Ontario is expanding asymptomatic COVID-19 testing in schools. Here's what you need to know

Asymptomatic testing for COVID-19 in schools is ramping up across Ontario, following a directive from Education Minister Stephen Lecce earlier this month.  

In this expansion of an earlier testing pilot effort in the fall, the province is calling for larger school boards to test at least five per cent of elementary and secondary schools weekly, with a goal of reaching about two per cent of the student population in the province. The campaign began with schools in areas such as Ottawa, Toronto, Peel and York Region over the past few weeks. 

We asked experts to explain what's behind this push, what's been blocking families from testing and how the new variants factor into this initiative.

Why is this being introduced?

Dr. Janine McCready of Michael Garron Hospital in Toronto was among the infectious disease physicians who worked with public health and education officials to conduct full-scale COVID-19 testing in schools that had outbreaks last fall. 

At one school in a hot spot area, the team discovered between four and five per cent of students without symptoms nonetheless tested positive for COVID-19, McCready said. That underlines the value of being proactive with asymptomatic testing, as another layer of protection against the coronavirus.

"We don't want to wait until there's a number of cases in the school," she said. "We really want to try and look for it and find it before it spreads within the classes. "

She said while staff conducting in-person classes have done an "amazing" job implementing several layers of safety measures in classrooms, "you'd like to prevent as much as possible."  

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Testing clinics at Ottawa-area schools have run for several weekends in areas where health officials have previously seen clusters of cases. The goal has been to identify people who have COVID-19 — including those who maybe resisted going for testing or didn't believe themselves at risk — and break the chain of transmission, said Dr. Nisha Thampi, medical director of infection prevention and control at CHEO, a pediatric health and research centre in Ottawa.

"What we're trying to drill down to is how can we make testing more accessible and more acceptable and easier to adopt as a way of being in the community."

Which schools are being selected?

Local health officials, school board representatives and public health units are teaming up to identify which schools will most benefit from asymptomatic testing clinics. 

So far, this has meant schools in communities or areas with higher prevalence of COVID-19, McCready said.

Families are hearing of drop-in testing clinics in their neighbourhoods from a variety of places: emails from principals, messages from community groups and social media posts from school boards or local public health units.

However, in future, testing could potentially expand to other schools where more cases appear "and that need that extra level of protection."

Who is being tested?

Typically, the testing is available for students and staff of the particular school, but some jurisdictions have also opened it up to parents and other family members. In some regions, testing is open to students and families from neighbouring schools near the venue hosting the clinic. The testing is voluntary.

Which tests are being used?

According to the province, up to 50,000 tests a week could be conducted as part of this push, using a combination of rapid antigen as well as polymerase chain reaction (PCR) testing. Which collection methods used will differ by jurisdiction, and officials are testing out different ways to make the collection process more palatable for kids.

Some might take a two-pronged approach, perhaps starting by administering rapid antigen tests, with positive cases then asked to return for a PCR test for confirmation. 

For those regions starting out with a PCR test, that doesn't necessarily mean students will be greeted with the imposing deep nasopharyngeal swab, used to collect a sample from the back of the nose and throat. In McCready's East Toronto region, for instance, her team is using a shorter oral-nasal swab. 

"A little swab goes in your mouth, on the back of your tongue, inside of your cheek and then just the front of your nose," she said. "Most of the time, the kids can actually self-collect, or it's easy for a parent or the health care provider to do it for them.

"Then those tests would go back to our lab and then be processed in about 24 hours."

Other teams are using saliva collection methods while elsewhere in Canada, some officials might be employing gargles, Thampi said. The bottom line is to make it easy.

"We recognize that acceptability of the testing is so important, especially if we want to encourage people to get tested each time that they may have been exposed to COVID-19. And it's far more acceptable to have less-invasive methods of collection."

What's been stopping families from getting tests?

There can be many reasons parents might be inclined to brush off symptoms and not take their kids to be tested, from wanting to avoid further in-school disruptions to the financial ramifications of halting work to quarantine, noted Thampi, a pediatric infectious diseases physician. 

"There's very little value in testing if individuals can't follow through on the public health recommendation to self-isolate," she said.

"We have to be sensitive about the supports that are available to [families] when a test is performed ... Supporting those individuals to be able to self-isolate with their households is a critical part of the testing process."

That some families must travel far to even reach an assessment centre is another barrier, she said, pointing out that there have been some promising mobile clinics bringing testing right to the doorstep of farther-flung communities.  

McCready also heard directly from parents about the need to make testing much easier for families and reducing the stigma around it.

"A lot of people did say: 'Testing at school would make it easier for me ... I wouldn't have to take my three or four kids, arrange them ... wait in line,'" she said. "If you just did it through the schools, it's normalized, and everyone's doing it."

How do the new variants factor into testing?

The different layers of measures schools are employing — from masking to physical distancing to improved ventilation — still work against the COVID-19 variants of concern, but the increased transmissibility of those variants means "you need to be even better at all those things," said McCready.

"The variants give us a sense of urgency to improving the processes that have been in place or thinking more creatively about how to get testing more accessible, acceptable and adopted in these communities where we're seeing transmission already," said Thampi.

How will we know if this is working?

"It's certainly not a one-size fits all process across the province," McCready said. "50,000 [tests] does sound like a huge number, and it's very daunting. But when you break it down and look at what each health unit, what each community, can do and what they would want to do, then it becomes more manageable."

Both she and Thampi said this push into asymptomatic school testing will require careful rollout as well as continual evaluation and adjustments to the process.

"We're able to look every week at how well the testing is going, what are tweaks that we can make," Thampi said. She will be looking at community uptake of testing as one barometer of success.

"How many families of students have received this information? What is the uptake in that community? ... Are we able to get families to come back if we're calling them with a positive rapid test? Are we able to break chains of transmission?"