The Provincial Antigen Screening Program was announced by the Ministry of Health on February 17, 2021. Through the program, rapid antigen tests are being distributed to organizations to enhance existing routine screening measures for asymptomatic employees and other identified groups entering the workplace.
Rapid antigen tests may allow for workplaces to proactively identify cases of COVID-19 that may have otherwise been missed through routine workplace screening, supporting employee safety and business continuity in a variety of workplaces.
Licensed retirement homes are identified as a priority sector for the program and are pre-approved to order tests. Participation is voluntary.
Rapid antigen screening does not replace existing workplace infection prevention and control (IPAC) measures. Like all asymptomatic screen tests, antigen screening is not considered to be an effective preventive measure for COVID-19 on its own and does not replace public health strategies such as symptom screening, physical distancing, personal protective equipment and hand hygiene. Large scale asymptomatic screening does not serve as an early warning signal for COVID-19.
Who Should be Tested and How Often – Special Information for Retirement Homes
Effective September 21, 2021, the Chief Medical Officer of Health has issued new instructions on vaccinations and testing for retirement home sector staff, contractors, volunteers and students. To support implementation, the Retirement Homes Regulatory Authority has issued new guidance on asymptomatic screen testing.
Retirement homes are now required to implement an antigen point-of-care testing (POCT) program for asymptomatic individuals who are not fully vaccinated or do not provide proof of vaccination. For these individuals, the antigen POCT must be performed at a minimum 1 time per week and up to 2-3 times per week for individuals who are not fully vaccinated. Retirement homes must verify the negative test results.
- Individuals who are partially vaccinated (have received one dose of a two-dose vaccine series, or a final dose of a two-dose vaccine series within the last 14 days) should undertake antigen testing until they are fully vaccinated.
- For individuals who are fully vaccinated, provincial guidance now states that antigen POCT is not recommended as the likelihood of COVID-19 is low for this group which reduces the utility of screening and could result in an increase of false positive results.
Rapid antigen test kits are available through the PASP to support these recommendations.
Retirement homes must continue to adhere to other applicable screening and testing requirements, including those in Directive #3 for Long-Term Care Homes issued by the Chief Medical Officer of Health.
Current Guidance on Antigen Testing
Provincial guidance on the use of antigen screening continues to be updated. The most recent guidance is outlined in the following links:
- COVID-19 Provincial Testing Guidance
- COVID-19 Guidance: Considerations for Antigen Point-of-Care Testing
- Management of Individuals with Point-of-Care Testing Results
- Management of Cases and Contacts of COVID-19 in Ontario
Guidance includes the following recent updates:
Who Should Not be Tested
- As of August 25, 2021, asymptomatic screen testing and antigen point-of-care testing (POCT) are not recommended for individuals who are fully vaccinated.
- An individual is considered fully vaccinated 14 days or more after receiving their second dose of a two-dose COVID-19 vaccine series or their first dose of a one-dose COVID-19 vaccine series.
- Guidance indicates that the likelihood of COVID-19 is low for this group which reduces the utility of screening and could result in an increase of false positive results.
Reducing the use of PCR tests for Screening Purposes
- As of August 25, 2021, in order to maintain capacity of the provincial testing system for symptomatic individuals and close contacts of confirmed cases, retirement home workers, visitors and government inspectors of retirement homes are no longer eligible to receive asymptomatic lab-based PCR testing through the publicly-funded system.
- This includes use of designated testing centres for specimen collection as well as use of public labs to process test samples.
- In conducting their asymptomatic screen testing programs, retirement homes can use rapid antigen POCT and continue to be pre-approved to order test kits through the Provincial Antigen Screening Program. For more information on how to onboard and order tests for the first time, please visit orcaretirement.com/news/coronavirus-update-resources/pasp/.
- Confirmatory testing is still required for a positive antigen POCT, and now can be done using a rapid molecular test (e.g., ID NOW) when rapid molecular tests can be reported into the Ontario Laboratories Information System (OLIS) as well as using laboratory-based PCR testing.
- A positive result on a rapid molecular test following a preliminary positive on an antigen POCT would be considered a confirmed test result, whereas a negative result on a rapid molecular test following a preliminary positive on an antigen POCT would require confirmation with a laboratory-based PCR test.
Antigen Testing Frequency
- As of August 25, 2021, it is recommended that antigen POCT be performed at least 1 time per week, and up to 2-3 times per week for individuals who are not fully vaccinated.
- Specimen collection for antigen POCT may be done by health professionals, or other trained individuals, in accordance with the manufacturer’s label
- To further expand access to antigen POCT, self-screening at home has been enabled through two changes to guidance:
- Voluntary, unsupervised self-swabbing has been enabled. Note that organizations may still elect to have a health professional or trained individual perform the test, and/or permit supervised self-swabbing.
- Waste generated from at-home rapid antigen screening is exempt from guidance for disposal of test kits for organizations performing on-site workplace antigen screening programs (see the “Waste Disposal” section below).
