COVID case count doesn't communicate Omicron reality in Sask.: doctor

A public health doctor in Saskatchewan says the real number of COVID-19 cases in the province is likely much higher than what's being reported in official data.

Dr. Cory Neudorf said the rapid spread of the Omicron variant and recent changes to the province's testing is helping widen that gap. 

As of Dec. 30, asymptomatic people in Saskatchewan who test positive on a rapid test are no longer recommended to get a PCR test to confirm their status. Instead, they should assume they have COVID-19, self-isolate and inform their contacts.

This means many people who test positive on a rapid test will never show up on the province's confirmed totals.

"That's really the only way that we can report positive cases because the rapid antigen tests are self-administered, and there's no official report of those because it's not done by a lab," Neudorf said. 

"So we're going to see a drop in positives because of that change, and in the testing procedures."

Dr. Saqib Shahab, the province's chief medical health officer, said last week that because of factors like asymptomic spread, provincial data has never been able to capture the full scope of the virus.

"We were identifying maybe 60 to 70 per cent of all cases. But right now, you know, that would be even lower. Even if we stuck to PCR testing, most people remain asymptomatic and transmit," Shahab said on Dec. 30.

What we expect is many, many more people to be positive, including more breakthrough cases or reinfections- Dr. Cory Neudorf, Saskatchewan public health physician 

Gathering real-time data

Neudorf said the Omicron variant is spreading faster and easier than others, with mild symptoms reported in immunized or previously infected people.

"What we expect is many, many more people to be positive, including more breakthrough cases or reinfections," he said.

He said monitoring the viral load in wastewater samples is one way public health gathers real-time data. Neudorf also noted outbreaks can give further insights into how Omicron spreads.

Last Thursday, Premier Scott Moe said provincial officials are looking at hospitalizations and ICU admissions as key indicators.

Neudorf said those have always been a lagging indicator of COVID'S impact within a community.

He said the percentage of positive cases requiring hospital or ICU care is expected to go down, but they could still add pressure if numbers climb too quickly. 

"With a high, high number, even a lower proportion is likely going to result in a high number of people who need hospitalization and ICU, potentially even to the rate of straining the health-care system again," he said.

Rapid rise, rapid fall?

Neudorf said that if the variant presents in Saskatchewan as it has in other countries, the province will see a rapid rise in the peak of cases heading into February. 

What happens next depends on how people behave. The doctor said an increase in booster doses and public health restrictions has played a role in places that have reported a rapid decline in cases. 

"It's always helpful if government makes that clear to people in the messaging, 'This is what we expect of you, or even require of you,' by putting restrictions in place," he said. 

"Those things will determine how fast we come out of this wave." 

The test positivity rate — the proportion of the people tested who are found positive — is expected to increase as a direct result of the province's targeted approach to PCR testing.

Neudorf said it will also be notable when test positivity begins to decrease.

"It's a good indication that other things are out there in the community causing symptoms. It's not as much COVID anymore, and that would be a good sign," he said. 

The government continues to recommend PCR tests for people who have symptoms of COVID-19, as well as those who work in health care, or long-term and personal care homes.