Testing surge capacity-A Canadian COVID-19 experience, Ontario's surge capacity for the first wave

As of September 1st 2020, over 42 000 COVID-19 cases and 2 800 COVID-19-related deaths have been confirmed in Ontario, Canada. Testing enables quick identification of cases, which results in effective contact tracing and containment of virus spread. Faced with a lack of surge capacity in the public health laboratory system at the start, health officials implemented changes to testing and laboratory infrastructure to significantly expand testing capacity to include 1) the centralization of resources; and 2) the integration of private and independent labs into the COVID-19 testing program. With these changes, testing capacity has grown from approximately 4,000/day in March to 32,000/day by the end of August, 2020. Eligibility criteria for testing has expanded to increase sensitivity and include testing of asymptomatic individuals. Along with previous outbreaks, the COVID-19 pandemic has highlighted the need for integration of testing surge capacity in public health systems before outbreaks occur. This paper details the development and implementation of a COVID-19 testing program in Ontario from January 2020 to September 2020 during the first-wave of the pandemic. The goal of this analysis is to explore the historical precedence, present influences, and future implications of the program.