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Rapid Testing for COVID-19

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Introduction

This document is intended to provide employers and administrators information for using rapid testing as an active screening tool for reducing COVID-19 transmission.

For general COVID-19 prevention practices for both employers and workers, refer to Protect Yourself and Others from COVID-19.

Consider the Risks

The risk of COVID-19 transmission increases in workplaces where people are working in closed spaces (with poor ventilation) and crowded places when with people from outside your immediate household. Risk is higher in settings where these factors overlap and/or involve close range conversations, singing, shouting or heavy breathing (e.g., exercising).

Each workplace may have unique situations. Conduct a risk assessment for each worksite and activity to determine what measures need to be put in place to control the transmission of COVID-19. Consult your local public health authority and jurisdictional health and safety regulator for further guidance.

People who are infected with the COVID-19 virus can spread it to others, even before they develop symptoms (pre-symptomatic), while some infected people will have no symptoms at all (asymptomatic). They can still spread the virus, even if they may not look or feel sick.

Control Measures

The most effective way to reduce the risk of COVID-19 transmission is to follow the hierarchy of controls and use a layered approach. Testing for COVID-19 is considered an added level of active screening. Detecting asymptomatic or pre-symptomatic COVID-19 positive individuals can help prevent workplace outbreaks.

Worker Self-Assessment

Encourage workers to stay home if they are sick or might be sick. Follow self-assessment steps from the Public Health Agency of Canada or your local public health authority.

Worker Screening

Screen your employees and others before they enter your workplace, following the recommendations provided by your local public health authority.

“Active screening” may be legally mandated in some jurisdictions and involves asking questions about a person’s health and possible exposures. Use a checklist or questionnaire provided by your local public health authority. Active screening is not intended as a clinical assessment or to take the place of medical advice. Rather it is a way to identify people who may spread the virus so that measures can be taken to prevent further transmission. Be sure to record the names and contact information of all workers to assist with contact tracing if needed.

If a designated person is screening individuals in person, the screener should maintain the greatest physical distance possible (i.e. at least 2 metres) and wear personal protective equipment (gloves, masks, facial or eye protection, etc.) as appropriate.

Screening Customers

Customers or clients could be asked about illness and exposure risks when they are booking their appointments (if applicable) and again at reception when arriving at the premises.

Entering the Workplace

If you put active screening measures into place, you need to also have a procedure for handling persons who screen as having possible concerns. Anyone who does not pass screening should not enter the facility, should wear a medical mask (If unavailable, wear a well-constructed and well-fitting non-medical mask), return home (while avoiding public transit as much as possible), and contact their health care provider or local public health authority and follow their advice.

Rapid Testing

Rapid testing can also be used as part of your active screening process to protect workers. While they are not as sensitive as laboratory (polymerase chain reaction (PCR)) tests, these rapid tests can be useful in detecting people infected with COVID-19, including those who are asymptomatic.

Rapid testing can be used following the initial screening procedures. The test will show if a person is infected at the time the test is taken. It does not tell if a person has had the infection previously. It will not prevent someone from getting COVID-19.

Types of Rapid Testing

Point of Care (POC) nucleic acid testing and rapid antigen detection tests (RADT) are two types of tests used to detect COVID-19. The nucleic acid test detects viral genetic material from a nasal swab, nasopharyngeal (NP) swab, throat swab or saliva. The RADT detects viral proteins from a nasal swab or NP swab. Samples do not need to be tested in a laboratory and results using the RADT can be obtained in one hour or less.

As of December 21, 2020, Canada has approved seven rapid tests for use. Tests may differ in terms of the type of sample collection, need for additional equipment (e.g. a reader device), testing sensitivity and cost. The RADT test may be preferred because of its ease of use and quick turnaround time.

Considerations When Choosing Rapid Testing

Organizations should consider the implications of introducing rapid testing in conjunction with other measures to prevent COVID-19 transmission:

  • Rapid testing should be conducted by a health professional who is trained in the handling, testing and disposal of testing kits in accordance with manufacturer’s instructions and guidance from the Public Health Agency of Canada.
  • Some rapid testing kits do not require freezer storage or refrigeration, but they do expire. Consider how kits and test results will be stored. How many kits will be needed and what type?
  • Determine how used kits will be handled. Are changes required to your hazardous waste disposal procedures and if so, who needs to be trained?
  • Develop a schedule for testing. Will this include all workers at the beginning of each shift or a random selection? How will you test all workers?
  • The turnaround time for test results vary from 15 minutes to one hour. Consider how this will influence the type of kit to purchase. How will waiting times impact the start of work? Will workers be able to maintain physical distancing while waiting for the results?
  • Test results are sensitive information and must remain confidential. Identify who will have access to the results, how results will be stored, and for how long. Follow your privacy laws and consult with your local public health authority on requirements for retaining documentation and the method for which documentation should be destroyed.
  • Review and update your business continuity plan to address any impact of positive test results on your ability to provide your product or services.
  • Where applicable, consult with your union and review the collective agreement language regarding the time for required testing, sensitive medical information, and worker privacy.
  • Continue to work with your joint health and safety committee or safety representative in the implementation of this and other health and safety measures.
  • Ensure the rationale and procedures for rapid screening tests are communicated to all workers in a language and format that is easy to understand.
  • Review absence and sick leave policies and provide information to all workers on the resources available to them, including government support.
  • Follow the guidance on RADT as provided by your local public health authority.

