This Briefing Note was completed by the Research, Analysis, and Evaluation Branch (Ministry of Health)
based on information provided by members of the COVID-19 Evidence Synthesis Network. Please refer to the Methods section for further information.
Purpose
This note provides a summary of evidence on approaches to COVID-19 testing identified in non-Canadian jurisdictions, with a focus on approaches to using three types of diagnostic tests: molecular,
antigen, and serologic. This note also includes information about the populations targeted for testing and the location of testing, as well as planned or proposed approaches to environmental surveillance testing.
*The full version of the Briefing Note including Supporting Evidence and the Appendix can be accessed in the PDF file at the top of the page*
Key Findings
- There are three main types of tests used in COVID-19 testing strategies identified across non-Canadian jurisdictions as well as emerging innovative surveillance testing strategies:
- Molecular: RT-PCR or rapid-PCR are the most commonly used tests and are typically used for those exhibiting symptoms of COVID-19 or are at particular risk due to either their living arrangements (e.g., congregate housing) or employment. For example, Australia, China, Hong Kong, Germany, Israel, Japan, New Zealand, and Singapore use strategic enhanced testing (using RT-PCR) for high-risk individuals (e.g., front-line health care workers, migrant workers, marketplace workers, tourism industry workers) or widespread testing in localized areas of concerns (e.g., schools, airports, or towns).
- Rapid point-of-care tests can be used to inform triage of RT-PCR use, allowing earlier detection of those testing positive. However, current evidence of test performance (i.e., using average observed sensitivities and specificities) suggests that rapid tests can only perform this type of triage role in higher-prevalence settings (i.e., 20% or higher) due to the relative risk of false positive results in lower prevalence settings.
- Some regions (e.g., Germany) adopted rapid response testing early in their COVID-19 management strategy and continue to do so, but have altered the criteria of who is eligible or must be tested as part of their ongoing surveillance.
- Two jurisdictions offer antigen testing: 1) France fully covers antigen testing through health insurance and a prescription is not required; and 2) The District of Columbia in the US offers this type of testing in select physician offices.
- Serologic tests are identified in many jurisdictions including all US states (except Alaska) to monitor the immune status of individuals. Italy and Switzerland are following a sub-cohort of their population longitudinally to assess antibody development, how long the immunity lasts, and whether it protects against re-infection. Potential uses of this type of testing include rapid return-to-work screening. In Australia, persons who have symptoms for more than one week are eligible for a serologic testing, with a follow up PCR test for positive COVID-19 results.
- Some jurisdictions are exploring different surveillance strategies such as wastewater monitoring (e.g., Australia, Italy, Netherlands, New Zealand) and are using different testing methods that are less intrusive (i.e., saliva and self-administered short nasal swabs) (i.e., New York).
- Molecular: RT-PCR or rapid-PCR are the most commonly used tests and are typically used for those exhibiting symptoms of COVID-19 or are at particular risk due to either their living arrangements (e.g., congregate housing) or employment. For example, Australia, China, Hong Kong, Germany, Israel, Japan, New Zealand, and Singapore use strategic enhanced testing (using RT-PCR) for high-risk individuals (e.g., front-line health care workers, migrant workers, marketplace workers, tourism industry workers) or widespread testing in localized areas of concerns (e.g., schools, airports, or towns).
Supporting Evidence
*The entirety of the Supporting Evidence section can be accessed in the PDF file located at the top of the page*
This section summarizes evidence on approaches to COVID-19 testing in non-Canadian jurisdictions.
The identified approaches are from 12 countries (i.e., Australia, China, France, Germany, Iceland, Israel,
Italy, Netherlands, New Zealand, South Korea, Switzerland, and the United Kingdom [UK]) and eight states in the United States (US) (i.e., Alaska, California [CA], District of Columbia [DC], Louisiana, Massachusetts [MA], Michigan, New York, and Rhode Island [RI]), with a focus on their approaches to using three types of diagnostic tests: molecular, antigen, and serologic. Some planned or proposed approaches to environmental surveillance testing are also included.
Additional details are provided on each of these topics in the Appendix as follows: Table 2 summarizes the testing approaches in eight countries and five US states. Table 3 summarizes novel strategies or
technologies for surveillance in 10 countries (i.e., Australia, China, Italy, Israel, Netherlands, New Zealand,
South Korea, Switzerland, the UK, and the US). Table 4 summarizes guidance from international health
agencies. Table 5 summarizes research and innovative technologies identified in France, Germany, Israel, and the US.
Methods
- The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following members of the Network provided evidence synthesis products that were used to develop this Evidence Synthesis Briefing Note:
- Dinnes_J, Deeks_JJ, Adriano_A, Berhane_S, Davenport_C, Dittrich_S, Emperador_D, Takwoingi_Y, Cunningham_J, Beese_S, Dretzke_J, Ferrante di Ruffano_L, Harris_IM, Price_MJ, Taylor-Phillips_S, Hooft_L, Leeflang_MMG, Spijker_R, Van den Bruel_A. Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD013705. DOI: 10.1002/14651858.CD013705.
- Ontario Health (Quality). Surveillance strategies and technologies used to monitor and manage COVID-19 spread: A jurisdictional scan, August 25, 2020.
- Waddell K, Wilson MG, Bhuiya A, Ahmad A, Gauvin FP, Wang Q, Lavis JN. COVID-19 rapid query response #3: What testing approaches are being used in other countries? Hamilton: McMaster Health Forum, 25 August 2020.
For more information or to request a copy of any of the cited reports, please contact the Research, Analysis and Evaluation Branch (Ministry of Health).