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• Patient-facing Healthcare workers
• Staff, volunteers, residents/inpatients, essential care providers, and visitors to high-risk settings. 
  • High risk settings include: hospitals (including complex continuing care facilities and paramedic services) and congregate living settings, including Long-Term Care, retirement homes, First Nation elder care lodges, group homes, shelters, hospices and correctional institutions.
• Household members of workers in high-risk settings.
• Temporary Foreign workers in congregate living settings. 
• Patients seeking emergency medical care, at the discretion of the treating clinician.
• Outpatients for whom COVID-19 treatment is being considered, including
  • Immunocompromised individuals not expected to mount an immune response to COVID-19 Vaccination or SARS-CoV-2 infection, regardless of vaccination status.
  • Individuals who are not fully vaccinated and at highest risk of severe disease (anyone aged >=70 years or >60 years who is Indigenous and/or has additional risk factors). Additional high-risk factors include obesity, dialysis or stage 5 kidney disease, diabetes, cerebral palsy, intellectual disability of any severity, sickle cell disease, receiving active cancer treatment, solid organ or stem cell transplant recipients or other important risk factors at the opinion of the physician.

• Pregnant people.
• People who are underhoused or homeless.
• First responders, including fire, police and paramedics.
• People aged 60 years and older.
• People who are immunocompromised.
• Adults aged 18 years and older, including:
  • who have one or more comorbidity that puts them at higher risk of severe COVID-19 disease
  • who are unvaccinated or have not completed their primary vaccine series.
  • who are vaccinated AND received their last COVID-19 vaccine dose more than 6 months ago AND have not had a SARS-COV-2 infection in the past 6 months.

• People who are from First Nation, Inuit, and Métis communities and individuals travelling into these communities for work.
• Close contacts of people in the context of confirmed or suspected outbreaks in high-risk settings as directed by the local public health unit. High risk settings include hospitals (including complex continuing care facilities and paramedic services) and congregate living settings, including long term care, retirement homes, First nation elder care lodges, group homes, shelters, hospices, and correctional institutions. All other setting would be considered NON-high risk.
• Asymptomatic testing in hospital, long-term care, retirement homes and other congregate living settings and institutions as per provincial guidance and/or directives. Ex. Return to work.
• Testing prior to surgery any patient with a scheduled surgical procedure requiring an anesthetic may be tested with PCR 24 to 48 hours prior.
• People with cancer.
• Patients booked for Hematopoietic cell therapy, hemodialysis patients.
•  Newborns born to people with confirmed COVID-19 at the time of birth within 24 hours of delivery, with a repeat test at 24 hours after birth if base line test is negative, or if the prenatal test results are pending at the time of discharge.

Testing prior to a scheduled (non-urgent/emergent) surgery in a hospital or other surgical setting (e.g., independent health facility, etc.):

• In the context of current COVID-19 epidemiology, any patient with a scheduled surgical procedure requiring a general anaesthetic may be tested with PCR 24-48 hours prior to procedure date.
• Regardless of vaccination status, patients should only go out for essential reasons (e.g., work, school) for 10 days prior to a scheduled procedure as is feasible.
• In the event of a positive test result, the scheduled non-urgent/emergent procedure should be delayed (at the discretion of the clinician) for a period of at least 10 days and until cleared by public health and/or infection control.

Newborns born to people with confirmed COVID-19 at the time of birth should be tested for COVID-19 within 24 hours of delivery, regardless of symptoms.

If parent testing is pending at the time of mother-baby discharge, then follow-up must be ensured such that if maternal testing is positive the baby is tested in a timely manner. If bringing the baby back for testing is impractical, the baby should be tested prior to discharge.

Newborns currently in the NICU/SCN born to mothers with confirmed COVID-19 at the time of birth should be tested within the first 24 hours after birth and, if the initial test is negative, again at 48 hours after birth, regardless of symptoms.

Newborns <48 hours old at time of transfer born to individuals who are asymptomatic and screen negative do not require PCR testing on hospital admission/transfer.

In the context of current COVID-19 epidemiology (>10 cases per 100,000/week), any patient may be tested with PCR 24-48 hours prior to treatment. In regions with low community transmission of COVID-19 klO cases per 100,000/week), routine testing prior to treatment is not required but should be done at the discretion of the treating clinician if they feel it is necessary or indicated, in particular when:

• High dose multidrug chemotherapy is planned
• Radiation treatment will involve treatment of lung tissue
• Treatment is planned in patients with a new ground glass lung opacity
• Treatment (radiation or systemic) is planned in patients who are significantly immunosuppressed

All patients booked for hematopoietic cell therapy should be tested 24-48 hours before their appointment apart from exceptional circumstances, e.g., Priority A case requiring urgent same day treatment.

Testing for symptomatic in-centre hemodialysis patients

• Test symptomatic patients using a low-threshold approach, incorporating symptoms within the COVID-19 Reference Document for Symptoms.
• Patients with persistent respiratory symptoms or fever despite a negative PCR test should be managed on Droplet and Contact Precautions and be retested as appropriate, based on clinical judgment.

Testing for in-centre hemodialysis patients who reside in Long-Term Care /retirement homes or other congregate living settings

• Periodic testing of asymptomatic patients from Long-Term Care/retirement homes is not recommended where the home does not have known cases.
• Periodic testing of hemodialysis patients in Long-Term Care/retirement homes with known cases or outbreaks should continue regularly until the outbreak is considered cleared.
• If a Long-Term Care/retirement home patient comes from a home where there is currently a COVID-19 outbreak or one is subsequently declared and the patient becomes a laboratory-confirmed case, decisions around additional testing of asymptomatic patients and staff should be left to the discretion of local infection prevention and control as testing decisions will be informed by the size and layout of the unit.
• Testing for in-centre hemodialysis patients who reside in Long-Term Care/retirement homes is to be conducted in the hemodialysis unit, or in accordance with hospital and local public health protocols, if not already done in the home.

Testing for hemodialysis patients in hemodialysis unit where outbreak declared

• If an outbreak is declared in a hemodialysis unit, test all patients in that unit regardless of whether they are symptomatic.
• Retesting should be directed by the outbreak management team overseeing the outbreak, in collaboration with local public health.