Last week, outgoing chief medical officer Brendan Murphy announced all returned travellers would be tested for COVID-19 before and after quarantine.
Some were surprised testing was not already required. Others were outraged some 30% of returned travellers in hotel quarantine in Victoria had declined to be tested.
This week, Victorian premier Daniel Andrews saidmore than 900 people in two Melbourne “hotspots” had declined door-to-door testing.
Again, there was outrage. People refusing COVID-19 tests were labelled selfish and rude.
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.
In the week ending June 28, FluTracking, a voluntary online surveillance system, reported only 46% of people with a fever and cough had gone for a COVID-19 test.
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.
We can’t dismiss these concerns as paranoid. Fears of invasive procedures are associated with past trauma, such assexual abuse.
People who have experienced discrimination and marginalisation may also be less likely to trust governments and health systems.
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?
Although federal and state laws can compel certain people to undergo testing under limited circumstances, acting chief medical officer Paul Kelly said it was “a last resort”.
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.
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.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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