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Lateral Flow Testing Guidance

COVID-19 can spread rapidly. The use of antigen-detecting rapid diagnostic or lateral flow tests (“LFTs”) assists in protecting our healthcare systems, and our community through quick identification via a more scalable and accessible option that does not create additional strain on the healthcare system.

The following guidance is available for specific sectors or settings.

 

How to take an LFT:

 

The below documents detail the national policy for lateral flow testing in the Cayman Islands. 

As a part of the phased re-opening plan of our borders, The Cayman Islands Government has approved new testing methods to be added to our national protocols, to assist with the screening of COVID-19 in the community. This additional testing will be done through antigen-detecting rapid diagnostic or lateral flow tests (“LFTs”).

LFTs should not replace laboratory based molecular or polymerase chain reaction (“PCR”) testing, which provides the most accurate results for clinical diagnostic detection, but will successfully assist in quickly identifying positive cases, which means we can lower the impact of isolation of close contacts.

COVID-19 spreads rapidly, and can cause severe strain on healthcare systems and societal disruption. The use of LFTs assists in protecting our healthcare systems, and our community through quick identification via a more scalable and accessible option that does not create additional strain on the healthcare system.

Many children with COVID-19 are asymptomatic. Therefore, their infections may be difficult to detect without regular testing.

This guidance is for early childhood care and education (ECCE) centres, schools and post compulsory educational institutions in the Cayman Islands using lateral flow test (also known as antigen-detecting rapid diagnostic tests).

Dowload Guidance.

 

If your child tests positive, report the positive test immediately and inform your child’s school of the result. Your child must stay at home. Public Health will advise when it is safe for your child to return to regular activities (school, sports, etc.).

Learn more about self isolation.

Screening testing of hospitality workers can also serve to promote safer working environments for hospitality workers and provide an additional measure of assurance to our tourist visitors. As with the intended use of lateral flow tests in other workplaces, the approved use of a 10-series of daily lateral flow tests for close contacts can also help tourism businesses to remain operational, by allowing hospitality workers who test negative to return to work.

Nature And Frequency Of Testing

In concert with the new mandatory lateral flow testing regime for incoming travellers beginning 20 November 2021, Tourism Businesses are strongly recommended to set up COVID-19 testing programmes for all employees, irrespective of their vaccination status, for the purpose of:

  • screening hospitality workers with no COVID-19 symptoms or mild symptoms, and promptly identifying any positive cases so that effective measures can be taken to prevent further transmission.

Tourism Businesses are also encouraged to participate in Public Health approved use of lateral flow tests to reduce the number of persons required to isolate as a result of a positive case. This will enable a good degree of business continuity alongside a reduction in people transmitting SARS-CoV-2 to the rest of the population enabling a safer health environment for all.


For the purpose of this protocol, hospitality workers should include:

  • Hospitality staff/worker/co-workers in a business that serve visitors as its primary audience. 
  • Workers in ancillary businesses who serve the hospitality industry. 
  • Workers in any Tourism businesses that serves tourism in any capacity in its business location and/or services. 
  • Workers that provide in-destination experiences, in relation to activities, leisure or business that a tourist participates in while in the jurisdiction. 
  • Workers involved in providing touristic leisure activities, such as waterspouts, spa, golf, beach activities and attending attractions or events.

 

In line with the National Policy on the Use of Antigen-Detecting Rapid Diagnostic Tests (“Lateral Flow Tests”) in the Cayman Islands:

  • Lateral flow tests, including self-administered lateral flow tests, may be used to provide COVID-19 screening tests for hospitality workers with no COVID-19 symptoms or mild symptoms;
  • Where lateral flow tests are used for this purpose, they should be administered at least twice weekly with a minimum of three days between tests;
  • The results of any positive tests for a hospitality worker must be reported to Public Health in accordance with the Public Health Act (2021 Revision), which indicates that COVID-19 is a notifiable disease that is required to be reported to the Medical Officer of Health, as soon as he/she becomes aware of the positive test results.
  • Where testing is introduced into the workplace by tourism businesses, the plans in respect of workplace testing should be set out in a formal workplace testing document. This document should help to provide tourism workers with sufficient information and assist in enabling testing to be carried out privately, fairly, and consistently. Employers should engage with employees prior to introducing employee testing.

