Provincial Antigen Screening Program

Note

This document is intended for use by anyone receiving free antigen screening tests from the government of Ontario, including Provincial Antigen Screening Program participants. This is a living document and includes guidance supported by currently available evidence. As evidence evolves, this document will be updated accordingly.

Individual ministries may have sector specific policies or directives related to rapid antigen testing, which must be considered in addition to the program information below.

In the instance where there is a discrepancy between program documents and provincial guidance, the COVID-19covid 19 Provincial Testing Guidance should always be considered the authoritative source.

1. Program overview

What is the Provincial Antigen Screening Program?

The Provincial Antigen Screening Program allows organizations to add an additional safety measure in workplaces, to help reduce the spread of COVID-19covid 19. Through the program, rapid antigen screening tests are distributed to enhance existing routine screening measures for asymptomatic employees and other identified groups. Rapid antigen screening tests may allow workplaces to proactively identify cases of COVID-19covid 19 that may have otherwise been missed, supporting employee safety and business continuity.

What is a rapid antigen test?

A rapid antigen POCT can be performed anywhere (i.e., on-site, at the place of employment) by a health professional or trained individual (see Who Can Perform a Rapid Antigen Test?) and does not require shipping a specimen to a lab for processing. It is currently administered through a nasopharyngeal swab, combined swabbing of throat and both nares, deep nasal swabbing (both nares) or anterior nasal swabbing (both nares) and takes approximately 15 minutes to yield results, depending on the specific test being used.

Frequent screening (2-3 times/week) with rapid antigen tests increases the chances of early identification of cases in otherwise asymptomatic individuals and mitigates the lower sensitivity of a single antigen test. Rapid antigen screening tests are less sensitive than lab-based polymerase chain reaction (PCR) tests that are performed at COVID-19covid 19 Assessment Centres and pharmacies. As such, rapid antigen screening tests may yield some false negative test results (i.e. a result that indicates the individual is not infected with COVID-19covid 19 when in fact they are), and to a lesser extent, some false positive test results (i.e., a result that indicates the individual is infected with COVID-19covid 19 when in fact they are not).

For this reason, rapid antigen tests should only be used as a screening tool, and as an added layer of security for workplaces beyond routine workplace screening measures and infection prevention and control measures. Results should therefore be interpreted with caution, and employees should continue to adhere to the necessary COVID-19covid 19 infection prevention and control measures, such as appropriate distancing, use of PPE, and hand washing, to reduce the risk of infection. A positive result on a rapid antigen test is considered a preliminary positive and must be followed up with a laboratory-based PCR test to act as a confirmatory test as soon as possible (ideally within 48 hours). The individual who received a positive result on the rapid antigen screening test should isolate until the result of the lab-based PCR test is known.

For more details on the sensitivity of specific rapid antigen tests, please see Appendix A: Additional Considerations for Sites using Abbott Panbio^TM and Appendix B: Additional Considerations for Sites using BD Veritor^TM.

Information on antigen screening frequency can be found in the COVID-19covid 19 Guidance: Considerations for Antigen Point-of-Care Screening document.

More details on parameters for the use of antigen tests in this program are outlined in the Parameters for the Use of Antigen Tests in the Provincial Antigen Screening Program section of this document.

What are the benefits of participating in the Program?

A key benefit of participating in the Provincial Antigen Screening Program is that rapid, on-site antigen screening may facilitate the identification of an individual infected with COVID-19covid 19 in the workplace that regular screening protocols (e.g., symptom screening) might otherwise miss. It may therefore help prevent asymptomatic individuals from unknowingly spreading COVID-19covid 19 in the workplace and break the chain of transmission for COVID-19covid 19.

How have rapid antigen tests been used in workplaces in Ontario to date?

Ontario conducted a time-limited employer pilot project in November 2020 until March 2021 to assess the value of the Abbott Panbio^TM antigen test as a screening tool to support employee safety and business continuity in a variety of workplaces. Results from this pilot support an increased understanding of how rapid antigen screening could be deployed more broadly as part of provincial COVID-19covid 19 response activities.