Continue to Evaluate Your Risks

Rapid testing does not replace public health and safety requirements. Employers must continue to conduct risk assessments on how COVID-19 can be transmitted in their workplaces and use the hierarchy of controls to provide a layered approach to reducing the risk. Continue with physical distancing, engineering controls, ventilation, cleaning, and disinfecting, using personal protective equipment (PPE) and wearing non-medical masks as part of your health and safety plan.

Responding to Test Results

Consider how you will manage the response to a rapid test:

  • When administered properly, a positive result means it is likely that the person is infected at the time the test is taken. They should not be allowed to enter the workplace or if already inside, should remain isolated from others. Consider administering another test.
  • All positive results from rapid testing should be confirmed through a PCR test. Individuals should contact their health care provider and local public health authority and follow their advice including isolating at home for up to 14 days.
  • A positive result may cause psychological distress and stigmatization. Ensure all employees are provided with mental health and grief support resources including your Employee Assistance Program (EAP) provider if available.
  • Positive results may continue for up to three months post-infection and may or may not indicate a true re-infection especially if the individual has no symptoms and no new exposure. Consult with your local public health authority to help manage these types of situations.
  • A negative result means it is likely the person was not infected at the time the test is taken. However, this does not mean that they could not become infected later. It is also possible that they could be infected but that it went undetected because they are in the very early stages of the infection. If symptoms develop, they may need to be retested.
  • Negative results can lead to reduced compliance with prevention measures, which can result in increased COVID-19 transmission. Organizations must continue to ensure all safety measures, including physical distancing, proper hand hygiene and the use of non-medical masks continue.

Responding to Sick Workers

Review your procedures for responding to a sick person at work:

  • Continue to encourage workers to self assess and report any symptoms even if mild.
  • Ask workers to self isolate, wash or sanitize their hands, and wear a mask (preferably a medical mask) until they can return home.
  • Consider preparing a separate area away from others in advance, such as the first aid room, an empty office, or a seat behind a barrier if space is limited.
  • Call 911 for assistance if the worker is severely ill (such as difficultly breathing or chest pain).
  • Clean and disinfect any surfaces or items that the worker has contacted:
    • Close off all areas the person used or was in. Consider common areas (e.g., washrooms), and any shared items (e.g. touch screens).
    • Increase air circulation in those areas by using the ventilation system or by opening doors and windows.
    • Wait 24 hours, if possible, before cleaning the areas.
    • Continue to follow routine procedures for cleaning and disinfecting.
    • Additional cleaning and disinfecting are not necessary if seven or more days has passed since the person who is ill or tests positive for COVID-19 was in the facility.
  • Provide information to workers on employer leaves of absences, sick benefits, and alternate government benefits.

Role of Authorities

  • All confirmed cases of COVID-19 are to be reported to the relevant jurisdictional public health authority, health and safety regulator and workers compensation board who will help you manage any workplace outbreaks.
  • The workers compensation board will determine if a worker’s COVID-19 diagnosis is work-related and determine the appropriate benefits (health care, loss of earnings).
  • The government health and safety regulator will:
    • inspect workplaces to monitor compliance with health and safety legislation.
    • investigate unsafe work practices, serious injuries, fatalities, hazardous exposures, work refusals and occupational illness, as related to worker health and safety. This includes investigation of reports of COVID-19 by employers and employees to government health and safety agencies.
  • The local public health authority will:
    • investigate clusters of cases associated with workplace locations.
    • provide guidance and recommendations on outbreak measures, investigation, and testing.
    • determine if an outbreak exists and when an outbreak is over.
  • Get additional guidance on the management of cases and contacts.

Return to Work

  • Consider whether employees are required to provide proof of a negative test result to return to work.
  • Employers should be flexible and not overburden the health care system with requests for medical notes. Unnecessarily visiting medical offices increases the risk of exposure for everyone.
  • An employee is not required to provide a medical note if they need to take a leave related to COVID-19.
  • Maintain confidentiality as much as possible. Employers should not disclose any personal information including medical diagnosis of ill employees to others.
  • Employers and workers must work together to identify any accommodation for a safe return to work.
  • Follow the guidance for return to work provided by the employee’s health care provider, local public health authority, and workers compensation board, if applicable.
  • Prior infection does not guarantee immunity. Workers who have previously tested positive and recovered can still become re-infected. They must adhere to the health and safety measures as required by the local public health authorities and their employer.

It is important that mental health resources and support are provided to all workers, including access to an employee assistance program, if available.

For further information on COVID-19, refer to the Public Health Agency of Canada.

Note that this guidance is just some of the adjustments organizations can make during a pandemic. Adapt this list by adding your own good practices and policies to meet your organization’s specific needs.

Disclaimer: As public and occupational health and safety information is changing rapidly, local public health authorities should be consulted for specific, regional guidance. This information is not intended to replace medical advice or legislated health and safety obligations. Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.

Document last updated February 24, 2021