Ontario is moving forward with a plan to conduct symptomatic COVID-19 tests inside neighbourhood pharmacies, as Shoppers Drug Mart pharmacy workers continue to express doubts about safety and other pharmacy chains refuse to participate or sit on the fence.

Earlier this week, CP24 revealed a plan approved by the Ontario Ministry of Health to conduct symptomatic COVID-19 tests inside pharmacies for the first time during the pandemic.

Officials said in a matter of days they will launch an appointment-only initiative to boost COVID-19 testing accessibility across the province with a voluntary opt-in for pharmacy chains.

The program would see high-risk close contacts of confirmed COVID-19 cases and symptomatic individuals be able to visit a pharmacy and receive a PCR COVID-19 test.

But multiple staff members at Shoppers Drug Mart, speaking to CP24 on condition of anonymity, said it is does not appear to them that their participation in the program is voluntary, and they continue to have serious concerns about their safety and the safety of their customers.

One person involved in management operations at a GTA Shoppers Drug Mart told CP24 they fear their franchise agreement with the Loblaws-owned chain of drug stores would be terminated if they refused to conduct symptomatic testing inside the store.

A memo sent to Shoppers Drug Mart franchisees, called “Associates,” on Nov. 8 and obtained by CP24 states that “all” locations in the province will eventually participate in the symptomatic testing program.

It said Associates would be sent a survey by the Ministry of Health to gauge their willingness to participate in symptomatic testing, but there was no need to fill it our because everyone was expected to participate.

“Shoppers Drug Mart Central Office has been working with the (Ministry of Health) to facilitate expansion of the Publicly Funded COVID-19 Testing Program to all Shoppers Drug Mart and Loblaw pharmacies in Ontario to better support patient access to care,” the memo read. "As such, there is no need for stores to complete the survey.”

Loblaws spokespeople said they were still assessing the parameters of the new program, and are "supporting" stores that did wish to participate.

"That said, our stores are locally owned and operated, and as such have the final decision on providing symptomatic testing for patients," Loblaws told CP24. "We understand this only works if the right safeguards are in place, and if we don’t believe this can be done safely, we won’t do it."

Meanwhile, Rexall, which operates more than 240 pharmacies in Ontario, said it would not participate in symptomatic in-store COVID-19 testing.

“We will continue low-risk, asymptomatic screening for work and travel clearance purposes at our over 240 Ontario locations,” spokesperson Andrew Forgione told CP24.

He declined to elaborate on why Rexall was passing on the program.

“We don’t have anything further to add,” he said.

Another chain, Pharmasave, with more than 500 outlets in Ontario, said they did not have enough information about the initiative.

“This is new and evolving and we are awaiting further details,” spokesperson Andrea Birrell said.

Chief Medical Officer of Health Dr. Kieran Moore said he was confident pharmacies could swab symptomatic patients without increasing risks for all involved.

“They’re professionals and they’ve been testing and working with us all along,” he said. “It’s so important that we have accessible testing and quick turn around times.”

The person involved in management at Shoppers Drug Mart told CP24 they have already seen customers move their business to the Rexall chain out of concern for their safety since the symptomatic in-store COVID-19 testing program was revealed.

They said that of all their staff, only two were “reluctantly” willing to do in-store symptomatic testing, “if they had to.”

Already there are discrepancies between how senior government officials and industry representatives have described what will take place inside stores.

Ontario Pharmacists Association President Justin Bates told CP24 on Wednesday that tests could be performed outdoors for added safety.

“Whether that’s outdoor space if it’s available, or a drop-off take-home element, not everyone’s going to be participating in the in-store element,” Bates said.

But the document prepared by Loblaws and sent to its pharmacists says that is not allowed.

Bates added that, to his knowledge, no pharmacy staff member would be forced to participate.

“They will be have to go through their own risk assessment, make sure they have capacity, they have the space and that all of their pharmacy teams feel comfortable with providing the service. If they’re not, they need to provide alternative options for them, either referring them to another location or another pharmacist who is comfortable,” he said.

The Ministry of Health says all tests should be conducted in a separate confined space, but Loblaws says tests can be performed anywhere, provided “screens” that preserve patient privacy are erected.

Ministry of Health officials said tests could be conducted in a space separated by a divider of some kind, but their infection prevention and control protocol did not specify what material it needs to be made of.

Moore said he envisioned testing to take place “separate from normal space for prescribing and the vaccination areas.”

He added that pharmacies conducting symptomatic testing should have separate entrances for test subjects, but then later corrected himself that it was merely recommended as a “best practice.”

“I didn’t mean to infer that all of them would have it, it is a best practice to have a separate entrance,” he said.

Requirements for a separate entrance do not appear anywhere in a 13-page guidance document for pharmacies released on Thursday.

University of Ottawa Epidemiologist Dr. Raywat Deonandan said that on its face, the new in-store symptomatic testing program “does not look great.”

“If they can do this in a tent outside in a parking lot - with good (infection prevention and control protocols), if they could make sure these individuals are not interacting with other people and that staff are wearing N95 masks, then this could be a good initiative,” he said.

Ministry of Health officials said Thursday they were completely open to pharmacies conducting symptomatic swabs outdoors.

As for use of respirator masks, Ontario officials said they did not think respirator masks such as N95s were appropriate for use in pharmacies.

“The pushback is that we already have symptomatic people in there shopping for cold medicine,” Deonandan said. “Symptoms are one thing, but the expectation of a positive test is another because you have been exposed - they’re showing up because they are being told they have been exposed.”

He said the likelihood of a person having COVID-19 infection is much higher if it is determined they already spent ample time in close contact with someone already known to have COVID-19.

Epidemiologist Dr. Ahmed Al-Jaishi at London Health Sciences Centre told CP24 that in his region, there might a be need for pharmacies to conduct symptomatic testing, as same-day access to appointments depends on which day you happen to need one.

“If I call one Tuesday or Thursday, I will have to wait at least one day to get tested,” he said. “Turnaround is 24-48 hours, so by the time we get the results (my kids’) symptoms have improved and they’re ready to go back to school.”

“All those things are barriers,” he said. “I am hoping that the increased risk of encountering people who are symptomatic is offset by how much quicker we can test people and get their results and isolate them.”

But both Deonandan and Al-Jaishi said plans from Loblaws documents involving only the use of medical masks for those collecting specimens, the prohibition on conducting swab tests outside, and conducting swabs out in the open in an area separated by privacy screens all gave them concern.

“The more I think about it, and not only that, the amount of information out there from the province about the policy, the more it becomes concerning to me,” Al-Jaishi said.

Ontario NDP education critic Marit Stiles said that the move to bring symptomatic people into pharmacies for tests would dissuade vulnerable people from picking up their prescriptions.

“They’re going to be standing in a pharmacy next to people who have COVID-19 is going to be scary for a lot of Ontarians. People will avoid picking up their prescriptions.”

The idea continues to make waves on social media.

In the day after the symptomatic pharmacy testing plan was made public, the hashtag #ShoppersDougMart was trending provincially on Twitter.

The Ministry of Health supplied to CP24 a poll on Wednesday.

Seventy six per cent of the online sample of 600 respondents said they would support COVID-19 testing in their neighbourhood pharmacy.

Among those 334 respondents at least partially vaccinated against COVID-19, 15 per cent said they would feel “very safe” visiting their neighbourhood pharmacy if it offered symptomatic COVID-19 testing, and 49 per cent said they would feel “somewhat safe.”