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Viral Testing

Learn about the COVID-19 testing guidance.

Last updated: January 24, 2022


Testing and laboratory guidance documents

These testing guidelines are meant to inform most testing indications and will likely change based on evolving local and regional individual or community settings and circumstances, as well as the need to reflect the risk of disease and severe outcomes across a wide variety of settings. 

This testing guidance does not replace the need for clinical judgment, which remains critical in determining whether a COVID-19 test should be offered to a patient.  COVID-19-like symptoms are not unique and, where appropriate, testing for other infections may need to be considered. 

Guidance for COVID-19 Testing


1. General guidance for people with new or worsening symptoms compatible with COVID-19:

Testing is recommended for:

A) Individuals who meet one of the following criteria:

Hospitalized individuals of any age where a positive result would impact treatment or care  

Individuals who may be at greater risk of developing severe disease and currently eligible for treatment: (NoteThese categories will be changed according to treatment priorities and as new treatments become available):

  • Individuals who are moderately to severely immunocompromised:
    • Have had a solid-organ transplant and are taking immunosuppressive therapy
    • Are on active treatment for a solid tumor or blood or bone marrow cancer
    • Have had a bone marrow or stem cell transplant
    • Have moderate to severe primary immunodeficiency
    • Have advanced or untreated HIV
    • Are on active treatment with immunosuppressive therapies
    • Are on dialysis and/or with severe kidney or renal disease

Have had a solid-organ transplant and are taking immunosuppressive therapy:
  • Have had a solid organ transplant. May include a heart, lung, liver, kidney, pancreas or islet cells, bowel or combination organ transplant

Are on active treatment for solid tumour or hematologic malignancies (like myeloma or leukemia):  

  • Since January 2020 have received an anti-CD20 drug for a malignant condition
  • Since March 2020, have received or are receiving systemic therapy (including chemotherapy, molecular therapy, immunotherapy, targeted therapies including CAR-T, monoclonal antibodies, hormonal therapy for cancer). This includes solid tumours as well as hematologic cancers within this time period
  • Since October 2020, have received or are receiving radiation therapy for cancer
Have had a hematopoietic stem cell transplant:
  • Since September 2019, have had bone marrow or stem cell transplant or are still taking immunosuppressant medications related to transplant
Have moderate to severe primary immunodeficiency:
  • Have combined immune deficiencies affecting T-cells, immune dysregulation (particularly familial hemophagocytic lymphohistiocytosis) or those with type 1 interferon defects (caused by a genetic primary immunodeficiency disorder or secondary to anti-interferon autoantibodies)
  • Have a moderate to severe primary immunodeficiency which has been diagnosed by an adult or pediatric immunologist and requires ongoing immunoglobulin replacement therapy (IVIG or SCIG) or the primary immunodeficiency has a confirmed genetic cause (e.g. DiGeorge syndrome, Wiskott-Aldrich syndrome)
Prior AIDS defining illness or prior CD4 count ≤ 200/mm3 or prior CD4 fraction ≤ 15% or any detectable plasma viral load since January 2021 or HIV infection and ≥ 65 years old or perinatally acquired HIV infection.

Are on active treatment with the following categories of immunosuppressive therapies:
  • Since January 2020, been treated with anti-CD20 agents: rituximab, ocrelizumab, ofatumumab, obinutuzumab, ibritumomab, tositumomab
  • Since January 2020, been treated with B-cell depleting agents: epratuzumab, MEDI-551, belimumab, BR3-Fc, AMG-623, atacicept, anti-BR3, alemtuzumab
  • Since December 15, 2020 been treated with biologics: abatacept, adalimumab, anakinra, benralizumab, brodalumab, canakinumab, certolizumab, dupilumab, etanercept, golimumab, guselkumab, infliximab, interferon products (alpha, beta, and pegylated forms), ixekizumab, mepolizumab, natalizumab, omalizumab, resilizumab, risankizumab, sarilumab, secukinumab, tildrakizumab, tocilizumab, ustekinumab, or vedolizumab
  • Since December 15, 2020 been treated with oral immune-suppressing drugs: azathioprine, baricitinib, cyclophosphamide, cyclosporine, leflunomide, dimethyl fumerate, everolimus, fingolimod, mycophenolate, siponimod, sirolimus, tacrolimus, tofacitinib, upadacitinib, methotrexate, dexamethasone, hydrocortisone, prednisone, methylprednisolone, or teriflunomide
  • Since December 15, 2020 been treated with steroids orally or by injection on an ongoing basis: dexamethasone, hydrocortisone, methylprednisolone, or prednisone
  • Since December 15, 2020, been treated with immune-suppressing Infusions/injections: cladribine, cyclophosphamide, glatiramer, methotrexate
Are on dialysis and/or with severe kidney or renal disease:
  • On dialysis (hemodialysis or peritoneal dialysis) or have stage 5 chronic kidney disease (eGFR <15ml/min or have glomerulonephritis and receiving steroid treatment 
    •  Individuals 18 years of age and older who are unvaccinated or partially vaccinated (i.e., have not received at least 2 doses of a 2-dose series or more than 14 days after receiving a single dose of a 1-dose series) 
      • Not all individuals in this category are eligible for treatment. An age-based criteria is being used for ease of implementing these guidelines. For more information please refer to the treatment information.

