Industry Advisory Roundtable on COVID-19 report: Accelerating Rapid Screening in the Workplace
The Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management has reviewed the first report of the COVID-19 Testing and Screening Expert Advisory Panel. The following is the Roundtable's response to this report.
On this page
- Executive summary
- The Industry Roundtable's work
- Building on the Expert Panel's first report
Canadian industries have been deeply affected by the pandemic. They have been working tirelessly to ensure their employees and the communities in which they operate are safe, all while maintaining business resiliency.
Canadian industries have the capacity to do more. The recommendations that follow outline a collaboration between industry and the federal government. This collaboration is designed to:
- support a safe restart of those sectors of the economy that have been fully or partly closed
- facilitate the opening of international, Canada-US and some provincial borders
Health Canada launched the Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management on October 5, 2020. Through the Industry Roundtable, the federal government engages and collaborates with leaders from all industry sectors in Canada.
The Industry Roundtable has advocated for wide-scale rapid antigen screening. This is a key tool for identifying potential infections and breaking the chain of transmission, thereby offering additional protection to employees.
Emerging evidence supports this view. The evidence indicates that rapid testing for screening purposes may help to prevent potential outbreaks in congregate and high-risk settings, such as workplaces. Data presented to the Industry Roundtable in late 2020 indicated that daily screening of 3% of the population is ideal. The data also indicate that 25% of those screens should be undertaken in workplaces that are critical to the country's economy.
To this end, the Industry Roundtable has been working with the Creative Destruction Lab Rapid Screening Consortium (CDL RSC) to advance workplace antigen screening pilots. Initial pilots, supported by the provinces, were launched in early January 2021 and provide evidence for the value of antigen screening in workplaces. These pilots also offer a framework for scaling up screening across the country.
On January 15, 2021, the COVID-19 Testing and Screening Expert Advisory Panel released its first report Priority strategies to optimize testing and screening for COVID-19 in Canada. This report provided guidance to:
- optimize testing and screening with lab-based PCR testing
- ramp up deployment of rapid tests for screening purposes
- ensure equity in testing and screening
- improve communication strategies
This report will contribute to accelerating the work that is under way. It will highlight the importance of a closer, results-based collaboration between the federal government and industry, with industry as an engine for progress.
For rapid screening to be effective in the workplace, the Industry Roundtable recommends the following:
- Reduce barriers to access by:
- maintaining the federal government's procurement role in the medium term
- providing rapid tests at no cost
- reducing barriers to access and optimizing distribution
- Promote task shifting and expand screening by:
- encouraging rapid test manufacturers to submit applications to Health Canada for broader use, including asymptomatic testing
- encouraging provinces and territories to provide temporary exemptions to enlarge the pool of people who may administer and interpret test results (for example, non-health care employees who have been furloughed)
- continuing to pursue new, self-administered tests
- Manage data by:
- using existing data management systems and approaches that provide a national view of anonymous data on asymptomatic populations, to help with policy- and decision-making
- Support small business by:
- developing funding initiatives to support access to screening programs for small businesses
- encouraging third-party partnerships for implementation, data collection and reporting
Canadian industries want to help and have the capacity to do more. The recommendations in this report outline how the industry sector and the federal government can work together during this unprecedented time. Being able to access a new source of data will be critical as rapid testing is scaled up. It will also contribute to a strong, safe restart of those sectors of the economy that have impacted.
The Industry Roundtable's work
The Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management was launched in consultation with the Industry Strategy Council.
Industry plays a key role in supporting public health measures and the restart of Canada's economy. The Industry Roundtable provides an avenue for the federal government to hear directly from and collaborate with leaders who represent the country's industry sectors. Key issues include:
- the role of testing, screening, tracing and data in addressing challenges faced by industry and helping to identify solutions
- workplace screening pilots to determine best approaches for testing and screening in the workplace
- guidance on rolling out screening programs more broadly if pilots are successful
The Industry Roundtable's work will complement the science and policy-related work of the COVID-19 Testing and Screening Expert Advisory Panel. Specifically, the Industry Roundtable will provide recommendations on testing and screening and how industry can help to restart the economy.
Securing barrier-free access to and building capacity for screening tools are the key to helping Canadians and the businesses that employ and serve them combat the spread of the COVID-19 virus.
Future reports will provide industry's perspective on critical sectors, contact tracing and opportunities to reduce barriers to screening programs.
Building on the Expert Panel's first report
The global and Canadian responses to COVID-19 demonstrate the importance of testing and screening to reduce the spread of infections. Testing is only one part of a robust public health response that should also include rapid contact tracing to reduce transmission. The effectiveness of testing and other strategies to contain COVID-19 require full support from the federal and provincial/territorial governments and communities.
