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@MGHToronto I’ve now called my 700th patient with COVID-19 diagnosed through our community assessment centres and outreach testing. A few observations:
1.COVID-19 public health strategies must address associated health inequities. Like most infectious diseases COVID-19 disproportionally affects specific groups.
2.The pattern is evident, intersections of: people living in high rises, multigenerational families with crowded living conditions, low paying essential service jobs without paid sick leave, racialized populations and poverty
3.Time from symptom onset to test is still too long to prevent secondary transmission. Most people are presenting for testing after day 7. We need low-barrier testing strategies embedded in at-risk communities
4.Lab capacity and turnaround time is still inadequate. If individuals are most infectious in the 5 days post symptom onset and symptoms trigger testing, any TAT greater than 24hrs is wasting precious time.
5.Working collaboratively with @TOPublicHealth this week contact tracers have finally beat me to a patient! We are making progress towards our goal of contact tracing within 24hrs. We must keep this up.
http://6.As a clinician who uses patterns to determine diagnosis this infection messes with me. Those I expect to do worse do well and those without traditional risk factors get admitted to the ICU.
7.I have the benefit of serial follow-up and asymptomatic infections clearly occur at a frequency of 15-20%.
8.Asymptomatic testing in persons without any exposure or risk factors is of uncertain benefit. I’ll never know but am seeing a lot of what I suspect are false positive tests. I suspect at least 1 in 4.
