When hit with a pandemic such as COVID-19, northern, remote and isolated communities in Canada can be particularly vulnerable. These communities are home to many First Nations, Metis and Inuit peoples who have historically experienced obstacles and challenges with equitable access to health care services. Unfortunately, they can often wait weeks for test results, leading to delays in diagnosis and treatment for affected individuals. This can lead to difficulties in contact tracing and corresponding public health actions to stop transmission. So how does one ensure that testing happens quickly and efficiently outside of laboratories in major population centres?
Equitable health care for all Canadians
Scientists at the National Microbiology Laboratory (NML) are working to support the needs of individuals living in northern, remote and isolated communities and help build local health care capacity. They are working directly with communities and engaging community leadership to provide point-of-care (POC) diagnostic testing devices. These devices give communities the ability to do their own testing and implement life-saving public health measures to rapidly contain and prevent outbreaks.
The NML has a long history of providing laboratory support for in-community testing. In the past, they sent mobile labs to Nunavut for tuberculosis testing and internationally in response to Ebola outbreaks in Africa.
It was a NML-wide team effort to set up in-community testing capacity for COVID-19 this past year. Experts from a variety of areas worked together in a complementary manner on many different fronts. The NML’s Dr. Paul Sandstrom and Dr. Adrienne Meyers spent years building relationships with northern, remote and isolated communities which formed the initial base for conversations with federal and provincial networks, Indigenous Services Canada and a variety of First Nations health authorities and provincial and territorial partners to identify the communities most in need. Dr. Cindi Corbett and Kym Antonation worked with the Canadian Public Health Laboratory Network (CPHLN), a federal, provincial and territorial network consisting of laboratory leaders from across the country to deploy testing equipment to areas that had laboratories without existing capacity for COVID-19 testing. This complementary approach allowed for further deployment of POC devices in-community with Paul and Adrienne’s team.
Working together to navigate challenges
At the start of the COVID-19 pandemic, there was a significant lack of testing options available for use in Canada. As new tests and technologies came to market, NML scientists worked rapidly to validate equipment and tests prior to their deployment. The warehouse and shipping teams also played an important role in managing incoming and outgoing shipments and finding efficient shipment options to reach remote communities that are not easily accessible.
The urgency was felt by all and many NML teams operated simultaneously, working with community leadership to identify what testing options were best for each community. These teams provided training virtually, remotely, and when required and allowed, in-person support on-site, as well as ongoing logistical support. They worked against the clock to get the devices running and people trained before outbreaks happened in the communities.
Many of the communities had never worked with such equipment or infectious samples before. As a result, the NML team developed user-friendly training materials in both official languages with the understanding that it wouldn’t always be health care professionals or laboratory staff being trained to use the equipment. The scientists also created videos and provided webinars, often multiple times a day. As word of the initiative spread, more communities reached out to express interest.
“The team is amazing and we’re so glad the communities are engaged and active—they’ve formed some pretty special relationships with our team and us as well—we feel very fortunate to be part of this work,” says Dr. Sandstrom.
Making an impact
POC testing has empowered communities to reduce the spread of COVID-19. The instruments they received are as reliable and consistent as laboratory-based tests, and fast—for example, one type of the deployed devices takes a maximum of 50 minutes to produce a result.
One success story is of two First Nations communities who used POC testing equipment to prevent an outbreak. These remote communities received equipment in the fall of 2020, and their community-based nursing team and support staff were trained to operate the equipment. In the spring of 2021, two children attending a local school tested positive for COVID-19 and the communities quickly mobilized to conduct widespread testing. Over the course of 10 days, more than 400 COVID-19 tests were completed, identifying over a dozen COVID-19 positive cases. All the tests were processed and contact tracing was completed on the same day as the test collection. The communities were able to rapidly implement a system of health care to keep their communities safe and protected.
A sustainable future
These POC devices, and the program as a whole, is setting the stage for the future. They can test for not only COVID-19, but a variety of infections including influenza, tuberculosis, chlamydia, HIV, meningitis and gastrointestinal diseases. The resources that NML helped establish within northern, remote and isolated communities during the COVID-19 pandemic has contributed to a sustainable future where the communities can take ownership over their health care.
“We’re creating a network that can be used long after the pandemic is over. COVID-19 will end, but we have created something that will last,” says Dr. Meyers.