Point-of-Care Tests for COVID-19 and Influenza in Canada

Abstract

What Is the Issue? Health care providers rely on laboratory tests to differentiate between respiratory illnesses that manifest in similar symptoms, such as COVID-19 and influenza. However, samples may travel to centralized laboratories to process, delaying test results and treatment. Point-of-care tests (POCTs) allow for diagnosis at the site of care but at the expense of diagnostic performance. Several commercial POCTs, specifically for COVID-19, have become increasingly available in Canada since the start of the pandemic. Decision-makers will need to consider which commercial POCT can meet their jurisdiction’s testing needs. POCTs in Canada and their Potential Impact Some POCTs, called “Multiplex tests,” can detect and differentiate between certain illnesses using a single sample. Some studies suggest that using POCTs for respiratory illness in hospitals and emergency departments can expedite diagnosis, improve patient flow, reduce admissions, and shorten the length of stay. Commercial POCTs vary in diagnostic performance, complexity, and costs. There are at least 37 authorized POCTs for COVID-19, influenza, or both in Canada. All devices accept a nasal, nasopharyngeal sample, or both sample types for testing. Some tests require a reader or analyzer to use test kits for diagnosis. POCTs can provide results in 1 hour or less. However, laboratory testing (i.e., nucleic acid amplification tests) remains the standard of care to diagnose COVID-19 and influenza, given their better diagnostic performance compared to POCTs. What Else Do We Need to Know? Confirmatory laboratory tests can reaffirm the diagnosis from POCTs. However, budget impact analyses and clinical studies on authorized tests in Canada do not consider how confirmatory lab tests impact findings on POCT use. Future studies should investigate the cost-effectiveness of POCTs with confirmatory testing, as well as the impact of incorrect diagnosis from POCT on patient outcomes. Rural and remote communities may benefit from POCTs for respiratory illness, given their distance to centralized laboratories.