of it? Could they be transmitting the virus unknowingly? Or can there be milder forms of it that present in a non-respiratory manner (e.g. that people might dismiss as a stomach bug?)

”Definitely probable. We don’t usually assume we are sick unless we experience symptoms of a given disease. I do believe there were lots of cases where the symptoms were so mild that people just dismissed them entirely, especially during the early days of the pandemic. As a result, we may not have taken any precautions during that time. On top of that, there is also the incubation period where symptoms are yet to appear. As I said, more and more evidence suggests transmission is possible before symptoms appear. So, it is possible that someone could transmit the virus unknowingly.

A study from China suggested symptoms related to the digestive system were present in about half of the patients admitted to hospital. So, gastrointestinal issues due to COVID-19 may be more common than previously thought. But as we were often only told about the classic symptoms of cough, fever and difficulty breathing, it is certainly probable that one may dismiss these digestive issues and think of them as anything other than COVID-19.”

Although COVID-19 in Ontario did not begin until late January’s ‘first patient’, people who were very ill with similar symptoms in November or December may be wondering if they actually could have had COVID-19 at that time. Is there any possibility that they may be a ‘recovered’ patient from a time when the illness wasn’t being tracked?

“It is certainly possible. Although the first official reported case of COVID-19 in China was recorded December 31, 2019, we now have evidence that suggests cases can be traced back to early December and even to November. There were also documented cases of atypical pneumonia in Italy that dated back to November 2019. At that time, we were in the midst of a flu season. These patients could have been easily dismissed as having complications from influenza.

People travel extensively nowadays, both domestically and internationally. It is definitely possible that the disease could have spread around the world, including Canada, months before we even noticed its existence.

Given that the vast majority of the people who developed COVID-19 eventually recovered without treatment, it is entirely possible that we could have a significantly number of ‘recovered’ patients that are unaccounted for.”

Was Canada and the world ready for what has unfolded with COVID-19, considering the existing demand for other health issues?

“In my opinion, the unpreparedness of the system has led to the mess we are seeing now. The system has failed us. To make things worse, inconsistent messages from officials in different parts of the world over the past few months have also significantly undermined the public’s trust in the authorities. Misinformation has been a major issue since Day 1. It certainly doesn’t help when we hear different directives and advisories every now and then.”

We keep hearing about the term ‘flattening the curve’ as being the answer to the COVID-19 crisis. What about patients who may be dealing with other health-related affliction?

“Right now, everyone is consumed with COVID-19. It is easy to forget that people experience a number of other health issues every single day. On average, every day in Canada almost 100 people suffer a heart attack and 170 people experience a stroke. People are diagnosed with serious and devastating diseases like cancer and dementia every day. What is happening with these people now?  Are these people still being cared for the way they should be, now that so many of our resources are re-prioritized to the fight against COVID-19? We know that many surgeries deemed non-essential have been postponed and countless diagnostic tests have been cancelled. Lakeridge Health, for example, has cancelled all cancer surgeries.

It has been said by some front-line health-care workers that they will be forced to ‘play God’ if and when they need to choose which admitted patients get to be put on a ventilator due to shortage of critical equipment. But I argue that we are already doing that: we are already needing to choose which disease(s) get priority, in addition to which patients are treated first.

At this point, we still don’t know how and when this pandemic will end. So we may not know the consequences of individuals with other non-coronavirus diseases until then. We may never know how many of these people die or have their health significantly compromised not as a result of these other health issues, but rather from the lack of medical attention that would have otherwise been available to them.

Outside of the hospital setting, it is also easy to forget some of the most vulnerable people out there. I have said before that multiple localized outbreaks at care homes would happen and they did. Outside of these facilities, there is also a great number of older adults living on their own, including those who are living with dementia and various forms of disabilities, who are also in urgent need of assistance. Their needs have never been greater given their vulnerability to COVID-19.”

What health concerns should consumers bear in mind related to buying and selling items online, or having products delivered to home? What should be people be doing to ensure these activities are safe from a health standpoint?

“I don’t think there are any specific health concerns related to buying and selling online right now. It is really no different from any other time for online shopping. If it is a food item, treat it the same as ordering take-outs or deliveries and adhere to food safety measures. If it is a non-food item, you may want to clean and disinfect it prior to using. But I think you should be doing that anyway with or without COVID-19.

Many people are afraid of touching things now, fearing that they may become sick as a result. I think this is really an over-reaction. Considering the amount of time it takes for someone to prepare your package, get it through shipping and finally deliver to your home, the virus is unlikely to be viable anymore. Even if it is, this virus can only cause disease if and only if it gets into your body, begins to replicate and causes damage. As long as you keep the virus from entering your body, you will not get sick. How do you do that? Wash your hands frequently with soap and water, including before and after you handle the package, and stop touching your face.

The only thing I would caution is to avoid person-to-person contact. If you are buying and selling privately, try to switch to cashless transactions. If you must involve cash, perhaps leave the money in a plastic bag and do not touch it for a couple days.”



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