Ontario's Science Table endorses asymptomatic COVID-19 surveillance testing for elementary school students

Ontario’s advisory panel of top epidemiologists has come out in favour of asymptomatic surveillance testing using rapid antigen tests for all elementary school students, especially in areas of the province where COVID-19 is especially prevalent.

On Thursday, the COVID-19 Science Advisory Table said that in areas where there are 35 or more weekly cases per 100,000 people – a threshold that currently includes virtually the entire province save for some of the GTA – elementary students should be tested with a rapid antigen screening test once per week.

In areas of the province with 250 or more weekly cases per 100,000, they recommend elementary, high school students and the unvaccinated should be tested two or three times per week.

“We considered elementary schools a priority for voluntary screen testing given that students less than 12 years of age are not fully vaccinated in Ontario,” the table wrote in its brief.

Science Table Director Dr. Peter Jüni told CP24 that the rapid antigen test, though not perfect, is consistently able to detect a positive result in people with a high viral load, the point in time in which they are most likely to infect others.

“The point is the rapid tests in the situation we're in now with Delta and probably also with Omicron, for all we know, really actually performed really well to identify people who are infectious right now,” he said. “We looked into that very carefully. They may miss some people who are not yet infections or who are not infectious anymore, and their viral load is relatively low. But this is not an issue.”

Last summer, the same panel suggested rapid antigen surveillance testing for asymptomatic children was unnecessary and would not detect enough infectious cases to make it worthwhile.

Regular symptomatic surveillance COVID-19 testing using rapid tests has been in place for months in long-term care homes, hospitals and a wide swath of essential businesses in Ontario.

But outside of the winter holiday break where the Ford government purchased 11 million rapid antigen tests to go home with all two million or more public school students, regular asymptomatic surveillance testing has not been in place in any public school this year.

The province has also allowed rapid antigen testing for schools where all students were returning after a COVID-19-related closure, and also plans dozens of mobile testing sites in high-traffic public spaces this winter holiday season, but has resisted calls to implement regular asymptomatic surveillance testing in schools.

They have also implemented a “test to stay” in some schools where asymptomatic students in a classroom can remain in class during an outbreak so long as they test negative. Rapid tests have also been sent to schools in Sudbury and Algoma due to a high prevalence of cases there.

Groups of parents attempted to source their own rapid antigen tests to set up surveillance testing at dozens of individual schools, but their access to supplies was cut off.

Private schools also inexplicably got access to provincial rapid antigen test supplies for surveillance testing of students at the start of September, access that ended after a published report by CP24.

Ontario’s testing guidance bars free asymptomatic testing, either through full PCR COVID-19 tests or rapid testing devices, except in limited circumstances.

Testing at pharmacies and assessment centres is limited to people showing symptoms of COVID-19, identified high-risk close contacts of identified cases and asymptomatic members of certain high-risk groups.

Rapid tests can be purchased and performed at pharmacies for between $17 and $40 per test. On the open market, they range from $10.50 per test to as high as $16 each to be used at home.

Yesterday, Ontario Premier Doug Ford said there was no need to widen Ontario’s testing guidance, saying that the fact the province has delivered more rapid tests to businesses, hospitals and congregate care settings than any other province by a wide margin meant they had the best program in the country.

A spokesperson for Health Minister Christine Elliott said the Science Table report that suggested something sparsely seen before in the province “affirmed” the government’s current testing strategy.

She said Elliott is urging the federal government to increase deliveries of rapid tests to Ontario. The province has received 34 million rapid tests to date.

“Ontario deploys every single test received from the federal government, which is why Minister Elliott wrote to her federal counterpart Minister Duclos last week about the limited number of Health Canada approved rapid tests compared to other jurisdictions. With an increased demand for rapid tests and limited supply, we are continuing to urge the federal government to increase the number of approved rapid tests available for use in Ontario and across the country.”

Jüni said the province should keep in mind that letting public health units take the lead in deploying rapid antigen tests to schools or other settings might be difficult given all the other responsibilities they have during the pandemic, including vaccine deployment, contact tracing and managing isolating of infected persons.

“We have situations already in some public health units where there's just so much to do, so are they really able to pull it of with rolling out rapid tests. We just need to be aware of that part.”