Canada is at a critical juncture where testing and screening can be enhanced with new technologies to combat the spread of COVID-19, reduce the testing burden and ease anxiety. These are key pillars to managing the "second wave" while the vaccine roll-out advances.
The Expert Panel and governments recognize that health and laboratory capacity is already, and will continue to be, limited. For good reason, the tightly regulated and quality controlled communicable disease landscape in Canada requires that licensed and accredited laboratories oversee the testing process.
The foundation of an effective public health response to COVID-19 has been referred to as a find, test, trace, isolate and support strategy. This strategy has several critical elements:
- find as many cases of COVID-19 as possible
- break as many chains of transmission as possible
- provide supports that encourage testing and, where appropriate, self-isolation and quarantine
- ensure all of the above elements are executed in a timely manner
Unlock the capacity of the private sector
The private sector plays a key role in supporting public health measures and a safe reopening of the economy. Private-sector companies are often the social centres of their communities. Emerging evidence shows that rapid tests may provide another layer of support in preventing outbreaks in communal and high-risk settings, such as workplaces.
A key factor in preventing outbreaks is the ability to identify carriers. Timing is crucial, as many individuals show no signs of infection. For industries, where scheduling is important, the ability to tentatively clear employees is vital. In industry settings, tests should be non-invasive, provide fast results and, where there's a possibility of being positive, take appropriate action, such as isolation and confirmatory testing).
The ability to collect data on asymptomatic populations will also complement provincial and territorial data sets. Industry is in a unique position to collect data anonymously, which can help to inform decision-making on re-starting the economy and re-opening borders.
Reduce test stockpiles and barriers to access
Canadian businesses need a secure and smooth supply of rapid tests. Currently, the federal government distributes rapid tests at no cost to provinces and territories, which distribute them within their jurisdictions. Giving industry direct access to tests is critical to optimizing distribution and maximizing efficiency.
Recommendation: The federal government should maintain its role as primary procurer of rapid screens and tests in the medium term, providing them at no cost. In the long term, it should look at how it can optimize approaches that continue to reduce barriers to access.
The Creative Destruction Lab Rapid Screening Consortium (CDL RSC) comprises 12 companies (some are members of the Industry Roundtable) that have national operations. CDL RSC seeks to develop a cost-effective system for re-opening the economy by establishing a robust screening system and implementation strategy.
CDL RSC is working with provinces to implement rapid screening pilots in workplaces to identify best practices and inform guidance to support the use of this technology in workplaces. Lessons learned from each launch will inform future pilots. Through continuous learning, there's a greater opportunity for experimentation and innovation, with the development of solutions and approaches for a broad range of sectors. The results will be available to businesses. The intent is to eventually integrate rapid screening in workplaces.
Liverpool, U.K., developed community testing using rapid tests. Called SMART (systematic meaningful asymptomatic repeated testing), this approach provides access to rapid tests to reduce transmission in outbreaks and implement targeted testing to protect key services and workplaces. Rapid testing began in early 2021. Data from the program will be used to refine the SMART approach.
The U.K. government developed a workplace testing program to increase rapid testing in sectors open during the lockdown and detect COVID-19 infection in asymptomatic individuals. Under the program, organizations register to receive free rapid tests. After March 31, 2021, the procurement and distribution outcomes will be reviewed in consultation with industry. To date, 2.5 million testing devices have been distributed. An online portal was developed for private-sector companies to register and access information.
In Canada: CDL RSC's rapid screening project emphasizes the quick setup of screening sites. Canada can quickly realize the benefits of rapid screening and develop best practices by:
- adapting international approaches of fast implementation
- ensuring continuity of workplaces
- ensuring a smooth supply
- gathering data
- facilitating workplace screening programs
Task shifting and technological authorizations
Currently, rapid antigen screens are authorized for use with people who have symptoms. However provincial and territorial health authorities can authorize their use to screen asymptomatic individuals, but not to diagnose. This gives jurisdictions the ability to be nimble and adapt as new technologies become available. Evidence indicates that serial screening with antigen tests may be used to detect the virus early in asymptomatic individuals, thereby helping to contain and manage potential outbreaks.
New testing technologies, such as home tests, are being developed and authorized outside of Canada. They offer increased choice and flexibility. Currently, manufacturers must apply for regulatory approval to introduce these new technologies to the Canadian market.
Furthermore, jurisdictions prescribe who may administer and/or interpret test results. The result is a patchwork of approaches across Canada. This creates additional challenges for national or multi-jurisdictional employers, as well as significant barriers for companies. Allowing businesses to train and deploy individuals to administer rapid tests would reduce the burden on health care staff, who are already stretched.
