SPORT MEDICINE ADVISORY COMMITTEE UPDATE:
General Statement on COVID-19 testing:
In Canada, indications for conducting testing for COVID-19 have changed over the course of the pandemic, as case definitions have evolved, and testing kits have become more available. The high-performance sport sector in Canada is considering testing of high-performance athletes in controlled, ‘bubble’ environments. Questions and considerations regarding athlete testing are under review and will inform a thoughtful, and planned response to the potential use of testing as one of numerous mitigation strategies used by an NSO in their return to training planning.
What is COVID-19 testing?
The most common test to confirm the diagnosis of COVID-19 is PCR testing of nasopharyngeal and/or throat swabs, combined with relevant clinical findings. The Public Health Agency of Canada has recommended using multiple samples over multiple days in those whose symptoms are strongly suggestive of COVID-19 yet return an initial negative test. In general, PCR tests for other respiratory viral infections tend to have a high sensitivity and specificity, although there is limited data specific to COVID-19.
As of May 20, 2020, two serology tests have been approved for use in Canada. At this stage the availability is limited to in Lab use and the reliable (approved) tests are not widely available for community screening. There is still significant debate on how long and to what level a person who has been infected with COVID 19 will maintain immunity or protection from a new infection. At this stage routine serology testing, specifically to enable return to group training or competition, is not recommended. As with everything in this pandemic this may change, and we will continue to monitor for any developments relevant to sports
What are issues with COVID-19 testing?
- There are at least 500 COVID -19 tests available around the world of which 19 are of sufficient sensitivity and specificity to be licensed for use in Canada.
- Even with the most reliable tests there are issues with timing of testing, methods of taking samples and viral shedding that may result in negative results in people who are asymptomatic yet may actually be infected.
- At present testing of asymptomatic individuals using nasal swabs (PCR tests) as a screening tool is not recommended to be used routinely as a method for clearing an individual for return to play or joining a training group. Research confirms that presently the most sensitive screen is a combination of daily symptom checks, testing of any symptomatic individuals, placing individuals with suspected COVID-19 infections in isolation until test results are available, isolation of any confirmed positive individuals and tracing of all contacts. Management of any positive cases must follow local public health regulations and guidelines.
When should a test be considered or used in a high-performance sport environment?
- The Canadian high-performance sector has considered the appropriate use of testing for high-performance athletes in controlled, ‘bubble’ environments. At this point, the position is to support testing for COVID-19 for athletes, coaches, staff, etc. in the daily training environment who are symptomatic only and not as a pre-entry screening measure. The fundamental principle underlying this approach is to protect the health and safety of athletes, coaches, staff, their families, facility staff and communities.
What are the considerations being undertaken in Canada for implementation of testing for high-performance athletes?
The decision to engage in testing of high-performance athletes in Canada is complex and consideration is being given to resource implications in the following areas:
- Expertise – testing will be carried out through the local health authority or with their approval in a designated area conforming to regulations including proper training of individuals involved in the performance of the test, cleaning of the test space and managing of the results of said testing per PHAC regulations.
- PPE - Use of personal protective equipment for all sample collection (e.g.) gloves, gowns, masks, eye protection. Safe handling of potentially contaminated equipment or surfaces in the patient environment, and respiratory hygiene/cough etiquette.
- Testing Isolation - A designated room is required for testing. This room must not be used for other purposes and must be a room that can be fully sanitized between each athlete test. There must be an entry point to this room that is separate from the exit.
These considerations are being addressed in a
High-Performance Athlete Testing Protocol.
Return to training protocol after symptomatic diagnosis is being researched and additional information and plan for how to return a high-performance athlete to training will be published in the near future. This is an area of developing information and best practices are in their infancy.
NSO decisions to engage in athlete COVID-19 testing should be made in consultation with a Team CMO and/or a CMO member of SMAC.
AN UPDATE WILL BE PROVIDED EVERY SECOND WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.