- Instead, persons undertaking at-home rapid antigen tests should consult their local municipality’s by-laws on the proper disposal of this waste to ensure it can be disposed of with the household trash.
- Please note, self-testing should not be performed to test for COVID-19 infection in symptomatic individuals, individuals with known contact with a COVID-19 case or in outbreaks.
- As a reminder, any individual supervising self-swabbing or doing self-swabbing must consult the self-swabbing training resource developed by Ontario Health in collaboration with Public Health Ontario and ensure they have appropriate knowledge, skills and judgement to perform the test.
Previous updates to guidance include the following:
Surveillance Testing for Individuals Previously Diagnosed with COVID-19
- As of May 26, 2021, individuals who have previously been diagnosed with and cleared of COVID-19 infection may resume asymptomatic screen testing after 90 days from their COVID-19 infection (based on the date of their positive result). If there is uncertainty about the validity of the COVID-19 infection (e.g., asymptomatic infection with high cycle threshold value result), resume asymptomatic screen testing immediately.
- This change reflects updated information on the increased likelihood of reinfection, in particular due to the emergence of variants of concern.
Reporting and Data Collection
- Effective May 12, 2021, an amendment to Regulation 569 under the Health Protection and Promotion Act (HPPA) has been put in place such that sites implementing antigen point-of-care screening in Ontario are no longer required to report preliminary positive results to Public Health Units. This applies to sites implementing antigen screening using point-of-care tests provided free of charge by the government, as well as sites implementing private testing. However, there is no change to the requirement that positive results from lab-based PCR tests be reported to Public Health Units.
- As of May 14, 2021, to further simplify and streamline weekly programmatic data reporting requirements, the Ministry of Health has removed the requirement for organizations implementing antigen point-of-care screening to report confirmatory lab-based PCR results. Sites are now only required to report the following aggregate level data to the province on a weekly basis:
- Number of antigen point-of-care test kits used.
- Number of invalid antigen point-of-care test results.
- Number of individuals who tested positive with an antigen point-of-care test.
- Number of individuals who tested negative with an antigen point-of-care test.
- Effective May 12, 2021, in consultation with the Ministry of Health, the Ministry of the Environment, Conservation and Parks, has removed the registration and manifesting requirements for organizations using antigen point-of-care tests under the Environmental Protection Act (EPA). This change will remove barriers to sites that may not be aware of their requirements under the EPA and will support sites to focus on building safe management and disposal infrastructure. The following regulatory obligations imposed on site generators are removed:
- Registration: submitting an initial Generator Registration Report to the Director (under the EPA) before transferring waste from the site.
- Manifesting: completing a manifest in respect of the waste that is leaving the site.
- The following regulation obligations are still in place:
- Storage and handling: The operator and owner of the site must store, handle and maintain the waste so as to prevent leaks or spills, and not store the waste for a period exceeding 24 months.
- Hiring an approved waste transportation system: The generator must only transfer waste offsite using a registered waste transportation hauler. These haulers would complete additional paperwork to explain the origin of the waste as required for transferring purposes.
- Facility operators are encouraged to follow the manufacturer instructions for safe use of COVID-19 antigen point-of-care kits and associated wastes. The following is general guidance for the proper storage and handling of this waste:
- The waste must be stored in containers to prevent leaks or spills and maintained in a way that prevents damage or deterioration of the container.
- The waste should be segregated from all other wastes by depositing it into an appropriate container with the appropriate yellow universal biohazard label.
- The waste should be stored in a secure area, not accessible to the general public, and not adjacent to supply storage areas or areas used for food preparation or consumption.
- Facility operators must only transfer waste offsite using a registered waste transportation hauler. Waste management carriers may be able to assist with guidance on proper disposal options.
Previous updates to guidance include the following:
- Effective February 17, 2021, to participate in the program, participants must complete a program agreement with the Province of Ontario. The program agreement has been integrated into the online ordering system for participating retirement homes. Retirement homes will attest to the following terms and conditions:
- Using test kits for intended purpose and not reselling;
- Reporting data weekly;
- Ensuring compliance with all applicable laws, provincial or federal directives, and provincial or federal guidance, including provincial Guidance on Antigen Screening and IPAC guidelines;
- Providing all other human resources and equipment/supplies (other than the test kits) at the participant’s own cost; and
- Ensuring that the person performing COVID-19 point-of-care antigen screening using the Test Kits at the participant’s site is a health professional or trained individual that has the appropriate knowledge, skills, judgment, and oversight to perform the test correctly.
- Effective March 3, 2021, all COVID-19 tests that are approved by Health Canada for point-of-care use are exempt from Regulation 682 and Regulation 683 under the Laboratory and Specimen Collection Centre Licensing Act.
- This change will allow for a broader range of health professionals to perform rapid antigen screening as part of the Provincial Antigen Screening Program. For example, health professionals may include both regulated health professionals and non-regulated health workers, such as personal support workers.
