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  • The COVID-19 pandemic has disrupted medical care around the world
  • A study in Ontario found a significant reduction in testing for hepatitis B and C viruses
  • Researchers urge efforts to intensify opportunities for testing people for these viruses

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infect the liver and can lead to chronic infection of this organ. If left undiagnosed and untreated, chronic infection with these viruses degrades the liver over time and can cause serious complications, including an increased risk for liver cancer.

The World Health Organization (WHO) has encouraged countries and regions to work toward eliminating viral hepatitis (particularly HBV and HCV infections) as a public health issue by 2030. Prior to the onset of the COVID-19 pandemic, Canada was moving toward this goal.

Disruptive effects

Researchers in Canada and many countries have reported that since the onset of the COVID-19 pandemic, there has been a decline in rates of screening for many conditions. Several factors have likely contributed to this decline, including a reduction in non-essential care in hospitals and clinics so that resources could be redirected toward caring for people with COVID-19. Some people with chronic conditions may also have avoided visiting hospitals and clinics because of fear of infection with SARS-Cov-2, the virus that causes COVID-19.

The pandemic has ebbed and flowed since 2020 in what researchers refer to as “waves.” It is possible that some people would initiate or renew clinic visits for evaluation of chronic viral hepatitis during periods when there was a relative decrease in rates of COVID-19.

In Ontario

Researchers at the University of Toronto, Western University and Ontario Public Health Laboratories conducted a study to find out more about rates of testing for HBV and HCV before and during the first three waves of the COVID-19 pandemic.

In summarizing their findings, the researchers stated that “significant decreases in HBV and HCV testing occurred during the first three waves of the pandemic and have not recovered.”

Study details

Researchers divided the time studied into the following periods:

  • first wave – March to August 2020
  • second wave – November 2020 to February 2021
  • third wave – March 2021 to May 2021

For comparison, the researchers used data from 2019.

The researchers focused on the following tests:

  • hepatitis B surface antigen (HBsAg)
  • HCV antibody


Researchers found that testing rates for HBV and HCV fell during the pandemic as follows:

  • first wave – a decline between 33% and 44%
  • second wave – a decline between 18% and 30%
  • third wave – a decline between 15% and 36%

The researchers noted that testing for viral hepatitis has not returned to pre-COVID-19 levels.

Bear in mind

The researchers stated that testing for viral hepatitis had been increasing prior to the onset of the COVID-19 pandemic. However, once the pandemic occurred, testing rates fell. In the case of HCV, based on the decline in HCV RNA testing, researchers think that initiation of HCV treatment also declined during at least the first wave of COVID-19.

The researchers warned that people who delay the initiation of HCV treatment may drop out of care and monitoring that is needed for this chronic infection. This could increase the proportion of people who develop HCV-related complications in the future. That there has likely been a sustained (over the course of the pandemic) decrease in initiation of HCV therapy also means that the goal of eliminating this infection at the level of a city, region or country has become more difficult to achieve.

To reach populations vulnerable to HBV and HCV, particularly people who experience homelessness and who inject drugs, the researchers encouraged policy planners to consider using COVID-19 vaccination clinics for community outreach. They advised policy planners to use these clinics to (re)connect people to testing and care for viral hepatitis. However, this is just one step; more strategies to help Canada get back on track to eliminating viral hepatitis need to be considered by ministries of health, hospitals and clinics.  

—Sean R. Hosein


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Mandel E, Peci A, Cronin K, et al. The impact of the first, second and third waves of COVID-19 on hepatitis B and C testing in Ontario, Canada. Journal of Viral Hepatitis. 2022 Mar;29(3):205-208.