An employee and employer experience survey conducted in January 2021 revealed that most participants felt that the pilot increased the sense of protection and security in the workplace. Additionally, employer perceived benefits to the workplace included the provision of test results in a timely manner, and a contribution to reducing the overall transmission of COVID-19covid 19. Most employers (90%) felt that implementation went smoothly. Most employees (85%) had no concerns with participating; for those who did have concerns, the largest concern was the impact on the ability to work in the event of a positive antigen test result.

Who is eligible to participate in this Program?

Any organization that is permitted to open under the Reopening Ontario Act and where individuals must be physically present on site may be eligible to participate in the program.

Interested organizations can visit ontario.ca/testingonsite to determine eligibility.

What Does Participation in the Program Mean for my Workplace?

If accepted to participate in this program, the government will provide employers with free rapid antigen test kits, pending available inventory.

All participating workplaces are required to agree to the program terms and conditions. Participating workplaces must adhere to the parameters outlined in the terms and conditions (i.e., use the antigen test kits in accordance with provincial guidance, and a requirement to report data to the Ministry of Health) in order to continue receiving a supply of rapid antigen tests and to avoid having their participation in the program terminated by the province.

The free test kits distributed through this program are to be used only for Ontario-based employers and must be used within the duration of the program (i.e., tests cannot be saved for future use). Tests must be used on an employer’s own employees or other identified groups; an employer cannot distribute or sell tests to any third party (e.g., a client company) or charge for the administration of a test. This does not preclude employers from using a contracted agency to administer the tests to their employees.

What are the financial considerations for my workplace?

The provincial government provides participating sites with the appropriate number of rapid antigen test kits to meet sector-specific testing guidelines, for free, depending on available inventory. Additional financial support may be provided at the discretion of a participating site’s respective ministries. Otherwise, participating employers will assume all additional program implementation costs (e.g., human resource expenses, supplies, and the implementation of physical safety measures).

Participating sites may work with a privately-contracted service delivery partner to administer the Provincial Antigen Screening Program, but are not required to.

For those sites that are interested in contracting a service provider to administer antigen screening, Antigen Testing Services Directory is available to help identify local service providers. The Antigen Testing Services Directory lists suppliers that attest to being able to provide rapid antigen screening services to support program participants. Services provided by a supplier listed on the Antigen Testing Services Directory are procured and paid for by the workplace or organization contracting the service. The use of the Antigen Testing Services Directory is voluntary.

What type of antigen tests will my workplace receive?

Currently, provincially supported rapid antigen screening is being conducted using the Abbott Panbio^TM test and BD Veritor^TM test. As more rapid antigen technologies become Health Canada approved and available for use in the province, additional devices may be deployed as part of the Provincial Antigen Screening Program. Organizations will be advised of which test type they should request through the Ontario Together website at ontario.ca/testingonsite.

Currently, all rapid antigen screening tests being used in Ontario perform similarly (i.e., all antigen tests detect specific proteins from the COVID-19covid 19 virus to screen and identify people who need further testing).

Rapid antigen test types may have different considerations in terms of instrumentation and workflow. The key difference between antigen test types is how the test result is read:

• Some rapid antigen tests (e.g., Abbott Panbio^TM) is interpreted by looking at the test cartridge and determining if the test is negative or positive by assessing if a positive test line is present.
• Some rapid antigen tests (e.g., BD Veritor^TM) require less interpretation, as the test result is read by entering the test cartridge into an analyzer machine that displays whether the test is negative or positive.

All rapid antigen tests can be performed using batch testing, which can help sites to screen large number of employees at once. For rapid antigen tests that require an analyzer machine, multiple analyzer machines can be provided to workplaces to support the anticipated throughput.

The Ontario government will continue to monitor Health Canada approval of additional rapid antigen tests for potential implementation within this program in the future.

How does my workplace receive tests once accepted into the Program?

Approved workplaces will be provided with information on how to order test kits and analyzer machines (if applicable) once they have completed their intake process through ontario.ca/testingonsite.

Participating employers will need to be able to store any rapid antigen tests received. Storage information on specific antigen test types can be found in Appendix A: Additional Considerations for Sites using Abbott Panbio^TM and Appendix B: Additional Considerations for Sites using BD Veritor^TM.