- Retirement homes are responsible for ensuring individuals administering antigen tests have the knowledge, skills, and judgement to perform the test.
- Effective March 3, 2021, specimen collection for point-of-care antigen tests may also be done by the person being tested (‘self-swabbing’). Self-swabbing for point-of-care antigen tests is not currently approved by Health Canada, but the Ministry of Health is of the opinion that it is appropriate, from a clinical perspective, to do self-collection for antigen point-of-care tests under the following specific circumstances:
- If a trained individual, including a health professional (regulated or unregulated) is supervising the self-swabbing.
- Any individual supervising self-swabbing must consult the self-swabbing training resource developed by Ontario Health in collaboration with Public Health Ontario and ensure that 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 (Hazardous Waste Class 312) as outlined in the guidance on the Safe Handling and Management of Rapid Antigen COVID-19 Testing Waste.
New Test Types
To date, the Abbott Panbio has been the most widely deployed rapid antigen tests to sectors and sites participating in the PASP. However, there are several comparable Health Canada-approved tests that have been procured by the Federal Government for allocation to provinces. Ontario is therefore incorporating these additional types of rapid antigen tests to ensure that supply needs continue to be met for sites participating in PASP, including those sectors and organizations implementing mandatory vaccine policies at the direction of the Chief Medical Officer of Health (CMOH).
Three antigen test types will now be deployed through the PASP: Abbott Panbio, BTNX, and BD Veritor. The province will also be introducing new test types as they get approved through Health Canada.
The Ministry of Health has also endorsed the use of the BD Veritor rapid antigen test as a visually-read device that can now be used without an analyzer machine.
All rapid antigen tests deployed through the PASP will have comparable performance specifications such as sensitivity, accuracy, storage requirements, and shelf life, and they can all be used as visually-read devices. The steps needed to perform each test are very similar.
The introduction of new tests offers implementation advantages. For example:
- BD Veritor can be easily made into ‘mini-kits’ to support at-home self-screening, due to how they’re packaged. Buffer solution is pre-titrated into small vials, reducing the steps needed to administer the test.
- Future supply of BTNX may come packaged in kits of five tests, also making them very easy for at-home use. In its current packaging, BTNX is very similar to Abbott Panbio.
Moving forward, when placing an order, tests will be deployed interchangeably to participating sites based on inventory availability. The e-Health and the Order Management System (OMS) ordering systems are being updated to reflect this.
To support implementation of new test types, training resources, training videos and key messages will be posted online imminently on the Ontario Health website, including:
- Generic training video to support use of all types of rapid antigen tests.
- “How to use test for self-screening” documents (Panbio, BD Veritor, BTNX).
- “How to make mini-screening kits” documents (Panbio, BD Veritor, BTNX).
Nasopharyngeal swab (NPS) is the specimen collection type with the highest sensitivity. NPS is a restricted act, and this specimen type may only be collected by physicians, nurse practitioners, or their delegate despite the exemptions noted above. Alternate specimen collection types are also acceptable, including a combined swab of throat and both nares, a nasal swab, or a deep nasal swab.
Ontario’s current inventory of PanbioTM rapid antigen test kits come with either nasopharyngeal (NP) swabs, or nasal swabs.
- NP swabs can be used for NP, combined throat + both nares, deep nasal (both sides) and nasal (both sides) specimen collections.
- Nasal swabs can be used for combined throat + both nares, deep nasal (both sides) and nasal (both sides) specimen collections.
The BD VeritorTM rapid antigen test kits come with a nasal swab that can be used to collect combined throat + both nares, deep nasal, and nasal specimens.
For more information, please see:
Informational Webinars and Training Materials
Ontario Health provides training materials including key information on how to collect the appropriate specimens for rapid antigen screening, how to order and store test kits, how to set up and run an antigen screening clinic, and how to interpret, communicate and document results.
For more information, please see:
Data Collection and Training
Participating retirement homes are required to report testing data through the Health Data Collection Service. Training materials on data collection and entry are available. For more information see the Ministry of Health’s Rapid Antigen Test Data Collection Guidance Document and Frequently Asked Questions.
To access the Health Data Collection Services website, new users must self-register for an account by completing the following steps:
- Navigate to the Health Data Collection Services Login PageThe login page will load in your browser, select
- A registration page will Navigate to and click on the facility drop-down arrow then select your facility. Select Apply. A table will appear. Select the types you are responsible for submitting.
- In the applicable text boxes, please enter your: E-mail, Password, Password Confirmation, Full Name, Telephone Number and any comments you would like the administrator to
- Select Upon completion of these steps, your registration request will be submitted to the Health Data Branch site administrators for approval. The registration page informs users that approval will be completed within 24 to 48 hours.
- You will receive a confirmation e-mail from DCS@HSIMI.ON.CA. You are now able to enter your data.
For additional information on data entry or registration, contact AskHealthData@ontario.ca.
- Testing can begin before the login is received.
- Data should be tracked manually until login information is received – you will have an opportunity to enter this information retroactively.