Recommendation: Encourage manufacturers of rapid tests to submit applications to Health Canada to use this technology more widely (for example, to include asymptomatic testing). Also encourage manufacturers of innovative technologies authorized outside of Canada to submit applications for regulatory approval. Provinces and territories should provide temporary exemptions to allow non-health care individuals (such as furloughed employees) to administer and interpret test results. Enlarging the pool of available 'testers' reduces demands on health care workers, who are already stretched.
The National School of Healthcare Science, in collaboration with the U.K. National Health Service, launched Project Nightingale. The goal of this task-shifting approach is to leverage the skills of health care professionals so that health care workers of all specialties can be trained and redeployed.
Nova Scotia developed a rapid test competency model where the operator (a layperson) receives training and repeats the procedures 10 times using Panbio rapid tests, while being observed. Key messages, such as "you are negative for the night," are cues for participants that testing reflects a moment in time. They reinforce the ongoing need to follow public health measures. Feedback on the model has been positive. So far, the training for non-health care workers has been positive.
Using Panbio tests, Air Canada developed a 1-day course, which was vetted by its medical department. The course includes a written and practical examination. The course also recommends task shifting, where furloughed staff are given the task of managing the screening process. In practice, volunteer employees book appointment times, enter the screening area and collect a nasal swab sample on themselves while a trained observer looks on. The observer processes the swab in the solution and test cartridge, and reads and enters the results in the online reporting platform. The employees are notified of their test results by email.
Air Canada does not draw upon important health care workers to perform this task. The program also reduces the amount of personal protective equipment used. It's cost-effective and can be adopted by small or medium-sized businesses. Since the launch of the first pilot on January 12, 2021, voluntary participation among Air Canada employees has been strong, with over 1,000 screenings done to date. Feedback has been positive, with participants reporting less anxiety levels due to the additional layer of safety.
In Canada: The task-shifting initiatives of the National School of Healthcare Science, Air Canada and Nova Scotia provide another approach to training and administering tests. In an industry context, employees who have, or can be trained by those with, transferable skills could be utilized. Furthermore, training a large group of people to administer, or self-administer, rapid tests makes it possible to tap into wider labour pools and set up screening sites.
Effectively and quickly sharing data is central to identifying and controlling outbreaks. Screening programs provide an opportunity to collect data on asymptomatic people. These data can complement provincial and territorial data sets. This type of anonymous information will help to inform public health decision-making and guidance.
Several workplace screening pilots using a variety of data management approached are currently taking place in Canada. For example, CDL RSC's approach emphasizes user-friendly, anonymized data collection, where information can be shared at a workplace and/or national level. This approach makes it possible for businesses and governments to benchmark and compare results, and thus make informed decisions.
Recommendation: Best practices from existing data management approaches should be leveraged to develop systems that can be used to identify outbreaks and support decision-making.
Support small enterprises
Small companies are those with fewer than 100 employees. These make up the majority of Canadian companies (97%). They're resilient, yet less able to weather economic shocks, such as shut-downs. A lack of financial and staff capacity makes it difficult for them to access and administer tests and report results. However, innovative partnerships can mitigate these issues by leveraging service providers (for example, private labs or pharmacies) or larger organizations that are close by.
Recommendation: Funding initiatives that support access to screening programs for small enterprises should be developed. Third-party partnerships for implementation, data collection and reporting should be encouraged.
In February 2021, the U.K. government announced an expansion to its workplace testing program. This involved widening the criteria from businesses with more than 250 employees to those with more than 50 employees. The result: the number of different businesses able to sign up increased, and small and medium-sized companies benefited from rapid testing.
The Texas Division of Emergency Management's (TDEM) COVID-19 Rapid Testing Program, launched in December 2020, helps small businesses in Texas conduct rapid tests on employees. TDEM provides local Chamber of Commerce organizations with COVID-19 testing supplies. These organizations distribute the tests to local small businesses that choose to participate in the program. Small businesses administer the tests to volunteer employees. One million rapid tests were dedicated to this initiative.
In Canada: Such a program offers a smooth method for organizations to sign up online and receive free rapid tests. This program could be strengthened by dedicating resources to small businesses.
Organizations that wish to be involved in workplace screening initiatives using rapid tests should contact their relevant provincial health authority and/or business associations.
Canadian industries want to help. The recommendations in this report indicate how industry and the federal government can collaborate to help build screening capacity and re-start the economy. Government can define clear sign-posts (such as a reduction in case counts and hospitalizations) as part of a data-based safe restart program.
As rapid screening is increased, new access to data will greatly contribute to a safe restart of those sectors of the economy that have been fully or partially closed, including borders.
Note: See the list of our Industry Advisory Roundtable members.
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