Guidance for Rapid Workplace Screening
TL;DR: the use of rapid antigen tests as a screening tool for workplaces is one of the most rapid ways that businesses, their customers and communities can stay safe, slow the spread and ensure a swift economic recovery from the COVID-19 pandemic.
Like all other screening tools at our disposal throughout the “new normal” – masks, sanitizer, social distancing, temperature checks – rapid testing is not a foolproof method to stop the spread of coronavirus. We know there is no silver bullet solution to ending the COVID-19 pandemic, but each of these screening tools is part of a comprehensive strategy that, when used together, will keep us safe and keep the economy going.
By implementing free, self-administered antigen testing into daily life, we can prevent community spread of COVID-19 in the workplace, at home and in the community.
On this page, you will find a comprehensive resource guide developed for businesses looking for guidance on how to implement the use of rapid COVID-19 antigen screening in their day-to-day operations. Scroll even further - and you'll find an extensive FAQ that should answer any questions that you, or your employees, may have on the use of rapid antigen testing as a screening tool for COVID-19.
This resource guide is available in French by clicking here.
Who this resource guide is for:
Canadian workplaces or businesses.
Why you should care and download this resource:
If you are a decision-maker at a Canadian workplace and you want to create safer working environments that further reduce the spread of COVID-19, this resource will help you do just that by providing you a step-by-step guide to incorporate rapid antigen testing into your workplace’s screening tools.
Why rapid screen:
Because they're safe, economical, fast and have the ability to detect carriers of COVID-19.
These are the type of tests that have been used to detect COVID-19 at testing centres across Canada since the onset of the global pandemic in March 2020. These deep nasal swabs (a.k.a. brain ticklers) are used to detect COVID-19 in individuals when they are exhibiting symptoms of the virus - because of their cost (approx. $50 per test) and the time needed to garner results. Results can be delivered in approximately 24-48 hours. These tests can only be performed by a health care professional.
These are new and not yet widely implemented across Canada (soon - hopefully!). They are not as accurate as PCR tests in detecting COVID-19 (~80% accuracy vs. 90%), however, like PCR, they can detect COVID-19 in asymptomatic individuals and individuals who are not yet exhibiting symptoms of the virus. As PCR tests are currently only being used when individuals have been exposed / exhibit symptoms of COVID-19, it is important to implement an additional type of testing for those not exposed/experiencing symptoms. This is extremely important and mass use of rapid tests will help stop a majority of community spread of COVID-19 - which has been scientifically attributed in part to asymptomatic carriers of the virus and infected persons who are not yet exhibiting symptoms. Because these tests are extremely cost-effective (think $5 vs. $50), can be self-administered, with results delivered in as little as 15 minutes - these are the tests we should be implementing on a mass scale.
Communitech is a public-private innovation hub based in Waterloo Region, Ontario that supports a community of more than 1,600 innovation companies – from startups to scale-ups to large global players. Our highly-unique business structure means that we can operate as a government agency in times of urgency (I think we can all agree a global pandemic qualifies as a time of urgency) and we have the ability to move fast and get s#!t done with a lot less red tape than others.
This is why the Government of Canada selected us to help start spreading the word to other Canadian corporations and businesses: using rapid tests as screening tools in workplaces is one of the most rapid ways we can actually begin to put an end to the spread of COVID-19, keep businesses open and keep employees, customers and the community safe.
Think of it like this: being opposed to the use of rapid antigen tests because they aren’t as accurate as PCR tests is the same as telling people not to wear masks because they aren’t as effective as wearing a Hazmat suit. Masks are not fool-proof methods of stopping spread of COVID-19 yet they have been widely implemented as a screening tool because they are (a) more affordable than Hazmat suits and (b) effective enough.
For a number of reasons:
1. PCR tests have to be distributed by a team of health care professionals whereas rapid antigen tests can be self-administered.
2. PCR tests cost approx. $50 per test vs. a $5 cost per rapid antigen tests.
3. PCR tests are too costly to be using to detect COVID-19 in asymptomatic carriers or infected persons not yet exhibiting symptoms. Rapid antigen tests are less expensive and take less time to garner results and can catch these currently undetected cases that are continuing community spread across the world.
We’re of the opinion that every opportunity that you have to reduce the risk of further COVID-19 spread is worth trying. We’re in the big data space and we work with numbers and analytics all day long. We know as well as anyone: to beat COVID-19, we have to play a numbers game. The more we test, the more we can stop COVID-19 from spreading.
There are many differences and many similarities between PCR molecular testing and rapid antigen testing for COVID-19.
Molecular PCR tests:
- How is it done? Nasal swabs, throat swabs and tests of saliva or other bodily fluids.
