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Viral Testing

B.C. is conducting COVID-19 diagnostic testing for patients who need it with compatible symptoms, however mild.

Last updated: January 5, 2021 10:30 AM


Testing and laboratory guidance

Who to test

Testing guidance is not meant to replace clinician assessment, and providers should continue using their clinical judgement in determining whether a COVID-19 test is required. COVID-like symptoms can be indicative of other infections (e.g. meningitis, invasive group A streptococcus disease, etc), further highlighting the importance of clinical judgement.

1. The general guidance for people with no known COVID-19 close contacts and who have new or worsening symptoms are: 

Recommend testing if any ONE of the following symptoms more predictive or strongly associated with COVID-19 are reported.
  • Fever or chills
  • Cough*
  • Loss of sense of smell or taste
  • Difficulty breathing
*Either new onset or worsening/exacerbation of chronic cough. 

Recommend testing if any TWO or more of the following general symptoms persist after 24 hours, and are not related to any other pre-existing conditions.

  • Sore throat
  • Loss of appetite
  • Extreme fatigue or tiredness
  • Headache
  • Body aches
  • Nausea, vomiting or diarrhea 
For those who have had close contact with a COVID-19 case, and have even a single symptom included above, testing is recommended.

Less common symptoms of COVID-19 infection include nasal symptoms (runny nose, sneezing, congestion and sinus involvement), conjunctivitis (pink eye), dizziness, confusion, abdominal pain, and skin rashes or discoloration of fingers or toes. Clinical judgement remains important in the differential diagnosis and work-up of individuals presenting with these symptoms (e.g., people with allergies). For more information on the diagnosis and management of COVID-19 infection, please refer to the clinical guidelines on the BCCDC website. 

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 suspect COVID-19 should be assessed by a health care provider. For more information on the diagnosis and management of COVID-19 infection in children, including MIS-C, please refer to the pediatric clinical guidance on the BCCDC website.

2. Consider a lower testing threshold for symptomatic individuals who: 
  • Are residents or staff of long-term care facilities 
  • Require admission to hospital or are likely to be admitted 
  • Are healthcare workers 
  • Are travellers who in the past 14 days returned to BC from outside Canada, or from an area with higher infection rates within Canada 
  • Are residents of remote, isolated, or Indigenous communities 
  • Live in congregate settings such as work-camps, correctional facilities, shelters, group homes, assisted living and seniors’ residences 
  • Are homeless or have unstable housing 
  • Are essential service providers, such as first responders
  • Have a chronic medical condition, are at risk for severe illness, or are immunocompromised due to medication or treatment
  • Live with someone at risk of severe disease from COVID-19 infection (e.g., elderly, chronic conditions)
3. COVID-19 testing is not routinely recommended for asymptomatic individuals.
Routine COVID-19 screening of asymptomatic people is not recommended in BC (e.g., in schools, daycares, prior to surgery or other procedures, in hospitals or healthcare settings, as a condition of employment or for travel). 

4. Medical Health Officers may recommend testing as part of public health investigations. 
Medical Health Officers may recommend testing for individuals who are part of a public health investigation of a case, cluster or an outbreak, regardless of symptom profile. 

Note: In May, the Provincial Health Officer temporarily removed the requirement for licensed practical nurses to have a client-specific order prior to performing nasopharyngeal swabs if being done as part of a screening program approved by a Medical Health Officer. 

Find a collection centre for patients to be assessed and tested

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

Medical Health Officers may recommend testing as part of public health investigations.

COVID-19 testing is not recommended for asymptomatic individuals in B.C.


  • Testing of asymptomatic individuals is only recommended for use in public health investigations of a case, cluster or outbreak, and under the direction of a Medical Health Officer.
  • B.C. does not recommend routine COVID-19 screening of asymptomatic people in schools, prior to surgery or other procedures, in hospitals or health care settings, as a condition of employment or for travel. 
  • This recommendation may differ from that of other provinces or countries, and other national or international health professional societies.
  • B.C.’s recommendation is based on current provincial and local epidemiology, the expected yield of screening tests, resource implications, and known limitations of COVID-19 NAT testing.
  • Read the information for Health Care Providers on Testing Asymptomatic Individuals for COVID-19.

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


Specimen collection


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 and/or patients with evidence of lower respiratory tract disease, collect a lower respiratory tract sample (e.g., sputum, endotracheal aspirate, bronchoalveolar lavage, etc.) in a sterile screw-top container in addition to a nasopharyngeal swab.

** Use with care when inserting into the nasopharyngeal cavity, as these swabs may cause mild trauma.  Gently insert only as far as possible, and avoid forcing against resistance.  Inserting approximately 2-3 cm will allow swabbing of the mid-turbinate area. In this case, swab bilateral mid-turbinates using a single swab to optimize sampling quality.

 
When testing is offered to children of any age, please 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.



Collect a nasopharyngeal (NP) swab according to the procedure described in the Appendix A of the pediatric testing guidelines

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.

For children >6 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 outpatients who are able to follow instructions on how to swish, gargle and spit a small amount of saline. Most people 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 here. 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 
  • PHN or Date of Birth (DOB) 
  • Specimen type (e.g., NP swab) 
  • Date & time of collection 
Please 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.

Patient hand out: Self-isolation while waiting for results

People who have been tested for COVID-19 are required to self-isolate while they wait for results. A handout for patients who have been tested is available.

Testing time

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. More information is available on the test results page. 

Understanding COVID-19 tests and interpreting results

  • FAQ for health providers explaining how the test works, what the test results mean, reasons for false negative results, the levels of virus shedding, and the sensitivity of the test.

Outpatient management

Most patients with confirmed COVID-19 will have mild to moderate symptoms can safely manage symptoms at home.

Primary care providers can refer to the Guidance for Primary Care Management of Adult Outpatients with Suspected or Confirmed COVID-19 for the assessment and management of adult patients with symptoms suggestive of COVID-19, suspected COVID-19, or confirmed diagnosis of COVID-19. Further information on outpatient management can be found to the BCCDC page on outpatient care

Guidance for caring for children with a confirmed case of COVID-19 can be found on the Pediatrics page.

Changes to testing guidelines over time

While COVID-19 testing was originally centralized at the BC Public Health Laboratory (BCPHL), testing capacity expanded to other B.C. laboratories over time.

SOURCE: Viral Testing ( )
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