Whether you’re a traveller getting a mandated COVID-19 test at the airport, or a worker on a job site like a film set or food processing plant that requires a negative test, odds are it’s being done by a private company.
Businesses offering polymerase chain reaction (PCR) tests are now a crucial part of Canada’s pandemic response, allowing thousands of people to continue to travel, visit loved ones in long-term care, and stay on the job.
But some doctors and health experts are concerned about what they say is a lack of regulation in what has become a rapidly growing part of the health-care industry.
“Who’s doing the tests? What are the standards? How do we know that they’re doing it at the same sensitivity and specificity as those done in provincial labs or hospital labs?” said Dr. Anna Banerji, a physician and infectious disease specialist at the University of Toronto’s Dalla Lana School of Public Health.
Publicly administered PCR tests are free and are meant for people with symptoms of COVID-19. Private companies generally test people who are asymptomatic, and charge a fee for the service. Demand is soaring as many workplaces require on-site testing in order to stay operational.
The federal government and the Ontario government recently added to that demand when both declared international air travellers must have PCR tests when they arrive in Canada.
A quick and non-exhaustive search by CBC News found 15 companies offering PCR tests for COVID-19 in Canada. Some, such as LifeLabs, which says it has conducted more than one million COVID-19 tests to date, and Dynacare, are well-known names in the specimen collection and diagnostic testing industry.
Others, such as Calgary’s Ichor Blood Services, pivoted to COVID-19 testing mid-pandemic.
Pure Lifestyle in Winnipeg offered fitness and medical services prior to launching its COVID-19 testing business just after Christmas.
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In Toronto, HCP Diagnostics garnered attention last fall when it started offering in-home COVID-19 testing for $400 per test. One of the directors of HCP is James Blackburn, who also co-owns an event company that organizes large parties, and a nightclub in Toronto’s Entertainment District.
Blackburn, who declined the CBC’s interview request, told The Pal’s Podcast recently that he moved into COVID-19 testing because the pandemic had shut down his other enterprises.
“If the beast squashes your business, you might as well try to get into another business and try to fight the beast, right?” he said.
Blackburn’s partners include a registered nurse and a doctor.
HCP’s timing was good. The company incorporated in October, but its website actually went live a month earlier, the same week the Ontario government amended two regulations under the Laboratory and Specimen Collection Centre Licensing Act in an effort to expand testing capacity.
The change allowed a wider range of people to get into the private testing business.
HCP is now providing on-site testing for film and TV production, construction sites, manufacturing and warehousing, as well as smaller businesses in Toronto’s downtown area.
In fact, HCP said it’s so busy, it had no time to talk with CBC News about its burgeoning business.
“Given the busy nature of our programs, I have been informed that our team will not be available,” HCP’s Emily Coles said in an email.
CBC News compared prices for PCR tests across the country and found they ranged from about $160 at Switch Health, which is also the company testing travellers at Pearson International Airport near Toronto to as much as $1,198, the top price charged by Northstream Safety and Rehab in Thunder Bay for a test done after-hours or on weekends.
Lack of oversight, experts say
But as private testing’s role in the pandemic grows, so is concern among some that it’s largely unregulated.
“When you have people working privately in no man’s land, then you really don’t know, are the tests accurate? Are they doing the right infection control?” said Banerji.
“I think there needs to be a body that has some oversight.”
While public tests are generally done in health-care environments such as hospitals and clinics, private tests can be done anywhere from construction sites to homes. Companies must use equipment and tests approved by Health Canada, but there’s no regulatory body governing the cost private companies are charging for tests, and there’s no single external system beyond the companies themselves to deal with complaints.
There are different governing bodies in each province that regulate the collection and processing of medical samples. In Alberta, for instance, the province does not license or approve companies for private COVID-19 testing.
In fact, no government agency in Canada is tracking how many companies are offering the service or even how many tests they’re doing across the country.
A spokesperson for Health Canada and the Public Health Agency of Canada said because medical tests fall under provincial and territorial jurisdiction, the CBC would have to contact each province and territory individually and compile the numbers ourselves.
So we did, and found the picture is still unclear.
Every province requires companies to report positive test results. But many provinces don’t know how many tests are being done overall.
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Of the nine provinces that responded, only Quebec and Nova Scotia provided a breakdown of the number of private versus public COVID-19 tests administered.
Saskatchewan and British Columbia say private tests are included along with public ones in a single number released to the public daily. But neither province could say what proportion of that daily number is private versus public tests.
Newfoundland, Ontario, Manitoba and Alberta don’t keep track of private testing data at all.
Apart from Quebec and Nova Scotia, none of the provinces that responded was able to provide a test positivity rate for private tests, a percentage that reflects how many of the total number of tests are coming back positive for COVID-19.
Experts say the lack of an accurate count and positivity rate of private tests means we may not have an accurate picture of the overall positivity rate in Canada.
“If the government is testing, say, 50,000 people and that gives us a positivity rate of four per cent, and the private sector is testing an additional 50,000 and they’re finding no cases at all, then in fact our test positivity rate is actually two per cent, not four per cent,” said Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa’s faculty of health sciences.
“That’s a big difference. The test positivity rate tells us two things: Are we testing enough? And how present the disease is in our population.”
CBC News also reached out to nearly a dozen companies to ask about the number of tests they conduct and the positivity rates they’ve observed.
Among those that responded was Quantum Genetix in Saskatchewan, which had been doing PCR testing on cattle prior to expanding to human COVID-19 testing late last year. Quantum Genetix said it has tested about 1,500 people and had a positivity rate of just under two per cent.
Another company, Dynacare, said it conducts between 5,000 and 10,000 PCR tests per day at its lab in Ontario. It said the positivity rate ebbs and flows, but over the past 30 days it has been near seven per cent.
Problems with private testing
With companies often dealing with customer complaints internally, it’s difficult to know how the quality of private testing compares with that of the public system.
The day before Christmas, Allan Asselin was visiting his 88-year-old mother, Mary, in her east end Toronto seniors’ residence when one of the nurses on staff walked into the room.
“She said, ‘Your mom has COVID. You have to leave,'” Asselin said.
“Needless to say, there were tears. She was shaking. She was just in a horrible state.”
Mary spent Christmas and several days afterward quarantined in her room, alone and scared.
Her COVID-19 test was processed in a private lab.
Three negative tests later, she was cleared. When Allen checked the Ontario government’s COVID-19 test results site, he found two entries for that first test back on Dec. 22, one positive and one negative.
“So did she have it or did she not have it?” he said.
In another case, a 34-year-old Montreal woman who pays $300 every two weeks to get tested to see her elderly father says she got a positive result in the mail with her name on it but the wrong date and location of the test, wrong home address, no health insurance card number, and the notification came a month after her test was performed.
“What good does it me, or the public, to get this information a month later, after walking around and hanging out with my family, [possibly] being unknowingly positive for a month?” said the woman, whom CBC News agreed not to identify for privacy reasons.
Private testing necessary
The fact is, however, the economy would likely not be reopening nearly as quickly as it is without private testing, which epidemiologists say plays a vital role in Canada’s pandemic response.
“I approve of private testing, if done strategically, because it alleviates strain on the public health system that should be used for things like proper surveillance, that should be used for actual symptomatic people arriving at hospitals and things like that,” said Deonandan.
Private companies, he said, should be tasked with what he calls “reassurance testing.”
“That’s when you need a test to go back to work or to keep going to work or maybe to engage in some other activity,” he said.
“But even then, that requires some serious ethical oversight.”