- Where can you get this test? At a COVID-19 testing centre.
- What does the test look for? Molecular tests look for genetic material that comes only from the virus.
- How long does it take to get results? It depends on lab capacity. Results may be ready within hours, but often take at least a day or two. Much longer turnaround times can typically be expected.
- What about accuracy? The rate of false negatives – a test that says you don’t have the virus when you actually do have the virus – varies depending on how long infection has been present: in one study, the false-negative rate was 20% when testing was performed five days after symptoms began, but much higher (up to 100%) earlier in infection.
- What is the false positive rate? False positives – how often the test says you have the virus when you actually do not – should be close to zero. Most false-positive results are thought to be due to lab contamination or other problems with how the lab has performed the test, not limitations of the test itself.
- How effective is PCR testing? A molecular PCR test using a nasal swab is usually the best option because it will have fewer false negative results than other diagnostic tests or samples from throat swabs or saliva. People who are in the hospital, though, may have other types of samples taken.
Rapid antigen tests:
- How is it done? A nasal or throat swab.
- Where can you get these tests? At a hospital, a doctor’s office or at home.
- What does the test look for? This test identifies protein fragments (antigens) from the virus.
- How long does it take to get results? The technology involved is similar to a pregnancy test or a rapid strep test, with results available in minutes.
- What about accuracy? False negative results tend to occur more often with antigen tests than with molecular tests. This is why antigen tests are not favoured by experts as a single test for active infection. Because antigen testing is quicker, less expensive and requires less complex technology to perform than molecular testing, most experts recommend repeated antigen testing as a reasonable strategy.
A molecular PCR COVID-19 diagnostic test is a test meant to investigate symptoms of a current infection. This is the only test that can officially diagnose a case of COVID-19.
If you are experiencing symptoms of COVID-19, you would need a molecular test to confirm your diagnosis and to inform the treatment advice offered by a medical professional.
An antigen test can detect COVID-19 within minutes – but with slightly less accuracy than the PCR test. For that reason, rapid antigen testing is used for screening purposes only and is NOT used for diagnosis of acute COVID-19 infection.
If you are not exhibiting symptoms of COVID-19, a rapid antigen test would be the fastest and least cost-prohibitive way to potentially determine if you were an asymptomatic carrier of the virus or infected but not yet exhibiting symptoms.
If an individual tests positive for COVID-19 through a rapid antigen test, they would then be directed to public health for a PCR test so that medical professionals can determine treatment for their diagnosis. They should follow all advice of public health as it relates to isolation and quarantine while awaiting further test results.
No. Rapid antigen tests can be thought of as one of the most effective screening tools for COVID-19. Additional screening tools that have become commonplace across the world include temperature and symptom checks.
Using rapid antigen tests for screening purposes can identify a much larger fraction of infectious people than simple symptom and temperature checks – at a fraction of the cost and time needed to perform a molecular test.
- Rapid antigen tests can come at a cost of $5 per screen and take up to 15 minutes to get a result.
- A PCR test can cost around $50 per test and take up to 24+ hours to get a result.
Yes - because of the speed to which they can get results and the cost of administering each rapid test is much less than the cost of administering a PCR test. Don’t think about it in terms of more accurate versus less accurate in detecting the virus. Instead, think of it in terms of adding another tool to our toolbox to help stop further transmission of the virus.
In a good majority of cases, the PCR tests being administered at community centres and hospitals throughout communities in Canada are detecting positive cases that have passed their contagiousness point. That is because PCR is available mostly to individuals exhibiting COVID-19 symptoms or who are aware that they have been exposed to a COVID-19 positive individual. In other words, most people who test positive are no longer contagious. Not all, but most.
However, because antigen tests are less costly and time-intensive - they are a tool that we can add to our toolbox of COVID-19 screening tools that can detect positive cases BEFORE the contagiousness period has passed.
Therefore, rapid antigen tests if implemented on a mass scale can detect more positive cases of COVID-19 in individuals who remain contagious while exhibiting no symptoms at a fraction of the cost of PCR tests with test results completed in less than half the time. It is for these reasons that rapid antigen tests are a great screening tool to curb the continued spread of COVID-19 variants.
One of the biggest reasons that COVID-19 has continued to spread through our communities even though we’ve been social distancing, masking up and washing our hands non-stop is the fact that a large subset of people who contract the virus do not exhibit symptoms when they are contagious. Those individuals have no reason to go through PCR testing through COVID-19 testing centres.
If we want to stop or slow asymptomatic spread, we should screen people as often as possible to catch the virus at its asymptomatic and contagious stages. Rapid antigen testing – while not having perfect accuracy rates – can do just this. The low costs of these tests and the speed to which they get results are even more proof that rapid antigen testing should be implemented as a widespread screening tool.
