Testing and Laboratory
Please note that as things change rapidly, Q&As and guidelines will be updated. Review this website often to ensure you have the most up to date information or consult your leader if you have concerns or identify discrepancies.
FAQ: COVID-19 PCR Testing and Patient Infectivity - Updated May 28, 2020:
- Infectivity or transmissibility of COVID-19 is assessed based on Public Health criteria
- PCR only detects viral RNA and not live virus
- What test is being used to identify COVID-19?
- COVID-19 is diagnosed in the Medical Microbiology laboratory using a molecular test (PCR) that detects SARS-CoV-2 viral RNA. This test only detects viral nucleic acid, not live virus.
- When are COVID-19 patients considered to be non-infectious?
As per the Public Health Update (VCH COVID-19 Isolation Clearance Criteria, April 28)1, patients admitted to hospital are considered no longer infectious if they meet one of the following criteria:
- At least 10 days have passed since onset of symptoms, fever has resolved without use of fever reducing medication AND two consecutive negative NP swabs at least 24 hours apart (test-based strategy); OR
- At least 10 days have passed since discharge from hospital, fever has resolved without use of fever-reducing medication AND symptoms (respiratory, gastrointestinal, and systemic) have improved; OR
- At least 40 days have passed since onset of symptoms (respiratory, gastrointestinal, and systemic).
A test-based strategy is often preferred for patients while they are admitted to hospital and for patients being transferred to long-term care facilities.
- If a patient is known to be COVID-19 positive, is repeat testing required?
Repeat testing may be done as above for a patient with ongoing hospitalization.
For patients who have previously been diagnosed with COVID-19 and have been subsequently cleared by Public Health, repeat testing is not indicated. The COVID-19 PCR test may continue to be positive after symptom resolution.
- Does a PCR positive result mean the patient is still infectious?
- Infectiousness is based on criteria set by Public Health. A PCR positive result indicates that viral RNA has been detected, but it does not indicate whether there is still live replicating virus. Viral cultures on 9 patients have been shown to be positive for up to 8 days after symptoms onset (2). A recent study by the National Microbiology Laboratory assessing a larger cross sectional cohort of 90 patients also reported similar results, where viral culture was only found in those patients <8 days from symptom onset (3).
- How long can COVID-19 patients continue to be PCR positive?
- COVID-19 COVID-19 virus PCR from nasopharyngeal swab samples have been reported to remain positive for a prolonged duration up to 48 days (4), but this does not suggest that they are infectious for that duration of time. At PHC, we have seen positive nasopharyngeal swabs samples up to 69 days after an initial positive test (and 80 days from symptom onset).
- VCH COVID-19 Isolation Clearance Criteria. http://www.vch.ca/Documents/Physicians_Update_2020-04-28.pdf
Wolfel R, et al. Virological Assessment of Hospitalized Patients with COVID-2019. Nature. 2020 Apr 1. doi: 10.1038/s41586-020-2196-x.
Bullard J, et al. Predicting infectious SARS-CoV-2 from diagnostic samples. Clinical Infectious Diseases. 2020. https://doi.org/10.1093/cid/ciaa638.
Zhou B, et al. The duration of viral shedding of discharged patients with severe COVID-19. Clinical Infectious Diseases. 2020. https://doi.org/10.1093/cid/ciaa451.
April 30, 2020:
PLEASE WATCH THIS VIDEO: TAKING PROPER NASOPHARYNGEAL SWABS TO REDUCE FALSE NEGATIVES AND IMPROVE PATIENT COMFORT
Dr. Andrew Thamboo, sinus and skull base surgeon, and Dr. Laura Allen, resident in otolaryngology, created an instructional video to help Providence staff and medical staff improve their skills when taking nasopharyngeal swabs (NPS) for respiratory viruses.
In addition to highlighting proper technique and anatomical considerations, the video shows the required personal protective equipment and donning and doffing of PPE.
Watch video here: https://youtu.be/f0xSKPm8IKA
Many PHC Clinical Nurse Educators (CNEs) have already attended hands-on training sessions with Dr. Thamboo. The plan is for CNEs to disseminate this education.
Julie Carleton from Professional Practice will be organizing further sessions for PHC Clinical Nurse Educators. Please review the video before attending future training sessions.
June 18, 2020:
COVID-19: Testing Guidelines for British Columbia: includes guidance for Testing by Nucleic Acid Tests (NATs)
Effective April 20, 2020:
Any British Columbian who is exhibiting cold, influenza or COVID-like symptoms is now able be assessed for and get a COVID-19 test from a physician, nurse practitioner or local community collection centre.
Individuals with respiratory or other COVID-like symptoms no longer have to be referred for testing by a health-care provider or by calling 811.
While testing is now available for those who need it, not everyone needs a test. If an individual has no symptoms, even if they are a contact of a confirmed case or a returning traveller, they do not require a test.
Effective April 5, 2020
As per recommendations by the Vancouver Coastal Health (VCH) Public Health, influenza A and B season has concluded and influenza testing will not be automatically added to COVID-19 virus test orders, and vice versa. Please review the updated order entry information regarding COVID-19 virus test orders.
Recommended samples types for COVID-19 testing are:
- Nasopharyngeal (NP) swab
VIDEO: How to perform nasopharyngeal swabs: taking proper nasopharyngeal swabs to reduce false negatives and improve patient comfort (April 30, 2020)
- For hospitalized patients and/or patients with evidence of lower respiratory tract disease, an NP swab is recommended and, if appropriate, a lower respiratory specimen (sputum/tracheal aspirate/BAL).
All specimens (cylindrical tube) must be affixed with a label which states:
- Patient name
- PHN or Date of Birth (DOB)
- Specimen type (e.g., NP swab)
- Date & time of collection
If applicable, please indicate one of the following codes on the specimen label to assist with processing:
- HCW1 – Health Care Worker – Direct Care
- HCW2 – Health Care Worker – Non-Direct Care
- LTC – Long-Term Care Facility
- OBK- Outbreak
- Including people are who homeless or have unstable housing
- HOS – Hospital (inpatient)
- CMM – Community (outpatient), including urgent and primary care centre
Please submit each specimen in an individual, sealed biohazard bag. Include a paper requisition which clearly states the patient information, the ordering physician, and the test name (COVID-19 NAT).
Please refer to the BCCDC Public Health Laboratory eLab Handbook under COVID-19 test for specimen requirements.
Samples collected for Influenza/RSV and/or COVID-19 at St. Paul's Hospital and Mount Saint Joseph's Hospital will be forwarded directly to the SPH Virology Laboratory. All COVID-19 testing for PHC patients will be tested at SPH Virology.
SPH Virology offers testing seven days a week. Multiple runs of testing occur throughout the day, with the expected turnaround time of 24 hours. Please contact the Medical Microbiologist on-call through switchboard if you have questions.
Ordering viral swabs
- Personal Protective Equipment (PPE)
- Testing and Laboratory
- Infection Prevention & Control for Surgical Procedures
- Acute Care
- Hand Hygiene
- Triage and Assessment
- Environmental Considerations
- Long Term Care Specific Information
- Ambulatory Care
- Community Resources
- Admitted Patients
- Care of the Deceased
- Travel Advisories
- Greeter Program Information
- Risk Mitigation in the Context of Dual Public Health Emergencies
- Visitation Rule Changes
If you need to reach PHC’s Infection Prevention and Control Team (IPAC), please call local 69357. Do not contact individual IPAC team members.