Industry Advisory Roundtable on COVID-19 testing: Task Shifting and Self-Administration for Workplace Screening Programs

The Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management has released a second report. This report reiterates the importance of task shifting to enable the use of rapid tests to screen for COVID-19 in workplace settings. Rapid screening helps with the quick isolation of positive COVID-19 cases to keep the rest of the workplace safe and support economic recovery.

On this page

• Executive summary
• Task shifting: What it is and how it helps
• Small- and medium-sized enterprises
• Recommendations
• Case studies and examples

Executive summary

There is a simple but effective way to provide additional protection to Canadians in the workplace: screen regularly. In its first report, the Industry Roundtable concluded that enabling businesses to establish workplace screening programs would help protect employees and communities. Workplace screening programs would catch potential infections early, particularly in contagious people who don’t show symptoms. Recent pilot programs in Ontario detected 89 confirmed positive cases between November and February, which helped prevent the spread of the virus in these workplaces.

The success of workplace screening programs depends on the ability of workplaces to:

• use a broad range of individuals to administer or supervise the screening tests
• avoid an additional burden on health care professionals

Using a broad range of individuals for workplace screening programs increases the capacity and accessibility of screening. It does so without having an impact on vaccination efforts and other health priorities. Adopting training across the country can enable workplace screening programs. The goal should be a consistent approach across jurisdictions with a move to virtual support and self administration.

Screening continues to be a complementary tool to protect Canadians, to limit the spread of the virus, and to maintain continuous economic activity. Screening will remain an important tool as vaccines rollout across the country. Reducing the barriers to screening will make it easier to avoid lock downs that have massive effects on the lives of Canadians.

Task shifting: What it is and how it helps

Task shifting, which includes using a broad range of health care professionals or other trained individuals to deliver care, is not a new concept. Recently, it has been used for rapid screening to expand the number of individuals eligible to deliver screening programs. Currently, in many jurisdictions, only limited numbers of health professionals, including nurses and doctors, are allowed to administer these screening tests.

Task shifting could expand eligibility to:

• a broader group of professionals such as pharmacists, dental therapists and paramedics
  • it would also allow these professionals to supervise self administration of these tests
• non-medical workers such as furloughed employees and community volunteers

Self administration should be a near-term goal for rapid screening programs. This goal is supported by studies in Canada showing that samples from self-administered tests were adequate for processing 99.8% of the time.

As described by the first Industry Roundtable report, how rapid screens are used is limited to the specific parameters manufacturers have submitted to Health Canada. Hence, to expand use, it is left to the provinces and territories to determine who may administer and interpret test results.

Some provinces have exemptions for laypeople to administer or self-administer rapid tests (see the annex for some provincial approaches). Other jurisdictions only allow certain medical professionals to administer these tests. If businesses are limited to medical professionals to support screening, this will:

• be a costly endeavor for companies
• put an additional burden on these high demand health human resources (HHR)

The lack of consistency of who can administer rapid tests across the country is difficult for companies with a large geographic footprint. Leadership across all federal, provincial, and territorial governments could enable adoption and use of these screens on an emergency basis. This will reduce the burden for scaling-up, as currently individual provinces need to provide accommodation and that increases the effort to rollout these programs across Canada.

This lack of standardized guidance is concerning because most of the rapid tests that have been procured and distributed by the federal government are unused. This creates an opportunity for businesses to train employees to administer or self-administer rapid tests, or have access third party providers, to:

• use rapid tests in rapid screening programs
• test on a cost-effective basis for businesses of all sizes
• limit the impact on scarce health human resources and health priorities, such as vaccinations

This approach gives Canada:

• more ways to use the rapid tests that are currently in storage
• broader use of these tools, potentially reducing the need for lock-downs

At the same time, it reduces pressure on public health resources as in-house employees and third parties take on the test administration role. Expanding task shifting beyond healthcare professionals is critical as more accessible methods of testing, such as self-administered tests and home tests, become available in Canada.

Figure 1 - Text description

The image shows a spectrum of 4 task shifting options for COVID-19 screening tests. It starts with those with high health human resource costs and high impact on health systems and moves towards those with low health human resource costs and large-scale screening.

The first option is ‘Default,’ in which only select roles likes nurses and doctors can administer COVID-19 screening tests.

The second option is the ‘Right Track,’ in which other health professionals can administer COVID-19 screening tests.

The third option is ‘Progress,’ in which rapid test users can self-administer tests as long as they are supervised.

The fourth and last option is ‘Optimal,’ in which non-medical employees and volunteers can administer or self-administer tests freely.

Small and Medium Size Enterprises (SMEs)

As highlighted in the first Industry Roundtable report, SMEs face significant barriers to establishing workplace screening programs. SMEs may not have the resources to:

• hire medical professionals
• take advantage of more flexible guidance that allows retraining of staff to support screening programs

To address this challenge, the Roundtable highlights the recent approach announced by Saskatchewan. This approach allows trained third-party providers to administer screening, thus expanding the number of areas in which rapid screening is offered. This approach, and others that leverage the national footprint of pharmacies and private labs, could be used to help SMEs protect their workplaces.

