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Backlog bewilderment

What happened to Nova Scotia’s COVID case count, and how it got back on track.

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I t was almost two weeks ago, on Friday, April 30, that news of a backlog first made its way to the daily COVID-19 update. At the time, public health top doc Robert Strang said Nova Scotians had turned out for testing in such high numbers, there was a slowdown in processing them.

“Because of that, there currently is a large backlog in the lab of about three days," Strang explained, getting at the distinction between pop-up testing locations that do quick onsite analysis to find potential positives, and definitive laboratory tests that use polymerase chain reaction technology to look for virus in swab samples. “We need to expect high case numbers in the days ahead as the lab and public health get caught up.”

The good doctor said the backlog of 45,000 tests would be cleared in a few days. In the meantime, he told Nova Scotians to only get a PCR test if they were a close contact of a COVID-positive person or had symptoms: “PCR tests at primary assessment centres will be only given to the people most likely to have COVID.”

The following week, on Tuesday, May 4, Strang said the testing backlog was cleared, right on the “about three days” schedule. But what public health didn’t mention at the time was that another problem had piled up. The first backlog was in tests being processed at the lab, figuring out whether a person’s nasal swab was positive for COVID. But clearing that backlog, by churning through tests at record speed, created a second backlog of data entry for the test results.

“There are a large number of positive cases that public health has not yet been able to contact or begin an investigation on,” Strang said at the Friday, May 7 briefing where the new backlog was acknowledged. For various reasons, these positives couldn’t be reported by the province: public health hadn’t completed contact tracing yet to find out who else might be at risk of infection, or case info wasn’t entered into the Panorama public health tracking system. Sometimes the person whose nose swab was tested hadn’t been notified they were COVID-positive.

“There’s still more than 200 other cases that still need to be entered,” said premier Iain Rankin that same Friday.

Nova Scotians went into the weekend uncertain what the case count really was. From April 30, when the backlog first came up, through Sunday, May 9, the province announced 1,559 new cases with no indication if the case was freshly diagnosed or coming from the backlog. More than 300 infections were announced on Saturday and Sunday alone; did that include any, all or none of Rankin’s 200+ cases? Answers had to wait until Monday’s C19 briefing.

“We have been making steady progress in addressing the case backlog in public health and we’re close to being caught up,” Strang reported on Monday, May 10. He said the 200+ cases from Friday were down to fewer than 100. “Many of the backlog cases were reported in our numbers over the last few days and some may continue to show up for a day or two, but by mid-week I expect the backlog will be cleared and we’ll be back to our usual process.”

Sure enough, on Wednesday, May 12, the province’s daily COVID press release said the backlog has been cleared: “All positive cases have been contacted and entered into Panorama, Public health has resumed contacting new positive cases after receiving lab confirmation.” Now Nova Scotia’s reported COVID cases should match the actual number of cases public health is aware of.

“That bulge that went through the lab and then the smaller bulge that went over to public health, it’s taken us a number of days,” Strang said. “We only have so much capacity, so many cases per day that public health can start new investigations on.”

He also gave a somewhat complicated bucket analogy of the backlog. But the bottom line is that the confusion Nova Scotians experienced about the daily release numbers during the whole episode is something Strang wants to prevent in future. “We’re going to monitor very carefully our case number and also monitor the number of tests being taken,” he said. “And keep a very close eye on not overwhelming the lab.”

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