Canadian Public Health Laboratory Network Best Practices for COVID-19

The ability to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, is a foundational component of Canada's containment and mitigation strategies. Laboratory confirmation of COVID-19 cases allows the appropriate clinical management and public health interventions. Whether the local goal is containment or mitigation will depend on local epidemiology of the pandemic. The Respiratory Virus Infections Working Group of the Canadian Public Health Laboratory Network has developed comprehensive Best Practice Guidelines for detection of SARS-CoV-2. Best practices for specimen collection, transportation, testing and biosafety are addressed from the perspective of Canadian public health laboratories to ensure a consistent approach across the country: Population-based testing for COVID-19 should initially be carried out for surveillanceNasopharyngeal swab is the specimen of choice for routine testingNucleic acid amplification tests (such as real-time reverse transcription polymerase chain reaction) are the method of choice for routine testing of SARS-CoV-2The decentralization of nucleic acid amplification testing for COVID-19 to hospital or other high complexity medical laboratories should be promoted to increase test capacity and meet increased demandsIn the early stages of the pandemic, positive (approximately 10-20) and negative (approximately 50) tests by a provincial laboratory require confirmation at the National Microbiology LaboratoryCo-circulation of other viral agents associated with influenza-like Illnesses (e.g. influenza A and B and respiratory syncytial virus) should be monitored as capacity permits, as part of ongoing surveillanceOnce validated, serological testing may be utilized for assessing the presence/absence of immune response to the SARS-CoV-2 at either the population or individual level for select indications, but is likely to be of limited utility in diagnosis of acute COVID-19 illness These recommendations will be updated as new information becomes available.