However, given the significant impact of shut downs on SMEs, they may need financial support to access these services. Incremental funding programs can help SMEs withstand the additional costs related to implementing rapid screening programs. Access to rapid screening would ensure SMEs have the capacity to quickly identify and isolate contagious individuals, and allow them to stay open. This support is critical to helping Canadian SMEs recover from the impacts of the pandemic and move forward in a position of strength.

Recommendations

The Industry Roundtable recommends a screening approach that:

• encourages employers to establish screening programs for employees through easy access to rapid tests and low cost of entry, which is enabled by task shifting
• allows for task shifting and the consistent use of rapid screening across Canada in the short term
• amends necessary regulatory regimes or creates programs that:
  • provide clear federal guidance
  • create alignment between provinces and territories for workplace screening programs
  • harmonizes these standards across the country
• creates standardized training (primarily online) to ensure quality assurance when task shifting. Standardized training will allow businesses to develop in-house capacity, leading to a consistent approach and quality assurance across the country.
• supports financially accessible screening services by third-party providers and pharmacies for use by SMEs,
• creates funding opportunities for SMEs
• aligns with the Ontario ‘self-swabbing’ model, especially as ‘at-home’ or self-administered rapid tests enter the Canadian marketplace
• recognizes companies that implement screening programs are well positioned to act quickly to prevent outbreaks in their workplaces and communities. They should be allowed to remain open as long as they maintain these surveillance efforts in the event of broad lock-down measures.

Case studies and examples

Here are a number of case studies and examples of various task-shifting initiatives.

On the right track: expansion to other health professionals

Public Health Ontario has taken steps to widen the available resources for rapid testing. As part of changes to the Laboratory and Specimen Collection Centre Licensing Act, Ontario has included exemptions to allow paramedics, pharmacists, dentists and other professions to administer point-of-care tests (such as rapid tests). They also provide exemptions for those participating in their Provincial Antigen Screening Program.

The Saskatchewan Health Authority is exploring similar approaches, leveraging community oral health providers, among others, to enhance their testing and screening capacity. This initiative includes allowing dental offices to undertake nasopharyngeal swabbing for self-testing and third-party providers delivering testing to walk-in or drive-thru sites, mobile testing and pop-up testing sites.

Progression: supervised self-administration

The Government of Canada is leading an initiative targeted at non-essential travelers who present at the US-Canada border. These travelers must participate in on-site screening. Personnel from the Canadian Red Cross observe these travelers as they administer and package their own sample for screening. They also give travelers a second screening kit to self administer on day 10 of the 14-day quarantine with supervision by video link.

Optimal: non-medical employees and volunteers.

The University of British Columbia used in-house nursing students as test administrators for first year residents, while the Downtown Halifax Business Commission used community volunteers to implement rapid testing among those visiting Halifax’s downtown. Training staff and volunteers in sample collection and testing procedures improves test accuracy and safely. Manitoba is partnering with Red River College to launch a new micro-credential program to build a skilled workforce to support its rapid testing strategy. This course is 11 hours (mixed online and in-person), tuition-free, and open to individuals with science backgrounds.

Public Health Ontario has recently expanded their guidance for antigen testing. The person being tested (‘self-swabbing’) can do specimen collection for rapid antigen tests if:

• either a trained individual or health care professional (regulated or unregulated) is supervising the self-swabbing, or
• the person being tested has undergone training

To support this, individuals who are observing self-swabbing (or self-swabbing without supervision) must have completed Ontario’s self-swabbing training resource, which provides instructions and videos for the administration of Abbott PanBio rapid tests.

While not all these exemptions target workplace settings, they show the forward motion in provinces towards widening the pool of resources and getting rapid tests into the hands of those who can put them to use.

Authorization of third party providers for rapid asymptomatic testing

There are opportunities to develop standardized guidance, training, and allow third-party provision for rapid screening. Currently there is a significant difference between provinces and territories on authorized administrators for COVID-19 testing, and a lack of standardized training material for the average business. Provincial initiatives like the micro-credit program in Manitoba can be expanded to support a standardized approach to task shifting. In some provinces third-party providers and pharmacies are already deeply involved in vaccination programs. They could also support screening initiatives using their national footprint and built-in resources.

Figure 2 - Text description

The image depicts a map of Canada where provinces and territories are marked as either having ‘Limited task-shifting’, ‘Some task-shifting’, or ‘Extensive task-shifting’. Alberta, Saskatchewan, and Ontario are considered to have ‘extensive task-shifting’, while British Columbia, Manitoba, and Quebec have ‘some task-shifting’. All other provinces and territories are considered to have ‘Limited task-shifting’.

Other examples of task shifting

• Dental therapists have been instrumental in the rolling-out of testing strategies within First Nations communities.
• Alberta’s Community Paramedics are supporting community screening in shelters and congregate living sites.