 

Responsibilities Of Tourism Businesses

Tourism Businesses may choose to introduce COVID-19 screening testing, using lateral flow tests, in different ways. For example, they may:

 

  • Set up a programme using self-administered lateral flow tests;
  • Set up a supervised on-site screening testing programme that is administered by a third-party Registered Healthcare Provider or by staff trained for this purpose;
  • Direct staff to use the services of a Registered Healthcare Provider approved for use by the tourism business for the purpose of providing lateral flow tests for their employees.

Tourism Businesses may also choose to use lateral flow tests to reduce the number of employees required to isolate, should they become primary contacts of a person who tests positive for SARS-CoV-2. Where a hospitality worker becomes a primary contact to a COVID-19 positive case, the worker may avoid mandatory isolation and continue to report to work if he/she:

  • Tests negative on a lateral flow test within 24 hours of close contact with a SARS-CoV-2positive person;
  • Commences a series of 10 daily lateral flow tests; and,
  • Continues to test negative each day while participating in the daily lateral flow testing programme.

 While participating in the daily lateral flow testing regime, the hospitality worker is also required to continue to monitor symptoms and to strictly adhere to all recommended COVID-19 prevention strategies, such as mask-wearing, handwashing, respiratory etiquette and physical distancing. Should the hospitality worker become symptomatic, even if the LFT result is negative, they should immediately isolate and contact the Public Health Department. 

All costs related to the provision of COVID-19 screening testing for employees of a tourism businesses, including lateral flow test kits or the provision of an internal or external testing service or the costs of PCR tests, must be met by the tourism business.

 

Responsibilities Of Hospitality Workers

In accordance with general Public Health guidance, any person with symptoms suggestive of COVID-19 disease should contact their local healthcare provider or the Flu Hotline to seek advice on the best next steps. The Flu Hotline can be reached on 1-800-534-8600 or 925-6327 (Flow) or 947-3077 (Digicel), or email flu@hsa.ky.

Hospitality workers may choose to conduct additional tests at home that are in excess of the number of tests carried out by the tourism business and/or at different intervals, for their own purposes. Under these circumstances:

  • The costs of these tests will be borne by the individual.
  • Hospitality staff are not required to provide the results of these tests to PH, unless there is a positive test result;
  • In this event that there is a positive test result, hospitality staff are required to follow the Public Health protocols for reporting a positive test result.

  

Procedures To Be Followed When A Hospitality Worker Tests Positive

If a team member tests positive on a lateral flow test, the employee must not attend work, must isolate and must follow Public Health protocols for reporting the positive result. Public Health policy will determine when it is safe for the employee to return to work.

Learn more about self isolation.

Procedures To Be Followed When A Hospitality Co-Worker Tests Positive

Once a hospitality staff member tests positive, a surveillance period is in effect for all team members who qualify as close contacts of the hospitality co-worker and this surveillance period will continue until no positive results are received for 10 consecutive days.

During a surveillance period, a tourism business may choose to implement a 10-day series of lateral flow tests for all close contacts in order to reduce the number of employees required to isolate, as prescribed in paragraph 37 above. 

If another co-worker tests positive during the 10-day surveillance period, the surveillance period resets and continues until there are no positive cases for 10 consecutive days.

Follow-up testing, using a laboratory-based PCR test may be conducted by the Public Health Department, but a positive or equivocal lateral flow test should be treated as indicating someone is very likely to have COVID-19.

It should be noted that if a hospitality worker is contacted by Public Health and he/she is instructed to self-isolate, a negative lateral flow test cannot be used to override the Public Health instruction made in accordance with the Public Health Act (2021 Revision) and any relevant Regulations. 