Individuals who live or work in high-risk settings:

  • Healthcare workers in hospitals, long-term care, assisted living or community clinics
  • First responders (police, ambulance, fire)
  • Staff and residents in congregate settings where a large proportion of the population is at risk for severe outcomes of COVID-19 such as long-term care facilities, shelters, correctional facilities and group homes
  • Communities with difficulty accessing testing and secondary or tertiary care such as rural, remote, isolated or Indigenous communities or work-camps

AND

B) Have symptoms compatible with COVID-19:

    • Fever or chills, cough (either new, or worsening/exacerbation of chronic cough), loss or change of sense or smell or taste, shortness of breath, sore throat, loss of appetite, extreme fatigue or tiredness, runny nose, sneezing, headache, body or muscle aches, nausea, vomiting or diarrhea

Testing is not recommended for other adults and children who develop mild symptoms. They are advised to stay home and self-isolate until they feel well enough to resume their regular activities.

2.  Additional guidance for children

All children who are suspected of having multisystem inflammatory syndrome (MIS-C) should also be tested. Infants less than 3 months of age who are febrile or who have suspected COVID-19 should be assessed by a health-care provider.  For more information on the diagnosis and management of COVID-19, please refer to the pediatric clinical care guidelines.  

3.  COVID-19 testing is not routinely recommended for asymptomatic individuals

Testing is not recommended in asymptomatic individuals outside of public health investigations and other specific circumstances.  

In BC, testing is not available through the provincial health care system for screening for travel.

One exception is asymptomatic, unvaccinated individuals who require a COVID-19 molecular test for travel for essential medical services and treatment. "Essential medical care" refers to appointments to receive medical services that are important to saving lives and improving health outcomes (see exceptions for the domestic travel requirements). For these individuals, testing as required by Transport Canada will be provided, regardless of symptoms.

4. Testing recommended by Medical Health Officers in high-risk settings or as part of a public health investigation

Testing is indicated when it changes either individual or community management. Your local medical health officer may issue region-specific recommendations based on epidemiology, vaccination rates or access to health services.

Medical health officers may also recommend testing as part of public health investigations. This may include testing of asymptomatic people who are part of a public health investigation of a case, cluster or an outbreak.

5. Rapid antigen tests

Nucleic acid amplification tests (NAAT; e.g., polymerase chain reaction or PCR) remain the most sensitive diagnostic test for COVID-19. While rapid antigen tests are less sensitive than standard NAAT tests, they provide faster results, can allow for self-testing and an increased number of individuals to be tested. Whether an individual receives a NAAT or rapid antigen test will depend on individual patient circumstances, local epidemiology, and availability of laboratory-based testing.

Learn more information about rapid antigen testing for COVID-19.


Specimen collection and Labelling


Personal protective equipment 

Use contact and droplet precautions with a surgical mask and eye protection when collecting a nasopharyngeal or throat swab, saline gargle or sputum. A N95 respirator is recommended for aerosolizing procedures. For more information, visit the page on personal protective equipment.


Collect a Nasopharyngeal (NP) Swab using the instructions provided in this video “How to perform a nasopharyngeal swab”.  Note the instructions for donning and doffing of personal protective equipment (PPE). 
 


Use the swab/collection device provided by your institution. The following swabs are currently validated and are available for use in B.C.:
  • YOCON Virus Sampling Kit
  • VWR Starplex Multitrans Collection Kit
  • Roche cobas™ PCR Dual Swab Sample Kit† 
  • Columbia Plastics Swab Kit
  • CopanTM NP swab with transport media * 
† These swabs have limited availability.
* These swabs are currently restricted to pediatric collections
** DO NOT use the orange packaged Hologic Aptima Multitest swabs for NP collections.

