More rapid self tests distributed in Sask., but some people are confused about when to use them

The rush on free rapid antigen self-tests in Saskatchewan was huge at the end of October when they first became available.

On the first day of distribution, the Swift Current and District Chamber of Commerce ran out of test kits within 45 minutes. In Saskatoon and Regina, lines formed as people waited to grab the kits.

Since then demand has become a bit quieter, but the tests continue to be available for free in the province.

Just last week, on Nov. 17, 2021, Saskatoon's TCU Place received a fresh supply of test boxes from the province to hand out to people.

"It's been smooth and it's been easy," said Tammy Sweeney, chief executive officer at TCU Place.

"It's been steady but not overwhelming. There's not been major lineups. It's very quick for people to get in and out."

TCU Place staff has been distributing rapid antigen self test kits since the beginning of November. 

Sweeney said the first couple of days were busier than what they see now. 

"We would have a few hundred people in a day," she said. "Now we're probably getting, I would say, about 100 a day."

On Wednesday, the facility had about 2,000 test kits, each of which contain five individually packed test devices. 

Sweeney said in an email that TCU Place will continue to receive more kits from the province until further notice. She said the supply should keep flowing until the end of the year.

The Greater Saskatoon Chamber of Commerce also continues to hand out free test kits to residents in the city. After being out of stock for a while, it recently received 4,744 new kits and started distributing them on Tuesday, the Chamber said.

Sask. hands out free tests as long as federal govt. provides them, says province

Between October 2020 and Nov. 12, 2021, the federal government sent more than 6.5 million rapid antigen tests to Saskatchewan, according to an email from the Saskatchewan Public Safety Agency (SPSA). 

As of Nov. 12, the province had distributed more than 532,000 tests to chambers of commerce, fire halls, hotels and malls, the agency said.

In addition, schools in Saskatchewan received 759,300 tests for children under the age of 12, and 750,000 tests were sent to testing and assessment centres of the Saskatchewan Health Authority for public pick-up.

Saskatchewan is expecting to receive another 4 million rapid antigen tests in December 2021, according to the SPSA.

"Saskatchewan will continue to provide tests to the public for free for as long as the tests are received through the federal allocation," said the agency.

"No decision has been communicated to Saskatchewan regarding the duration of the federal government's allocation of rapid antigen tests."

Long-term care facilities, shelters, group homes and schools also continue to receive the free tests, said the province.

Province wants people to use tests regularly

So far, TCU Place hasn't faced any challenges handing out the free kits, said Sweeney.

"We just encourage anybody and everybody to come down."

The province also seems to encourage people to continuously pick up the free kits. 

The rapid antigen tests are intended to be used routinely once or twice per week, said the SPSA in its email.

"A box of five tests will last an individual from two weeks to a month," said the agency. "A family will use their supply faster."

People coming to TCU Place or the The Greater Saskatoon Chamber of Commerce don't need to show ID to get test kits. 

In an email, the Chamber said it internally keeps track of businesses that pick up test kits because they are only allowed a maximum of 10.

The province is not tracking who individual tests are being given to, said the SPSA.

"We are relying on the public to do the right thing and use this resource responsibly," said the agency.

While people have come back repeatedly to pick up test kits from TCU Place, nobody seems to have abused the system so far, said Sweeney.

Staff at the Saskatoon convention and arts centre won't hand someone a bag of 20 boxes, according to its CEO. However, a family that requires more than one bag can get additional kits.

Confusion about how to use tests

While the free tests continue to be available in Saskatchewan, it is not clear to everybody how and when to actually use them.

Anita Duff has never picked up any rapid test kits, she said. The Saskatoon woman has no idea when people should use them at home.

"That is a good question," she said.

"There is so much information out there, it's confusing."

Heather Isaac and her family have picked up free rapid tests before, but they never tried them, she said. 

"We haven't had to use them yet because we have had no symptoms," said the woman from Martensville.

According to the province, though, people should only use the rapid antigen self-tests when they are asymptomatic, since the free tests are not a tool for diagnosing the disease.

Anyone who experiences COVID-19 symptoms should get a PCR test at one of the Saskatchewan Health Authority's testing sites or drive-thru options, or by calling 811 to book a test, says the government on its website.

The free kits for at-home testing are also not accepted as a proof of a negative COVID-19 test for unvaccinated residents. People who need a negative test result can go to a private lab and pay for a rapid antigen test or a PCR test.

"The rapid antigen tests available in Saskatchewan are approved by Health Canada for use on asymptomatic people," said the Saskatchewan Public Safety Agency in its email to CBC.

The PCR test "is the gold-standard test to diagnose COVID-19."

The government sees the free rapid tests as a screening tool and "an added layer of protection to reduce transmission," according to the SPSA.

Low sensitivity of rapid antigen tests

If not used correctly, the free self-tests can also provide a wrong feeling of security.

"It's a first line of detection," said Dr. Nazeem Muhajarine, an epidemiologist at the University of Saskatchewan.  

"You have to do the test exactly the way that it is instructed…. Without doing that, then the test is not valid."

In addition to the instructions provided in each testing kit, videos and self-test guides are also available on the government's website.

Getting a false negative result might not only be the result of people making mistakes. It is important to understand that a negative rapid test result does not necessarily mean one is free of infection, said Muhajarine in an email.

"This can happen if the Rapid Antigen test is done during the incubation period, the time between exposure to the virus and before showing symptoms," wrote Muhajarine.

"During this period there may be insufficient viral proteins [antigen] in the nose or throat. The viral proteins are in sufficient amounts around one to two days before symptoms are seen."

The epidemiologist refered to a recent study from Quebec that is still undergoing peer review. 

In the study, rapid antigen tests demonstrated sensitivity as low as 28.6 per cent in asymptomatic participants, according to the Situation, Background, Assessment, Recommendation (SBAR) published by the Coronavirus Variants Rapid Response Network on Nov. 23. 

Sensitivity describes a test's ability to correctly identify people who are truly positive, meaning how well the test can detect the virus, said Muhajarine in his email. In comparison, specificity is defined as a test's ability to correctly identify people who are truly negative.

"These antigen rapid tests have high specificity but relatively low sensitivity [especially in asymptomatic people]," said the epidemiologist from Saskatoon.

"If the first test is negative, in order to ensure that it is truly negative, a second test within 24 hrs or so is recommended."

The advantage of rapid antigen tests is their comparably cheap price and the quickly available test results, said the university professor in an email.

Timing of rapid testing can be important, says epidemiologist

Doing a second rapid test after a first negative result is especially a good idea after traveling, going to a party or attending any other big gathering, said the epidemiologist.

The timing of the first self-test plays an important role, he said.

"I don't think that you should be doing it within 24 hours [after the party]," said Muhajarine

"The viral load increases, continues to increase, up to about three to four days, particularly the delta variant."

People should catch the viral load while it is on the rise, said Muhajarine.

He said people might want to do a first test 24 to 48 hours after attending an event.

If the result is negative, he would do another rapid test within 24 to 48 hours, he said.