Most rapid antigen tests come with nasal swabs. Health professionals or other trained individuals performing a rapid antigen test may collect a variety of specimen types, in accordance with COVID-19covid 19 Guidance: Considerations for Antigen Point-of-Care Testing. Ordering separate swabs or new kits is not necessary to support alternate specimen collection types.

Will my workplace receive training?

Training materials are available from Ontario Health in an online format and include suite of written materials and pre-recorded training modules. Participation in training is not a mandatory requirement of this program but will help build confidence and competence for those performing the screening.

Any individual supervising self-swabbing must consult the self-swabbing training resource developed by Ontario Health in collaboration with Public Health Ontario and ensure they have the appropriate knowledge, skills, and judgment to provide appropriate self-swabbing oversight, including how to operate the device, personal protective equipment (PPE) requirements, and how to safely dispose of waste.

For more information on self-swabbing, please see the Can Individuals do Self-Swabbing section of this document.

2. How does my workplace use antigen screening tests?

How should an antigen test be Used in this Program?

Antigen testing is a screening tool and does not diagnose COVID-19covid 19. Participating employers must adhere to the following parameters of use throughout the program:

1. Antigen screening tests must be used in accordance with the Chief Medical Officer of Health’s COVID-19covid 19 Guidance: Considerations for Antigen Point-of-Care Testing.
2. Antigen tests must be used in accordance with Provincial Antigen Screening Program terms and conditions, including the weekly reporting of data.
3. Antigen screening tests do not replace infection prevention and control measures such as symptom screening, appropriate distancing, use of PPE, and hand-hygiene activities. Antigen screening is not required under the Occupational Health and Safety Act, 1990, nor does it replace any duties under the Occupational Health and Safety Act to take all precautions reasonable in the circumstances to protect the health and safety of workers. These measures are essential to prevent the transmission of COVID-19covid 19, whereas testing can only identify individuals after transmission has occurred.
4. Antigen screening tests should only be used on asymptomatic individuals who have passed the initial standard screening conducted within the workplace. They should not be used for symptomatic individuals, or individuals who have had close contact with known positive cases in the context of this program. Symptomatic individuals, or individuals who have had close contact with known positive cases should be directed to an Assessment Centre for testing.
5. Antigen screening tests should not be used in either a confirmed or suspected outbreak in a workplace setting, per provincial testing guidance.
6. Antigen screening tests do not allow a workplace to open that should otherwise be closed based on current public health guidance. Antigen tests should not be used to return employees or individuals to the workplace who could otherwise work from home.
7. As per COVID-19covid 19 Provincial Testing Guidance, a positive result on a rapid antigen test is considered a preliminary positive and should be followed up with a laboratory-based PCR test to act as a confirmatory test as soon as possible (ideally within 48 hours). Participation in the Provincial Antigen Screening Program does not provide participants with priority access to confirmatory lab-based PCR tests.
8. As per COVID-19covid 19 Provincial Testing Guidance, an individual who receives a positive antigen test result must self-isolate, until the result of the confirmatory, lab-based PCR test is known.
9. A workplace can set up their on-site testing clinic following any workflow/process that is operationally feasible and follows appropriate IPAC and health and safety protocols.

Who can perform a rapid antigen test?

A broad range of health professionals and trained individuals can perform antigen screening tests. This includes, but is not limited to:

• Audiologists and Speech-Language Pathologists, Chiropodists and Podiatrists, Chiropractors, Dental Hygienists, Dental Technologists, Dentists, Denturists, Dieticians, Homeopaths, Kinesiologists, Massage Therapists, Medical Laboratory Technologists, Medical Radiation Technologists, Physicians, Midwives, Naturopaths, Nurses, Occupational Therapists, Opticians, Optometrists, Paramedics and other community paramedicine practitioners, Pharmacists, Physiotherapists, Psychologists, Psychotherapists, Respiratory Therapists, Traditional Chinese Medicine Practitioners and Acupuncturists, Personal Support Workers, Physician Assistants, Physiotherapy Assistants, Speech-Language Assistants, Osteopaths, etc.
• Any other trained individual who has the knowledge, skills, and judgment to administer the test in accordance with the manufacturer’s label.

