Rosie DiManno: Delays, flip-flops and bad decisions on COVID-19 testing are costing us dearly

“It goes up your nose.”

Well of course it does, the swab. Who doesn’t know that by now?

With not a client in sight, we were forced to get nosy with the pharmacist at this Shoppers Drug Mart on Danforth Ave. as she fielded inquiries over the phone, jotting down bookings for testing. Nor was there a lineup at three other outlets visited on Friday, as Shoppers launched the service at 60 of its stores across Ontario, though only 43 were up and running according to a company spokesperson.

There is confusion, given that the province did a quick U-turn this week — inside of 24 hours — on its testing directive, flipping from whoever-wants-it to only the symptomatic, at the province’s 151 assessment centres.

The pharmacies that came online Friday are intended to test, by appointment, only people who have no symptoms, including those who might need proof of negative results before they can visit family members in long-term care homes and those with confirmed exposures to the coronavirus-afflicted and positive-determined environments.

It is hoped that culling the asymptomatic from the herd will ease the tremendous burden on labs that actually do the sample processing, with the goal of 50,000 a day, although present capacity is 40,000. And, crucially, prioritizing those at high-risk.

The usefulness of asymptomatic testing is limited, primarily because it’s just a snapshot of a specific time — you might test negative today but positive a day later. It’s also true that small numbers of people unaware they were infected have seeded huge swaths of new cases. But as the Star’s Kate Allen , targeted testing data of asymptomatic individuals compiled over the summer, targeting high-risk settings such as long-term care homes, farms and factories, yielded few new cases.

The more-testing mantra to which Ontario has cleaved since the pandemic struck globally is not particularly efficient, when applied broadly and generically, as experts have been warning for months; low-value outcomes for limited public spending resources.

However, for that kind of catchment undertaking, some dentists are wondering why they haven’t been deployed to the task, since they’re in people’s mouths all the time.

“It hasn’t been for any lack of trying or contacting people in the government,” says Dr. George Christodoulou, co-CEO of Altima Healthcare group, one of Canada’s largest dental medical groups, with 50 offices in Ontario. “I’ve tried to lobby all three levels of government and get nothing back except an automatic email reply.”

Christodoulou points out that there are more than 5,000 dentists practising in the province and about 14,000 dental hygienists. “Typically we work in teams. With one dentist and two hygienists, we see more than 20 patients a day. That’s 100,000 patients a day that can be tested.

“Ideally, it would be part of a regular visit,” Christodoulou continues. “Appointments are made, procedures are followed. The protocols are there so that when a patient comes to our office, they’re escorted in. We have the PPE, we already minimize contact. It’s the same as the oral cancer screening we do for some of our patients. It would only take an extra minute or two.

“So, you’d be coming in for your cleaning or your filling and part of that exam would also include a nasopharyngeal screening or the antibody antigen procedure, especially the saliva ones.

“Who’s better trained to handle saliva than dentists?”

Yet a spokesperson for the Ontario Dental Association counters that it’s not as simple as Christodoulou suggests. “We’re certainly aware of the idea of COVID-19 testing in dental offices but the main priority for most dentists so far has been getting through the backlog of patients they weren’t able to treat for 12 weeks during the shutdown,” Maggie Blood tells the Star via email.

Blood says many dentists are still struggling to obtain the more protective N95 masks, and “won’t have enough of a supply to do COVID-19 testing as well as treat patients.”

The ODA has asked the Ministry of Health repeatedly to designate dentists as front-line medical staff so they can access provincial stockpiles of personal protective equipment.

“That being said, we’ll be watching with interest how the rollout for testing at pharmacies goes.”

While Ontario is reactively slapdash in attempts to curtail the predicted surge of COVID-19 — on Friday that bars and restaurants will henceforth stop serving alcohol after 11 p.m., although there’s no empirical evidence that these establishments have been connected to a surge, and strip clubs ordered to pack up their G-strings, close down their fleshy emporiums — Premier Doug Ford has repeatedly called out the feds for failing to get their rapid-result saliva-based testing act together.

Instead of waiting in a long queue at assessment centres to get a swab shoved up one’s nose, then waiting days for the findings, saliva-based tests can produce results in minutes. Yet Health Canada has taken an exactingly cautious approach in evaluating the efficacy. Health Minister Patty Hajdu has doubled down on resistance, reiterating last week that saliva tests will not be approved until everyone is absolutely satisfied they won’t actually endanger the lives of Canadians because they are inaccurate or offer a false sense of security.

False sense of security, you may recall, is what was posited by leading health authorities in this country who originally disapproved of masking for the general public — and now they’re mandated in Toronto for indoor public spaces.

Three Toronto hospitals, as of this week, began offering saliva tests for some groups of eligible patients, although they’re still recommended as a primary option and samples still need to be sent to a lab for analysis, which could result in longer turnaround times than the swabs. Which rather defeats the purpose.

Meanwhile, British Columbia last week introduced a new saline gargle test — swish and spit — for students from kindergarten to Grade 12. And Edmonton’s International Airport has joined a saliva trial program — devices that will light up green or red, within one minute, indicating if the traveller is virus-free. They do not need to be administered by medical professionals.

In the U.S., the Food and Drug Administration last month gave emergency-use authorization for a fifth saliva-based test developed by the Yale School of Public Health that requires minimal processing and allegedly much of the accuracy of nasal swab results.

There is another alternative, for the anxious asymptomatic but it comes at a high cost: A company is offering at-home testing, saying its employees will travel anywhere in the GTA for the purpose, charging $399 per person, plus a fee of $329 for every additional person in the household. Doctors have slammed the scheme as “pandemic profiteering.”

But we don’t know, do we, how dire the situation will become in the second wave months ahead — 409 new positives Friday in Ontario, 236 in Toronto.

So here’s the backwards-glance global timeline tweeted out by the Johns Hopkins Center for Health Security.

One case to one million cases: 90 days

One million to 5 million: 48 days

5 million to 10 million: 38 days

10 million to 20 million: 44 days

20 million to 30 million: 37 days.

The numbers explode, even as the time span contracts.

Rosie DiManno is a Toronto-based columnist covering sports and current affairs for the Star. Follow her on Twitter: