Rapid COVID-19 Tests Complementing Lab-based PCR Tests Across Select Jurisdictions

Last Updated: December 24, 2020

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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 Canadian and international experiences with the use of rapid COVID-19 tests (i.e., diagnostic, screening) have been used to complement lab-based polymerase chain reaction (PCR) testing across jurisdictions, including mass testing, testing target populations, tests used (i.e., rapid molecular, antigen tests), and outcomes of testing programs.

*The full version of the Briefing Note including ‘Additional Testing for Screening and Monitoring for COVID-19’ under Supporting Evidence along with the Appendix can be accessed in the PDF file at the top of the page*

Key Findings

“Re-testing” for COVID-19

Limitations

Analysis for Ontario

Supporting Evidence

This section below summarizes the status of rapid point-of-care testing across jurisdictions. In addition, information about testing for screening and monitoring for COVID-19 is provided.

Rapid Point-of-Care Testing for COVID-19

Scientific Evidence

Outcomes of Rapid Point-of-Care Testing

  • No identified studies have reported the impact of rapid point-of-care testing on the transmission of COVID-19.
  • No identified academic or grey literature have evaluated the impact the Abbott ID NOW molecular test or Panbio COVID-19 Ag antigen test.

International Evidence

Use of Rapid Point-of-Care Tests

  • Rapid point-of-care antigen tests for COVID-19 are currently being used in Canada, the United States (US), England, United Kingdom (UK), Germany and Slovakia.
    • Tests are being deployed both for asymptomatic general public screening and for symptomatic screening, with positive results being confirmed by reverse transcription polymerase chain reaction (RT-PCR) tests. Table 5 in the Appendix summarizes the current use of rapid antigen testing programs for COVID-19 across jurisdictions.

Specific Point-of-Care Tests

  • Two point-of-care tests have been reviewed for use in managing the pandemic—Abbott ID NOW (molecular) test and Panbio COVID-19 Ag (antigen) test.
    • Only the US explicitly mentioned use of the Abbott ID Now test, prioritized for rural and remote regions; no jurisdictions mentioned use of the Panbio COVID-19 Ag Rapid Test Device.
    • The effects and costs of implementing and broadly using the Abbott ID NOW and Panbio COVID-19 Ag antigen point-of-care tests in managing the pandemic remain unknown.
    • Additional information about the uses of Abbott’s ID NOW COVID-19 Test and Panbio COVID-19 Ag Rapid Test in the United States, Italy, and Spain is provided in Table 6 in the Appendix.

“Re-testing” for COVID-19

  • Many jurisdictions report that point-of-care tests do not have adequate accuracy (i.e., sensitivity, specificity).
  • Where rapid point-of-care testing is used for asymptomatic populations, repeat testing has been suggested (i.e., after two to three days); confirmatory RT-PCR testing is also recommended.

Outcomes of Rapid Point-of-Care Testing

  • Use of rapid point-of-care tests has been shown to fast-track triage, free up resources, and prevent bottlenecks in testing.

Canadian Scan

  • Rapid point-of-care molecular diagnostic testing promises to increase testing volume in Canada, and reduce lab volumes and wait times.
    • Xpert Xpress SARS-CoV-1 (aka GeneXpert) is a Health Canada-approved point-of-care molecular testing device that is used in various provinces and territories, largely in smaller labs that otherwise would need to have specimens transported to larger labs located in urban centers.
  • Additional information about the current uses of rapid molecular tests in Canada, the United States, the United Kingdom, and Italy is provided Table 7 in the Appendix.

Ontario Scan

  • Guidance from Ontario indicates rapid antigen testing should only be considered for asymptomatic individuals if they are high-risk or part of a screening pilot

Use of Mass Testing for COVID-19

Scientific Evidence

Outcomes of Mass Testing

  • No identified studies have evaluated the impact of mass testing in the jurisdictions of interest; i.e., United Kingdom, Germany, Iceland, Slovakia, and China.
    • A formal evaluation of the City of Liverpool pilot program is ongoing. The evaluation will focus on the immediate biological, behavioural and systems integration aspects of testing, then on the longer-term public health impacts.

International Scan

Purpose of Mass Testing

  • The reviewed mass testing programs examined virus spread, particularly asymptomatic cases, in the defined population.
    • Information was used to trace and isolate cases and close contacts and to inform decisions on future public health measures (e.g., reopening of schools or avoiding a lockdown).

Reasons for Mass Testing

  • Thresholds leading to the initiation of mass testing varies by jurisdiction. In China, a few cases (i.e., two or three) led to localized mass testing, whereas in Germany mass testing was initiated when the local community was overwhelmed (e.g., insufficient staff to respond to emergencies).

Implementation

  • Mass testing campaigns were typically government run, but most often implemented on a voluntary basis in local settings.
  • Mass testing initiatives had large resource needs (e.g., staffing) and some jurisdictions were supported by bodies such as the Armed Forces or the Red Cross.

Tests Used

  • Slovakia, the City of Liverpool (UK), and Hildburghausen (Germany) used rapid antigen tests.
  • Iceland and China used the World Health Organization (WHO) recommended laboratory RT-PCR tests, with China applying pooled sample processing.

*To view the complete Supporting Evidence, including ‘Additional Testing for Screening and Monitoring for COVID-19’, please access the PDF file at the top of the page

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:

  • Canadian Agency for Drugs and Technologies in Health (CADTH). (July 27, 2020). CADTH Briefing Note: Workplace COVID-19 Prevention Measures and the Role of Testing in Workplace Safety.
  • CADTH. (2020). CADTH Horizon Scan: COVID-19 Testing – A summary (Draft).
  • CADTH. (October 20, 2020). CADTH Horizon Scan: Rapid Point-of-Care Antigen Testing for SARS-CoV-2 Infection (Version 2).
  • CADTH. (December 2020). Health Technology Review – Rapid Point-of-Care Testing for COVID-19.
  • Ontario Health (October 2, 2020). An Expedited Summary of the Evidence and Jurisdictional Scan on the Use of Abbott’s ID NOW COVID-19 Test and Panbio COVID-19 Ag Rapid Test Device for Assessing Individuals During the COVID-19 Pandemic.
  • Ontario Health Quality. (August 26, 2020). A Jurisdictional Scan of Surveillance Strategies and Technologies Being Used to Monitor and Manage COVID-19 Spread. Ontario Health Quality. (Confidential)
  • Ontario Health (December 2020). The Use of Mass Testing for COVID-19: A Jurisdictional Scan. (Confidential Draft).