Requisition forms are not required for health professionals performing a rapid antigen test as part of this program.

Can individuals do supervised self-swabbing?

Supervised self-swabbing reduces barriers to expanding access to rapid antigen testing. One trained professional can observe multiple individuals collecting their own self-swabs, increasing the volume of tests that can be completed within a given time frame. Self-swabbing is voluntary, meaning that employers or organizations that want to begin self-swabbing are able to, but are under no requirement to implement it. Supervised self-swabbing can be used for any Health Canada approved rapid antigen screening test (e.g., Abbott Panbio, BD Veritor, etc.).

Any individual who is supervising self-swabbing must consult the self-swabbing training resource and ensure they have the appropriate knowledge, skills, and judgment to provide appropriate self-swabbing oversight, including how to operate the device, PPE requirements, and how to safely dispose of biowaste.

Once the swab is collected, the trained individual will complete the administration of the test, which includes processing the specimen collected on the swab to achieve a result.

What are the key considerations for interpreting test results?

Rapid antigen tests are less sensitive and specific than lab-based PCR tests, so results are not as accurate. Rapid antigen tests may yield some false negative test results (i.e., a result that indicates the individual is not infected with COVID-19covid 19 when in fact they are), and to a lesser extent, some false positive test results (i.e., a result that indicates the individual is infected with COVID-19covid 19 when in fact they are not). Results should therefore be interpreted with caution and employees should be reminded of the possibility that the test result may be inaccurate. Participating employers should reinforce the importance of continuing to adhere to the necessary COVID-19covid 19 infection prevention and control measures, such as appropriate distancing, use of PPE, and hand washing, to reduce the risk of infection.

If an employee tested with a rapid antigen test receives a positive result, they should be reminded that the test result should be interpreted as a preliminary positive and that it may be inaccurate. That employee must seek a lab-based PCR test as soon as possible (ideally within 48 hours) to act as a confirmatory test, and should self-isolate until a confirmatory test result is received.

Further information regarding reporting requirements associated with a positive test result on a rapid antigen test during this program are outlined in the What are the Reporting Requirements in the Case of a Positive Antigen Test Result section of this document.

How does my Workplace Dispose of Used Rapid Antigen Screening Tests?

Waste generated from rapid antigen screening tests is considered a hazardous waste under the Environmental Protection Act. The Ontario government recently made amendments to the regulation governing hazardous waste management to exempt waste from these tests from collecting, storage and transportation requirements as long as the waste is disposed in Ontario. This waste must still be disposed of at a waste facility approved to handle biomedical waste. In addition, those collecting, storing or transporting these kits should follow Ontario’s guidance on the Safe Handling and Management of Rapid Antigen COVID-19covid 19 Testing Waste.

Specific considerations for biosafety, including the disposal of specimens, kits, and other materials from Abbott Panbio ^TM are also provided by Public Health Ontario.

Unused or expired tests cannot be returned due to quality control and infection prevention control considerations. If employers withdraw from the program or have unused or expired tests, they should contact their ministry representative to determine next steps.

3. Program reporting requirements

What are the general Reporting Requirements for Sites Receiving Free Antigen Tests from the Government?

All organizations receiving antigen screening tests for free are required to report a weekly, aggregated data set to the provincial government. The following information will be required from participating organizations:

1. The type of rapid test used.
2. Number of rapid antigen tests used.
3. Number of invalid rapid antigen test results.
4. Number of individuals who tested positive with a rapid antigen test.
5. Number of individuals who tested negative with a rapid antigen test.

The method for reporting data may vary depending on how sites have received antigen screening tests:

• Organizations who are shipped tests directly will be required to report into a centralized database, the Health Data Collection Service. Once an employer is accepted to participate, they will be onboarded on to the Health Data Collection Service and provided information and training on how to submit data and register data entry persons. Data must be entered weekly by Friday at 11:59pm EST. For participating employers that have more than one site participating in the program, data should be entered for each participating site.
• For organizations that pick-up tests from a distribution hub (e.g., a local Chamber of Commerce), required data should be reported in the manner indicated by the pick-up location.

