Rob Murray: I’m speaking with Dr. James Clem from the Alpine Medical Clinic in Banff. We’re going to talk about COVID-19 testing. So when a person gets a COVID-19 test, what exactly are they being tested for?

Dr. James Clem: The test, at least at our clinic and I think in most of the Bow Valley, is actually a throat swab. What it’s trying to do is detect any virus that’s living in the back of the throat in that moment.

RM: That doesn’t mean that people should feel complacent if they get a negative test because it’s just a snapshot of a point in time, right?

JC: It does not have any detection value into the future. It doesn’t say whether in the past you’ve been exposed to it. So that runny nose that you had three weeks ago, it doesn’t tell you whether or not that was COVID-19. There is also maybe some confusion around antibody testing, which is under development, which has the potential to show a previous exposure or infection because your immune system has been triggered to show that it’s been exposed to COVID-19 in the past, versus the test that’s actually being done in our clinic to show acute infection in that moment.

RM: How accurate is the testing? I mean, is it possible to have a false negative?

JC: There’s no perfect test. It is very sensitive and quite accurate if the technique is done properly and there is viral load that is even possible to detect in the back of the pharynx, but we don’t know enough yet to say if there’s a period of time where that virus is living in other parts of the respiratory system before it develops in the back of the pharynx. We also have user issues in terms of, is it done properly? It’s not an pleasant test to do all the time. Some people have a very strong gag reflex which makes it challenging to get a good sample from the back of the throat.

RM: Do you have any estimate of the number of tests that have been performed locally?

JC: We have been increasing testing month by month. In March, 13 tests were completed. In April, 296. In May, 476. In June, 847. That’s across everywhere from our Morley clinic all the way up to Lake Louise, including Banff and Canmore. As well, we’ve been working with the medical officer of health to increase our testing capacity. If there is an outbreak we want to have the ability to test about 500 people within 48 hours. The Bow Valley Primary Care Network is working on a plan to achieve that capacity for residents.

RM: So where can people get tested locally?

JC: Both the Alpine Medical Clinic as well as the Bear Street Clinic are providing testing. I can speak specifically for our process at the Alpine Clinic. Here, you call in and you do some screening over the phone. I know that the Ridgeview Clinic in Canmore is doing testing as well as the Canmore Associate Medical Clinic. In Morley, the Stony Health Clinic (for Stoney Nation residents only), as well as the Lake Louise Clinic.

RM: This is just for symptomatic patients at the moment locally here, isn’t it?

JC: It is. Potential or anticipated shortages of some of the testing supplies has meant that we’ve scaled back the testing for patients that are asymptomatic at the moment. That may change.

RM: I’m curious, as businesses are reopening, if you’re finding that there are employers in the Valley who have been requesting that their employees get tested before returning to work. Is that a thing?

JC: Yeah, that is something that we’ve seen here, where I would say that questionable symptoms are requiring a test as well as a printed sort of proof that you do not have COVID-19. Then there are other times where I think that employers have been completely reasonable – they have a very sensitive policy that if patients have any symptoms that they need to self-isolate and directing them to testing, which I think is it’s great. I think a bit of the overreach can be a bit much, but I would probably prefer a more sensitive process where we’re capturing everybody to get testing done so that we’re not risking any outbreaks. I know that with Dr. Deena Hinshaw, that’s been one of the main recommendations from the beginning is this sort of change in our culture to say, if I’m not feeling well at all, then I should be empowered to stay home from work so that I don’t expose everybody else. In the pre-COVID era, I think a lot of people would maybe push through mild symptoms and go to work anyways. Yes, it’s been a thing that employers have been recommending that their employees get testing. I would caution them about sending their employees for asymptomatic testing as they may not be able to find clinics that have the capacity to do that at the moment.

RM: I want to talk a little bit about my experience because a couple of weeks ago I came down with some cold or flu-like symptoms. We have a very strict process here at our office about having to do an employee questionnaire. I obviously didn’t pass the questionnaire that day. I had some local testing done. It came back negative. My company policy still said that I had to stay at home for 14 days. It was a huge pain for everybody involved here at the radio station because schedules had to be moved around, some vacation days had to be shifted around, and I was thinking to myself that it was probably just a cold. Maybe I shouldn’t have said anything and gone to work like what I would have done in the past, but ultimately I think honesty is the best policy in this kind of situation, even if it is a big pain for everybody, isn’t it?

JC: Yeah, it is a huge pain with the scheduling issues that we run into if one of our employees has to take time off, especially for such a long duration. I’ve heard the same issues for patients whose children are in local daycares, and daycare policy is that if they have any symptoms then they have to be away from daycare, so families are juggling around childcare for two week period of time. We’re always worrying about the worst case scenario and an outbreak for your fellow employees of COVID-19. How do we compare that to the personal discomfort as well as personal burden of having to take 14 days off? You’re right. Had you gone to work and tried to cover up the symptoms, there’s a very good chance that maybe you didn’t pass it on to anybody else, but it’s always that chance that this could then become a local outbreak at Mountain FM. That would be devastating, and I think that there’d be a lot of feelings of guilt. I would feel the same way if that happened with me here covering up symptoms. I’m seeing patients throughout the day. If I were to be taking two weeks off, then all of my patients are missing out on having their symptoms addressed. It’s not an easy answer, but I think public health is definitely strongly on the side of being more precautious despite the rescheduling nightmares that it poses.

RM: The Bow Valley Primary Care Network website has a great list of local resources and the numbers to call to book an appointment if you do need a symptomatic COVID test here in the Bow Valley. Dr. James Clem, thanks so much for joining me on the show today.

JC: Thanks for having me, Rob.

Filed under: Banff, Bow Valley PCN, Canmore, covid-19