Israeli gas mask urban dictionary11/4/2023 An understandable skepticism of this apparently new and unfamiliar approach to public health surveillance was expressed by some medical and public health professionals. With the enormous public health management challenges posed by the COVID-19 pandemic, recognition of wastewater surveillance in Canada as a scientifically valid method to assess population-level disease states and its integration into the public health decision-making framework, has been an uphill struggle for credibility. 2019) epidemiological modelling and assessment of incidence, prevalence, and other metrics. Such changes in testing policy and lack of standardization between (and even within) public health jurisdictions have undermined the ability of clinical COVID-19 test results (i.e., case counts and their associated metadata) to serve as an effective, high-quality, primary data source that is a requirement for gold standard ( Umemneku Chikere et al. In addition to regional differences in testing policies, reporting practices also differed across the country and at different times in the pandemic. Thus, emergence of more transmissible variants of the original Wuhan-Hu–1 SARS-CoV-2 virus (often referred to as the wild-type strain) led to increased challenges to clinical test-trace capacity resulting in a variety of changes in policies governing who in the population will be tested (e.g., random, self-selected, contact with cases, high risk, symptomatic only). Moreover, mitigation of disease incidence using a classic test-trace-isolate strategy, such as the one many jurisdictions in Canada employed up until the advent of Omicron, has poor scalability, requires high rates of public compliance, and is ineffective for mitigating transmission when the etiologic agent is highly contagious (i.e., SARS-CoV-2 Omicron and its sub-variants, Contreras et al. Gaps and inefficiencies in disease surveillance can lead to inaccurate intelligence and subsequent inadequate or even inappropriate responses from key decision makers. Financial and human resource limitations aside, the lack of harmonization and standards in clinical surveillance and reporting across Canada is a reality that is inherent to clinical surveillance systems around the world but is pronounced in the Canadian federation over such a large expanse of land and disparity in health systems. While the national testing rates were comparable to other G7 countries ( GCDL 2022), systemic inequalities within and between provincial/territorial health jurisdictions, including shortages of personal protective equipment, contributed to inadequate responses most notably in congregate care settings which ultimately led to high morbidity and death rates ( CPHA 2021). Early in the pandemic, many Canadian jurisdictions struggled to rapidly perform enough clinical testing of individual patients to accurately track and report the incidence and prevalence of COVID-19 in the population to allow for timely contact tracing.
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