All data is reported and stored at the aggregate level; no patient identifiable data is collected.

The province may, at its discretion, terminate an employer’s participation in the program and stop supplying test kits for failing to comply with reporting or other program requirements.

The government may request additional information throughout the course of the program as it evolves in order to inform future use cases for rapid antigen tests, and the impact of antigen screening in a range of workplace settings.

Long-term care homes should follow the reporting requirements specified by the Ministry of Long-Term Care.

What are the reporting requirements in the case of a positive antigen test result?

A positive result on a rapid antigen test is considered a preliminary (presumptive) positive. Any individual that receives a preliminary positive is required to receive a follow-up, confirmatory lab-based PCR test at a COVID-19covid 19 Assessment Centre as soon as possible (ideally within 48 hours). This individual must also self-isolate immediately, until the result of the confirmatory lab-based PCR test is known. A positive laboratory result will be uploaded into the Ontario Laboratories Information System (OLIS) and the appropriate PHU will be notified accordingly. An employer has no obligation to inform a PHU of an employee’s result or report the confirmatory test result to the Ministry of Health.

In the instance that an employee does contract COVID-19covid 19 and the infection was due to exposure at the workplace, in accordance with the Occupational Health and Safety Act, the employer must give notice in writing within four days to:

• The Ministry of Labour, Training and Skills Development
• The workplace’s joint health and safety committee or health and safety representative
• The worker’s trade union (if applicable)

Additionally, you must report any occupationally acquired illnesses to the Workplace Safety and Insurance Board within three days of receiving notification of the illness, in accordance with the Workplace Safety and Insurance Act.

Further information on what is required when a positive result is detected on a rapid antigen test during this program can be found in the COVID-19covid 19 Guidance: Considerations for Rapid Antigen Screening document.

Appendix A: Additional considerations for sites using Abbott Panbio^TM

• For specific information on Abbott Panbio^TM, please visit the manufacturer’s website.
• An overview of how the Panbio^TM test is performed can be found here.
• An Onboarding Guide, as well as training modules on how to use Abbott Panbio^TM have been developed by Ontario Health and can be found on their website.
• Specific considerations for biosafety are available through Public Health Ontario guidance.
• Until utilized, the current inventory of the Abbott Panbio^TM test kits come with either nasopharyngeal (NP) swabs or nasal swabs. Either swab kit type may be distributed based on available inventory.
  • When placing an order, there is no need to specify which type of test kit to receive, unless an organization specifically requests the kits that contain NP swabs. This type of request is contingent on available supply.

Space and storage requirements for Abbott Panbio^TM Rapid Antigen Tests:

1. No. of Tests in a Box = 25
   1. Box Dimensions = 23 cm x 12.5 cm x 9 cm
   2. Box Weight = 2 lbs
2. No. Tests in a Case = 800 (32 inner boxes)
   1. Case Dimensions = 47 cm x 53 cm x 39 cm
   2. Case Weight = 33 lbs
3. No. of Tests per Pallet = 9,600 (12 cases)
4. During transportation and storage, test kits need to remain between 2 and 30 degrees Celsius and are not to be frozen.

Appendix B: Additional considerations for sites using BD Veritor^TM

• For specific information on BD Veritor^TM, please visit the manufacturer’s website.
• An overview of the BD Veritor^TM test is performed can be found here.
• An Onboarding Guide, as well as training modules on how to use BD Veritor^TM have been developed by Ontario Health and can be found on their website.
• Test kits are available with nasal swabs.
• Some test kits may have a longer shelf life then indicated by the marked expiry date. Please see the BD Veritor^TM Onboarding Guide for more details.

Space and storage requirements for BD Veritor^TM Rapid Antigen Tests:

1. No. of tests in a Box = 30
   1. Box Dimensions = 24.8 cm x 20.2 cm x 15.2 cm
2. No. of tests in a pallet = 4,320 (or 144 boxes in a pallet)
3. Weight of analyzers = 0.3 kg
4. During transportation and storage, test kits need to remain between 2-30 degrees Celsius and are not to be frozen.