 

When Lateral Flow Tests May Be Administered By Public Health

Lateral flow tests may be used by Public Health for diagnostic purposes, as part of an outbreak investigation and response. Where lateral flow tests are used by PH for this purpose:

  • The tests may be administered to affected hospitality workers regardless of vaccination status.
  • These lateral flow tests may form part of a Public Health strategy to:
    • Provide a more rapid response for identifying persons actively infected with COVID-19 virus, to help guide clinical and infection control decisions.
    • Reduce the number of persons required to isolate as a result of a positive case.

If you’re administering a lateral flow test yourself for the first time, here’s a guide on how to do it safely and accurately.

 

Before Taking Your Test:

  • Read the instruction manual: Test kit instructions can differ depending on the brand, so make sure to read them thoroughly before you get started.
  • Check your test kit contents: Contents are listed in the instruction manual so check you have everything you need. If any of your kit is damaged or missing, do not use it. Instead, contact the supplier details in the instruction booklet or the place you purchased your kit for a replacement.
  • Do not eat, drink or smoke 30 minutes prior to completing the test.
  • Prepare your test area: You’ll need a clean, dry, and flat surface to lay out your kit. Sanitise the surface thoroughly and make sure it’s completely dry before you start taking your sample.
  • Sanitise your hands: You don’t want to contaminate your sample so make sure you thoroughly wash your hands with soap and water before handling the kit. If you don’t have any available, sanitiser also works.

Step 1: Set Up Your Test

  1. Remove the contents and place them on the sanitised flat surface.
  2. Take out the cassette from the sealed bag. Once opened, you need to take the test within 30 minutes.
  3. If your kit doesn’t come with a pre-filled buffer extraction tube, fill the tube with the provided fluid. Be sure not to spill any fluid on your skin or in your eyes. Seek medical attention if this happens.
  4. Place the tube on the tube holder.

Step 2: Take Your Sample

Note: Some kits will only require a nasal sample while others may require a throat and nasal swab. If your kit only requires a nasal sample, you can skip step two (2).

  1. Take the swab out of the bag. Avoid touching the fabric tip.
  1. Insert the swab into the back of the throat and rub it over the back of your throat. Make sure the tip doesn’t come in contact with your teeth, gums, and tongue.
  2. Next, insert the swab into your nostril gently until you meet a little resistance. If you feel any pain, don’t insert the swab any further.
  3. Rotate the swab 5 times, ensuring that you touch the inside walls of your nostril.

 

Step 3: Process Your Sample

  1. Put the swab into the extraction buffer tube with the fabric end immersed into the liquid.
  2. Gently press the tip into the tube’s bottom surface while rotating it around for 30 seconds.
  3. Squeeze the tube’s bottom so you can pinch the fabric end of the swab. This will transfer your sample into the liquid.
  4. Attach the dropper cover to the tube. Allow it to mix thoroughly by swirling the tube around gently.
  5. With the test cassette on the flat surface, squeeze out 4 drops into the specimen well (usually marked with an S).
  6. Wait for 15 to 30 minutes before reading your results.

Doing The Test For Another Person

Adults should be responsible for performing a lateral flow test for children below the age of 12 and you can do the test for another person if they are not confident doing it themselves.

Here are a few guidelines you need to remember:

  • When taking a nasal sample, insert the swab gently. Slowly push inside until you feel some resistance and ask the person to let you know if it feels painful or too uncomfortable.
  • Make sure to sanitise your child’s hands, even if they aren’t performing the test to make sure they don’t contaminate the sample whilst you’re performing the test.
  • If they are anxious or nervous, reassure them before taking the test and if available do one yourself first to show them the process.

After Your Lateral Flow Test:

  • Dispose of your test kit properly.
  • Don’t read your results after 40 minutes as this will no longer be an accurate reading.
  • Avoid waiting between taking your sample and adding it to the cassette window. Test your nasal/throat swab immediately after getting your sample.
  • Sanitise your hands after using the kit.