For hospitalized patients with evidence of lower respiratory tract disease, collect a lower respiratory tract sample (e.g., sputum, endotracheal aspirate, bronchoalveolar lavage, etc.) if feasible in a screw-top sterile container in addition to a nasopharyngeal swab. 
 
When testing is offered to children of any age, ensure the tester is appropriately trained to perform the nasopharyngeal swab (NP) safely, and there are adequate supports available. 

For older youth, please refer to the adult testing guidelines for specimen collection and labelling information.

For children and infants, collect a nasopharyngeal (NP) swab. A video for families and children to watch regarding NP swab collection:



Use the swab/collection device provided by your institution. The following swabs are currently validated for use in nasopharyngeal specimen collection in infants and young children in BC: 

  • Copan™ minitip swab with transport media
  • BD™ minitip swab with transport media 
  • Roche cobas™ PCR Dual Swab Sample Kit† 
† These swabs have limited availability and should only be used if the preferred swabs are not available. For children over six years of age, Yocon virus sampling kit is generally appropriate. 

For hospitalized school-aged children and youth, collect an NP swab. For hospitalized patients with evidence of lower respiratory tract disease, collect a lower respiratory tract sample (e.g., sputum, endotracheal aspirate, bronchoalveolar lavage, etc.) if feasible in a screw-top sterile container in addition to a nasopharyngeal swab. 

 

Saline (salt water) gargle is an approved alternative to NP swab collection for individuals who are able to follow instructions on how to swish, gargle and spit a small amount of saline. Most children 5 years of age and older are able to provide a saline gargle sample with some guidance. 

Videos demonstrating saline gargle collections for children and adults can be found below. It is recommended that the video is reviewed and the method practiced at least two hours before going to a collection centre. 

Please ensure that the individual has not eaten, had anything to drink, smoked, used a vape, chewed gum or brushed their teeth for one hour before sample collection. 

Use the collection device and saline provided by your institution. The collection system is sterile and consists of a funnel attached to a 10mL collection tube with cap and 5mL of sterile saline. 
 
All specimens (cylindrical tube) must have an attached label with: 
  • Patient name 
  • Personal health number (PHN) or Date of Birth (DOB) 
  • Specimen type (e.g., NP swab) 
  • Date & time of collection 
if possible, add one of the following codes to the specimen label:

  • HCW1 – Health Care Worker – Direct Care
  • HCW2 – Health Care Worker – Non-Direct Care
  • LTC – Long Term Care Facility
  • OBK – Outbreaks, clusters or case contacts
  • HOS – Hospitalized
  • CMM – Community
    • Community or Outpatient, including Urgent and Primary Care Centres
  • CGT – People living in congregate settings such as work-camps, correctional facilities, shelters, group homes, assisted living and seniors’ residences.
  • TREEPL – Tree planters
  • SCHOOL – People attending school in-person including students, teachers and support staff

Please submit each specimen in an individual, sealed biohazard bag.


Include a paper requisition, completed in full, which clearly states the patient information, the ordering physician, and the test name (COVID-19 NAT).


Paper Requisitions are available here.

Please refer to the BCCDC Public Health Laboratory eLab Handbook under COVID-19 test for specimen requirements. 

COVID-19 testing and self-collected specimens

The interim guidelines describe an overall provincial approach for supporting self-collection of specimens for COVID-19 diagnosis in settings without accessible health services.


Self-collection is not broadly available at this time, and self-collection kits can only be ordered through an initial project phase in partnership with Northern Health and some remote work camp settings in the Northern and Interior regions. More information on the use of self-collection can be found here.

Information for clients and patients

Individuals with symptoms can find a collection centre where they can be assessed and tested by:


There are some private pay clinics that offer testing for a fee to people who require asymptomatic testing for reasons that fall outside of B.C. public health recommendations, as outlined in the testing guidelines, such as for travel or employment. 


See the list of clinics offering private testing services

People who have been tested for COVID-19 are required to self-isolate while they wait for results:

Tests are run multiple times throughout the day in laboratories across B.C. Testing time varies depending on testing location. 

Patients can get their results by phone, text or online.

Help clients under what their PCR COVID-19 test results mean and next steps: 


Understanding Test Results

tested positive for COVID-19 or have been told you have COVID-19, learn how to take care of yourself, self-isolate and notify your close contacts.


What to do if you've tested positive


Outpatient management

Most patients with confirmed COVID-19 will have mild to moderate symptoms can safely manage symptoms at home. Find guidance for caring for:

SOURCE: Viral Testing ( )
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