Last week, outgoing chief medical officer Brendan Murphy announced all returned travellers would be tested for COVID-19 before and after quarantine.
A positive test result, together with contact tracing, gives public health authorities important information about the spread of SARS-CoV-2, the coronavirus that causes COVID-19, in a community.
So why might people at higher risk of a positive result be reluctant testers? And what can we do to improve testing rates?
The many reasons why
Reluctance to be tested for COVID-19 is not unique to returned travellers in hotel quarantine or people living in “hotspot” suburbs.
That can be for a variety of reasons.
A medical test result is not a neutral piece of information. People may refuse medical testing (if they have symptoms) or screening (if no symptoms) of any type because they want to avoid the consequences of a positive result.
Reasons may relate to potentially losing money or work
Many reasons for avoiding testing are likely to be structural: a casualised workforce means fewer workers with sick leave and a higher burden associated with having to isolate while waiting for test results. After a COVID-19 test in NSW, for instance, this can take 24-72 hours.
Then there’s the issue of precarious work. If people can’t attend work, either waiting at home for test results or recovering from sickness, they may lose their job altogether.
In the case of hotel quarantine, a positive result on day ten will mean a longer stay in isolation. Hotel quarantine is not an easy experience for many, particularly if quarantining alone.
An extension of time at a point where the end is in sight may be a very difficult proposition to stomach, such that avoiding testing is a preferable option.
Another structural issue is whether governments have done enough to reach linguistically diverse communities with public health advice, which Victoria’s chief health officer Brett Sutton recently admitted may be an issue.
Through no fault of their own, may people who don’t speak English as a first language, in Victoria or elsewhere, may not be getting COVID-19 health advice about symptoms, isolation or testing many of us take for granted.
People might fear the procedure or live with past traumas
Reasons may be personal and include fear of the test procedure itself (or fear it will hurt their children), distrust in government or public health systems, and worry about the extent of public health department scrutiny a positive result will bring.
People may also feel unprepared and cautious in the case of door-knocking testing campaigns.
COVID-19 can also lead to social stigma, including blame and ostracism, even after recovery.
As with any health-related decision, people usually consider, consciously or not, whether benefits outweigh harms. If the benefit of a test is assumed to be low, particularly if symptoms are light or absent, the balance may tip to harms related to discomfort, lost income or diminished freedoms.
Should we force people to get tested?
Forcing a person to undergo a test contravenes that person’s right to bodily integrity. This is the right to make decisions about what happens to your own body, without outside coercion.
It also involves medical personnel having to override their professional responsibility to obtain voluntary and informed consent.
Some states have indicated they will introduce punishments for refusing testing. They include an extension of hotel quarantine and the potential for fines for people not willing to participate in community testing.
Forced testing will backfire
We don’t think forced testing is the way to go. A heavy-handed approach can create an antagonistic and mistrustful relationship with public health institutions.
The current situation is not the only infectious disease emergency we will face. Removing barriers to participating in public health activities, in the immediate and long term, will enable people to comply with and help build trusted institutions. This is likely to create an enduring public good.
Victoria is trying to make testing easier. It is offering a test that takes a saliva sample rather than a nasal swab, which is widely perceived to be unpleasant.
This may encourage parents to have their children tested. The test is less sensitive, however, so the gains in increased uptake may be lost in a larger number of false negatives (people who have the virus but test negative).
Ultimately, we need to understand why people refuse testing, and to refine public health approaches to testing that support individuals to make decisions in the public interest.
No COVID-19 cases at Deerhurst – My Muskoka Now
HUNTSVILLE, ON-Deerhurst Resort has confirmed that none of its staff have tested positive for the COVID-19 virus after servicing a large group.
Over the August long weekend, a large group of 30 visited the resort, but upon their return home, which is outside Muskoka, 11 of them tested positive for the virus.
When the Simcoe Muskoka District Health Unit was notified of the active cases, contact tracing led them to believe one staff member of the resort was a potential risk of contracting the virus. With this result of the employee testing negative for the virus, all outstanding concerns have been put to rest.