Reading And Interpreting Your Results

Positive Result
  • A positive result will yield two lines. One line will be on the control line (C) and the other should be at the test line (T).
  • Faint lines are still to be interpreted as a positive result.

 

Negative Result
  • A negative result will only have one line located at the control line (C).
  • There should be no line, even a faint one, at the test line (T) area.

 

Void Result

A test can be considered void due to either of the following:

  • No lines appear.
  • One line at the test area (T) but none at the control line (C) area.

 

In the case of positive results you should immediately report it here.

In the case of a positive result, you must also self isolate. Learn more.

Where routine screening of employees using Lateral Flow Tests (LFTs) is conducted, it is recommended that it be administered regardless of whether or not persons are fully vaccinated, and as a minimum recommended standard, tests should be conducted twice weekly, with each test taken within a minimum of three days of each other.

Employers may choose to set up their own workplace testing, or they may choose to hire a third-party provider to administer the tests. 

Employers may also provide employees with test kits and ask employees to carry out tests at home before attending the office and may choose to implement appropriate protocols for confirming that the tests have been administered as requested and to confirm the results.

Where testing is implemented in the workplace by employers, the employers may choose to implement the testing as a voluntary regime to which the employee is invited to participate, in order to encourage the health and safety of the entire workplace. Where a testing regime is mandatory, it is recommended that employers conduct a comprehensive assessment of any legal issues before introducing such a policy. 

Where testing is introduced into the workplace by employers, the plans in respect of workplace testing should be set out in a formal workplace testing policy document. This policy should help to provide employees with sufficient information and assist in enabling testing to be carried out privately, fairly, and consistently. Employers should engage with employees prior to introducing employee testing. 

The testing regime must be carried out in a manner that is compliant with the Data Protection Act (2021 Revision) and its requirements for the storing and processing of sensitive personal data relating to the health of the employees. (For related guidance, please see guidance note on “Employee Vaccination Status Checks” published by the Office of the Ombudsman.)  Where LFTs are used for screening testing within an organisation, they must be implemented as part of a layered approach that includes other prevention measures, as the tests alone cannot be relied on as a means of completely eradicating SARS-CoV-2 infections within the organisation, even if employees are entirely compliant.  

Other prevention and control strategies that should be implemented alongside screening testing include:

  • promoting vaccination uptake; 
  • consistent and correct use of masks; 
  • physical distancing; 
  • handwashing and respiratory etiquette;
  • improved ventilation; 
  • routine cleaning with disinfection;
  • remote working;
  • flexible working arrangements; 
  • split shifts or separating teams; and
  • staying home when sick and getting tested.

 

How Much Does Screening Employees With Lateral Flow Tests Cost? Who Pays?

The full cost of implementing a screening regime using LFTs, including the purchase of LFT kits, must be borne by the employer, organisation, or individual. 

 

What Happens If My Employee Has A Positive LFT Result?

You must use the form here to report your positive result, because SARS-CoV-2 (COVID-19) is what is known as a notifiable disease. This means it is required to be reported to the Medical Officer of Health as soon as someone is aware of a positive result or a potential case.  

Where employers introduce the reporting of results as part of their company policy, it is recommended that employers conduct a comprehensive assessment of any legal issues and ensure that the policy is carried out in a manner that is compliant with the Data Protection Act (2021) and its requirements for the storing and processing of sensitive personal data relating to the health of the employees.

What Are Antigen-Detecting Rapid Diagnostic Or Lateral Flow Tests?

Antigen-Detecting Rapid Diagnostic Tests use lateral flow immunoassays to detect SARS-CoV-2 viral proteins (antigens) in swabs from the nose, or both throat and nose, to offer a faster and less expensive method to detect SAR-CoV-2 than PCR tests. The tests give a quick result, often between 15-30 minutes, using a disposable test cassette that is similar to some pregnancy tests. 

