Why have we stopped testing for COVID?

Once upon a time, rapid tests for COVID19 were widely available and free of charge at groceries and pharmacies. Public health sent a clear message: results matter. The current absence of tests is a striking departure that implies testing is no longer relevant and that SARSCoV2 has ceased to be a threat. Both are false.

The scarcity of rapid tests is Ontarians' most recent loss to their ability to gauge COVID19. First came the shutdown of Ontario's Science Advisory Table. Then Ontario stopped providing timely data to Canada's Longterm Care COVID Tracker, leading to its closure. Two months later, funding for nearly all of Ontario's wastewater surveillance sites ended.

No one should be fooled into thinking that COVID19 no longer matters. Research efforts on COVID19's delayed health effects continue. Its expanding list now includes a higher risk of Type 2 diabetes, lower cognition, higher rates of anxiety and depression, and a two to threefold increased risk of heart attack and stroke.

These delayed health risks resulted in an estimated 90,500 excess deaths in 2023. That's more than 11 times what the Public Health Agency of Canada had reported over the same period and more than 45 times the deaths from motor vehicle accidents in Canada during the same year.

Such profound harms should have galvanized Ontario into ramping up testing, prevention and transmission of SARSCoV2. Instead, the opposite happened: Rather than educate the public on its delayed health consequences, Ontario continued to fixate on only its immediate hospitalizations and deaths.

The longterm harms of SARSCoV2 were further downplayed in October when Ontario advised clinicians to restrict testing to those who qualify for the antiviral treatment Paxlovid. But because so few of them can get an appointment within the fiveday timeframe required for Paxlovid, testing plummeted. It's a policy that blinds everyone involved from fully understanding the risks SARSCoV2 poses, including patients, their contacts and the health systems on which they rely.

Ontario's advice to avoid testing what ails a patient fails to meet the standard of care expected of other chronic diseases known to cause later harms. Patients are routinely screened for high blood pressure and diabetes because, like COVID19, they too raise the later risk of heart attacks and strokes.

Few Canadians realize how common long COVID is, nor how much that risk rises after each infection. Quebec research showed that after the initial infection, 13 per cent reported having at least one symptom lasting three months or longer with nearly half enduring symptoms for one year. Subsequent infections proved even riskier. A whopping 37 per cent of those infected reported longterm symptoms after a third bout of COVID19. Threequarters reported missing school or work as a result and one in five reported their symptoms “often or always limited their daily activities.”

Despite all of this, Ontario has left the cost of rapid tests almost entirely to patients. This hits those who can least afford them the hardest. Lowincome populations faced a 30 per cent higher mortality rate from COVID19. It's not easy to afford the $7 per test that Shoppers Drug Mart charges. When early testing is negative, it needs to be repeated. The cost rises even more when household contacts need testing. Compounding this is the threat of lost income when tests are positive. Placing the burden of testing on those who can least afford it is a poor public health strategy that ensures the ongoing spread of COVID19.

Transparency is crucial to public health, but far too little effort has gone into informing the public about the longterm health hazards posed by repeated COVID19 infections. That needs to change. A good place to start is by providing free rapid tests to enable Ontarians to gauge their risk and that of their loved ones. Its messaging would be clear: Results still matter.

With COVID19 tests now both rare and costly, Ontarians are missing a vital tool to keep themselves in the know about the longterm health risks COVID poses