COVID-19 is a numbers game. The more we test, the more we can stop COVID-19 from spreading. If PCR tests are to be reserved for those COVID-19 carriers exhibiting symptoms (and other use cases as outlined on public health websites/guidelines), we need another testing method for COVID-19 carriers who are not exhibiting symptoms.
No screening tool is 100% accurate. Hand washing isn’t 100% accurate. Social distancing isn’t 100% accurate. Temperature checking isn’t 100% accurate. However, each of these screening tools is accurate enough of the time to warrant their widespread use. The same sentiment can be applied for the use of rapid antigen testing.
Think of it like this: catching 80% of asymptomatic carriers of COVID-19 before they unknowingly contribute to community spread of this global pandemic is a lot higher than catching 0% of asymptomatic carriers. There is no denying that implementing widespread use of rapid antigen tests as a screening tool in public spaces will drastically reduce community transmission and curb the spread of COVID-19.
No. Think of pregnancy tests - even the ones you can buy around the country from convenience or dollar stores for literally one or two loonies receive accurate results in just a few minutes. As well, like with COVID-19, a female testing for pregnancy doesn’t always have symptoms of pregnancy when taking a test. The speed at which the results are delivered have no bearing on the accuracy of a test. While a rapid antigen test may take up to 15 minutes for results, a typical pregnancy test needs only 3 minutes to determine pregnancy. And finally, a female testing positive for pregnancy using a pregnancy test would be directed to consult their doctor and undergo a molecular test to confirm their diagnosis and inform their care plan.
The same logic applies to screening for COVID-19 using a rapid antigen test – you may not have symptoms, so a positive test result would mean a visit to the doctor for an official diagnosis.
Ideally everywhere and all the time (daily) in any setting where people are sharing a non-trivial volume of air with others outside their household. If this could be achieved, the pandemic would rapidly fizzle out.
Some places that have been piloting screening programs with rapid antigen tests – and seeing success – include essential workplaces.
Right now, Canada’s health care system is burdened enough. We can’t add to the plate of health care workers – they are already overflowing. If we want to reach as many Canadians as possible quickly and frequently, we need to enlist resources outside of public health.
When considering a single test in isolation, yes. One source of false negative test results is improper swabbing procedures. A health care professional trained in taking swabs is presumably less likely to make such mistakes. However, current research suggests that with some basic instruction, a self-administered nostril swab can be nearly as effective as a health care administered swab of any type.
The results of a single screen in isolation is less important than the results of the screening program as whole. If relaxing the health care professional requirement results in even 50% more screens being administered, then the overall results will definitely be better even if there is a modest loss in sensitivity per test. The effectiveness of a screening program is much more sensitive to the number (frequency) of tests being done than to the sensitivity of the individual tests. When considering the sensitivity of a screening program as a whole, think of the tests which aren’t getting done due to lack of personnel as tests with 0% sensitivity.
A key concern in any testing program is biosafety, ensuring the safety of those involved in running the program and uninfected people attending. Biosafety expertise (as is common with many healthcare professionals) is essential to any screening program outside the home.
Here’s the math on that: when asymptomatic screening programs were piloted in Ontario in February 2021 (such as in schools), about 1% have been positive. If we conservatively assume only half of these represent contagious individuals with a viral load high enough to register on a rapid antigen test, then using only 100,000 antigen tests should be expected to interrupt transmission from 500 cases (and all the cases they would spread to). When cases are flat or growing slowly (R just above 1), it takes only a small reduction in new cases to cause cases to shrink (R<1). By specifically identifying infectious people who are out in the community and at risk of spreading to others, a single positive test can interrupt a transmission chain which might otherwise cause a large number of infections.
A variety of distribution programs are being developed, including in workplaces and in the community.
We’ve done a lot of research ourselves and can suggest the following accredited reading materials:
- Coronavirus (COVID-19) Update: FDA Authorizes Antigen Test as First Over-the-Counter Fully At-Home Diagnostic Test for COVID-19
- At-home self-testing of teachers with a SARS-CoV-2 rapid antigen test to reduce potential transmissions in schools
- Abbott antigen test gets FDA nod as first at-home, virtually guided COVID-19 diagnostic
- ABBOTT'S PANBIO RAPID ANTIGEN TEST RECEIVES CE MARK FOR ASYMPTOMATIC SCREENING AND SELF-ADMINISTERED SAMPLE COLLECTION WITH NASAL SWAB
- Evaluation of Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection at Two Community-Based Testing Sites — Pima County, Arizona, November 3–17, 2020
- FAQ - RapidTests.org