The World Health Organization’s performance standards require that such tests correctly identify at least 80% of infected people (test sensitivity) and correctly identify the infection cause to be SARS-CoV-2 in 97% of cases (test specificity). In the Cayman Islands, by Regulations, only LFTs that meet these standards can be imported or supplied.  

What Are Some Key Benefits Of Lateral Flow Tests?

Some of the key benefits that the Government expects to receive are as follows: 

  1. They are 10% or less of the cost of a PCR test;
  2. They can be used and interpreted by someone who has no prior expertise, and many are designed for home use; 
  3. People can conduct the tests at home or at the workplace, so travel to and mixing with people in a healthcare setting is not required;
  4. They are self-empowering which many members of the public will be grateful for (e.g. in the protection of the elderly and vulnerable);
  5. They can assist in identifying people who are infected but asymptomatic in a matter of minutes; 
  6. Their use can decrease the workload on laboratory services; 
  7. They greatly increase access to a reliable diagnostic technique; and,
  8. Their use can decrease disruptions within educational, caregiving and employment settings. 

What Are Some Key Limitations Of Lateral Flow Tests?

Although LFTs do not tend to perform as well as the more sensitive PCR tests when viral loads are low, they do perform well with higher viral loads (when someone is most infectious) or when used repeatedly.

All testing for SAR-CoV-2, including lateral flow testing, depends on the integrity of the sampling technique and therefore the sample. Care must be taken to an avoid improper or insufficient collections (e.g. swabbing the nostril too quickly). The manufacturer’s instructions must be followed carefully in order to ensure the accurate results. 

 

What Is The National LFT Policy For?

The purpose of the policy is to provide a framework and guidance for the strategic use of lateral flow tests, both for home and supervised use, in order to:

  1. ensure the tests used by the Government, private sector and home use are accurate and reliable; 
  2. reduce the threat of SARS-CoV-2 infections with the early detection and isolation of any positive person which will have an immediate impact on the numbers who might present to clinics and hospitals;
  3. achieve more rapid and widespread testing capacity in the Cayman Islands;
  4. enhance our ability to protect some of our most vulnerable populations, including our children in our early childhood care and education centres and schools, who are not yet eligible for an approved COVID-19 vaccination;   
  5. provide additional information to guide the Government’s policies, from the collection and reporting of testing results; and 
  6. build confidence that places of work and recreation can be safe environments even in the face of community transmission, and that attending or patronising such places does not create unreasonable risks to a person’s health or the health of family members with whom they live.  

Additionally, this National policy also serves as the overarching framework for various sectors (e.g. education, tourism, social care services, etc) to create guidance documents that will assist with the deployment of lLFTs in their respective organisation or setting. Private sector employers may also use this policy to assist in developing their own lateral flow testing policies as this document outlines the reporting requirements and other recommendations such as testing intervals.    

What Lateral Flow Tests Can I Use?

Only LFTs that meet the criteria set out in the Control of COVID-19 (Testing) Regulations, 2021, should be supplied for the purpose of SARS-CoV-2 rapid testing in the Cayman Islands (including tests used in workplaces or homes for personal use).

The UK Health Security Agency (formerly known as Public Health England) has undertaken rigorous testing for a large number of lateral flow devices and this is set out here.

Three LFTs brands have been initially identified for use by the Health Services Authority and were selected based on recommendations and proven outcomes as noted by the regulatory bodies at World Health Organization (WHO) and the UK Health Security Agency (formerly known as Public Health England). These three are:

  • ACON Biotech Flowflex SARS-CoV-2 Antigen Rapid Test
  • Bioperfectus Technologies Novel Corona Virus Ag Rapid Test kit, and
  • Hughes Veritas Rapid Antigen Test for SARS-CoV-2.

Any other LFT brand selected for use by the Cayman Islands Government will undergo confirmatory testing by the accredited laboratory of the Cayman Islands Health Services Authority (HSA).  

