With COVID-19 testing limited, public health following 'curve of hospitalizations'

Ottawa's medical officer of health says Ottawa Public Health is keeping a close eye on hospitalizations from COVID-19 as a key indicator of how much virus is in the community because testing has been restricted to a select number of groups.

Speaking to reporters at a press conference on Tuesday, Dr. Vera Etches said the Omicron variant has changed how public health approaches the pandemic.

"The number of people who test positive is not a good indication of the amount of COVID in the community because it's restricted to certain populations," Etches said. "Following that curve isn't going to help us."

Etches said keeping watch on how hospitals are affected will give public health a better idea of how the virus is affecting the community.

"We'll follow that curve of the hospitalizations … if the amount of COVID is continuing to grow, we'd see the hospitalizations growing, and then when it falls, we could have some confidence that the amount of COVID in our community is decreasing," she said.

"We're in a different type of pandemic now. Omicron has really changed how we approach this," Etches said. "We're no longer looking to find every person who's positive with a test and count and contain. We need to assume, because of the amount out there and the limits on our testing system, that if somebody has symptoms that it could be Omicron and the best way to control transmission is for people to stay home with their household when they're sick."

As of Dec. 31, 2021, PCR testing is only being recommended to people with COVID-19 symptoms from one of the groups below. Everyone else is asked to stay home and isolate for at least five days with their household if they develop symptoms.

• Hospitalized patients
• Patients in Emergency Departments, at the discretion of the treating clinician
• Patient-facing health care workers
• Staff, residents, essential care providers, and visitors in hospitals and congregate living settings, including long-term care, retirement homes, First Nation elder care lodges, group homes, shelters, hospices, temporary foreign worker settings, and correctional institutions
• Outpatients for whom COVID-19 treatment is being considered
• Underhoused or homeless
• People who are from First Nation, Inuit, and Métis communities and individuals travelling into these communities for work
• Symptomatic elementary and secondary students and education staff who have received a PCR School take-home testing kit through their school
• People on admission/transfer to or from hospital or congregate living setting
• High-risk contacts and asymptomatic/symptomatic people in the context of confirmed or suspected outbreaks in high-risk settings, including hospitals, long-term care, retirement homes, other congregate living settings and institutions, and other settings as directed by Ottawa Public Health
• Individuals, and one accompanying caregiver, with written prior approval for out-of-country medical services from the General Manager, OHIP
• Asymptomatic testing in hospital, long-term care, retirement homes and other congregate living settings and Institutions as per provincial guidance and/or Directives

Ottawa Public Health's COVID-19 dashboard continues to publish daily case counts, but says that confirmed cases are an underestimate of the true number of people with COVID-19 in Ottawa.

The Ottawa COVID-19 Testing Taskforce, which co-ordinates testing centres in the city, says the changes in provincial criteria for testing mark a significant change and are understandably disruptive to many.

"Throughout the pandemic, testing has remained an important approach to detect and trace COVID-19. With the Omicron variant and its heightened transmissibility, the growth of cases and contacts has exceeded the ability of testing centres and public health to continue its current approach," the taskforce says. "We are in a scenario where it is vital to free up much needed testing capacity to ensure front-line services can continue to operate and to ensure those at highest risk of severe outcomes and those caring for them have timely access to test results."

The taskforce has also said that emergency departments will apply the same testing criteria as assessment centres.

"Ottawa-area hospitals are seeing residents coming to emergency departments for a COVID-19 test. Ottawa’s emergency departments apply the same criteria to those in the general public with symptoms or exposures who do not require admission to hospital, and therefore these individuals will not be tested," the group says. "It is important that hospital emergency departments continue to focus their resources on emergency illnesses and injuries."

Etches says the best way to manage transmission of the Omicron variant at this time is to limit contact with as many people as possible.

"The speed of growth should slow with people limiting their contacts," she said. "We would expect that exponential growth would start to slow now that people are limiting the number of people they're meeting up with indoors without masks."

She also says that while vaccination is not stopping infection and transmission, it is still effective in keeping people out of the hospital.

"I'm going to continue to recommend that we have that protection from vaccines and that I think that, after this wave, we should end up in a place with more immunity across the board."