“While we were hoping this would not happen, the possibility of COVID transmission is exactly why all of our stringent prevention measures have been in place since we re-opened,” said General Manager of the resort, Jesse Hamilton. “Everything from capping occupancy, fully disinfecting guest rooms after each departure, frequent sanitization, social distancing in all facilities and mandatory face coverings for staff in all areas of the hotel operation have proven effective, for which we are grateful.”
As the resort has been closely working with the SMDHU, the assessment of the contact risk and the high degree of compliance of infection control practises, has led to the green light being given to Deerhurst to stay open.
Hamilton said they appreciate the concern of staff, guests and their community when hearing about the presence of COVID at the resort.
She noted that until important facts were fully known, they didn’t want to add any potential misinformation or alarm to the situation.
“We put our trust and confidence in the public health authorities from whom we took direction and in our safety protocols, which appear to have passed a test we never hoped to take.”
More than 500 people may have been exposed to COVID-19 at Toronto strip club – CTV Toronto
More than 500 people may have been exposed to COVID-19 after visiting an adult entertainment club in Toronto, public health officials say.
According to Toronto Public Health, an employee at Brass Rail Tavern, located near Yonge and Bloor streets, has tested positive for the disease.
The employee worked at the facility on the following dates: Aug. 4 ( 7 p.m. to 2:30 a.m. on Aug. 5), Aug. 5 (8 p.m to 3 a.m. on Aug. 6), Aug. 7 ( 9 p.m. to 3 a.m. on Aug. 8) and Aug. 8 (7 p.m. to 2:30 a.m. to Aug. 9).
“As a precaution, TPH is advising anyone who attended the Brass Rail Tavern during these dates and times to monitor themselves for COVID-19 symptoms for the 14 days after their last visit during this time period,” officials said in a news release issued on Friday.
“There was no risk to anyone attending the Brass Rail Tavern outside of these dates and times.”
Toronto Public Health said they have followed up with all known close contacts of the employee and have asked those individuals to self-isolate for 14 days and get a COVID-19 test. Officials are also notifying customers directly through the establishment’s contact tracing log.
The Brass Rail Tavern is cooperating with public health to ensure all COVID-19 Stage 3 reopening protocols are in place, officials said.
Approximately 550 people passed through the establishments on the dates the employee worked, Toronto Public Health said, and those individuals should visit the government’s website and use their COVID-19 assessment tool. They also say there is no need to self-isolate and “people can continue their routine daily activities if an individual remains healthy and does not develop symptoms.”
Anyone who develops symptoms should immediately contact Toronto Public Health, take a COVID-19 test and self-isolate.
City warns hundreds may have been exposed to COVID-19 at Brass Rail strip club – CBC.ca
The City of Toronto says about 550 people may have been exposed to COVID-19 at a downtown strip club earlier this month.
Toronto Public Health says it is notifying people who visited the Brass Rail Tavern at 701 Yonge St. about a potential exposure.
Officials say an employee who tested positive for the virus was at the club on these dates and times:
- Aug. 4 from 7 p.m. to 2:30 a.m. on Aug. 5
- Aug. 5 from 8 p.m. to 3 a.m. on Aug. 6
- Aug. 7 from 9 p.m. to 3 a.m. on Aug. 8
- Aug. 8 from 7 p.m. to 2:30 a.m. on Aug. 9
Public health says there was no risk to anyone who went to the club outside of those dates and times.
“As a precaution, [Toronto Public Health] is advising anyone who attended the Brass Rail Tavern during these dates and times to monitor themselves for COVID-19 symptoms for the 14 days after their last visit during this time period,” the city said in a news release.
Public health officials say they have followed up with “all known close contacts” of the person who tested positive, and asked those people to self-isolate for two weeks and go get tested.
They are also directly notifying people who gave their name and contact information to the club for its contact tracing log, according to a news release.
“The establishment is collaborating with [public health] to ensure all COVID-19 Stage 3 reopening protocols are in place in this setting, including staff and patrons wearing masks, infection prevention and control measures are in place, and appropriate physical distancing measures are followed,” the news release reads.
According to the city’s website, as of the afternoon of Aug. 12, 15,548 cases of COVID-19 to Toronto Public Health, while 14,132 people have recovered.
Health officials recommend that anyone who has symptoms or feels as though they may have been exposed to COVID-19 use the province’s COVID-19 self-assessment tool.
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