On the 26th of November 2021, the Medical Officer of Health, under regulations 4(3) of the Control of COVID-19 (Testing) Regulations, 2021, has also approved the use of FlowFlex SARS-CoV-2 Antigen Rapid Test kits marked 'For professional in vitro diagnostic use only' for personal use provided that:

  • They are individually packaged for distribution in appropriate bags. These same bags can be used for placing the testing material after testing for disposal.
  • It is also recommended that clear instructions be provided to users of these test kits.

Who Can Be Screened Using Lateral Flow Tests?

In order to prevent additional spread of the virus, screening is intended to identify persons with SARS-CoV-2 infection who have either no symptoms or mild symptoms (sometimes termed ‘paucisymptomatic’) and who might otherwise go undetected. 

Screening is not intended for children under the age of 2 years.

Screening is not intended for persons who are symptomatic. In line with Public Health advice, persons with symptoms should stay home when sick.  Any person with symptoms suggestive of COVID-19 disease should contact their local healthcare provider or the Flu Hotline to seek advice on the best next steps. The Flu Hotline can be reached on 1-800-534-8600 or 947-3077 (Digicel), or email flu@hsa.ky.

Screening is not intended for persons who have recovered from laboratory confirmed (PCR) COVID-19 test within the past 90 days and are asymptomatic.  To avoid false positives, they should follow the advice of the Public Health Department on how to conduct future testing (including screening tests).  

Who Can Use Lateral Flow Tests?

The Cayman Islands Government recommends the use of approved LFTs for a wide range of purposes and contexts, including the following:

  1. For testing at home, as part of a personal routine to safeguard the health and safety of individuals and their families.
  2. Under the direction of Public Health for diagnostic purposes, as part of an outbreak investigation and response, in order to:
    • provide a more rapid response for identifying persons actively infected with SARS-CoV-2 virus to help guide clinical and infection control decisions; and
    • reduce the number of children and families required to isolate as a result of a positive case. 
  3. For routine testing for some healthcare workers and other frontline workers.
  4. For high risk congregate settings that house some of our most vulnerable populations (e.g. schools, institutional homes, prisons and detention centres).
  5. For organisations providing high touch and personal services to the public (e.g. barbershops, hairdressing salons, and spas), social venues (e.g. restaurants, bars, nightclubs, and cinemas), and fitness facilities (e.g. gyms, fitness centres, or other indoor fitness areas).
  6. As part of a voluntary or mandatory testing programme by employers, especially within organisations with high volumes of customer traffic, in order to ensure that workplaces operate as safely as possible and can maintain business continuity.
  7. With sports athletes and staff engaging in moderate and high risk sports organised by sports leagues, including youth sports teams and activities.
  8. Visitors, prior to entry into certain settings, including but not limited to healthcare facilities and institutional care homes; prisons and places of detention; and as may be required by certain businesses and venues. 

How Will The Costs Of Implementing A Screening Testing Programme Be Met? 

All test kits for screening testing using LFTs within the civil service will be met by the Government and will be provided free of charge to employees.  

All test kits for screening and surveillance testing using LFTs for staff, teachers and children in ECCE centres and schools, both Government and private, will be provided by the Government and will be free of charge to staff, teachers, and children. Supplies of test kits will initially be provided to staff, teachers, and children for routine screening and, in the event of an outbreak or a positive case, additional supplies will be provided for those individuals only.

In any other scenario, the full cost of implementing a screening regime using LFTs, including the purchase of LFT kits, must be borne by the employer, organisation, or individual. 

When Lateral Flow Tests May Be Administered By Public Health?

LFTs may be used by PH for diagnostic purposes, as part of an outbreak investigation and response. Where LFTs are used by PH for this purpose the tests will be administered to affected children and adults, regardless of vaccination status and these LFTs will form part of a PH strategy to:

    • Provide a more rapid response for identifying persons actively infected with SARS-CoV-2 virus, to help guide clinical and infection control decisions.
    • Reduce the number of children and families required to isolate as a result of a positive case.

Report Your LFT Result

Cayman Islands Government, Government Admin Building, Grand Cayman, Cayman Islands, Tel: 345 949 7900

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