Screening at workplaces and schools
Screening involves testing a group of people to detect COVID-19 at an early stage, even though there is no suspicion that the individual might be ill. In this way, people who have COVID-19, or who are about to fall ill with the disease, can be identified even if they do not experience any symptoms. Screening does not replace other preventive measures, but can be a valuable complement to other efforts to reduce the risk of the spread of infection in a workplace
Screening – why and when?
When an infectious disease spreads in a society, we try in various ways to prevent more people from becoming infected. Screening is one effort that can be used as a complement to other protective measures in some workplaces. This involves testing a group of people even though there is no suspicion that the individual being tested might have COVID-19. The aim is to identify people who have COVID-19, or who are about to fall ill, but who do not experience any symptoms. In this way, measures can be put in place at an early stage to reduce the risk of the further spread of infection.
At workplaces where staff need to be on-site and where close contact is difficult to avoid, regular screening for COVID-19 can be a tool for detecting infection at an early stage. However, screening should not be used to open up workplaces whose employees can telecommute.
Screening should be seen as a supplementary effort in addition to other protective measures. It is therefore important to keep your distance from others, be observant of symptoms and use personal protective equipment if this is recommended at your workplace. Screening does not replace the testing that is carried out when someone is ill and already has symptoms, or when tracing infection.
Antigen tests for screening
For screening, antigen tests can be used. These tests do not provide as reliable answers as a PCR test, because they are not as sensitive. Among other things, this means that a person may have COVID-19 even if the test result is negative. It also means that some people who do not have the disease may get a “false positive” test result. The advantage of antigen testing is that these tests provide rapid results, can be widely used, and identify some of those who have COVID-19 before these individuals develop symptoms.
COVID-19 is classified as a disease that is dangerous to public health and society and which must be reported according to the terms of the Swedish Communicable Diseases Act. A positive test result from an antigen test must be confirmed with a PCR test. In the meantime, the individual who received the positive result should behave as if they have COVID-19.
If you or someone in your family has fallen ill (in Swedish)
Regular screening is a way to protect you and your colleagues from being infected by people who are in the process of falling ill or who actually have COVID-19 but have not realised that they are ill. This method can identify people just before their symptoms appear. This reduces the risk that they will spread the infection further at the workplace. Participation is voluntary and occurs according to an agreement with your employer.
There are different ways to conduct a screening. If screening is used at your workplace, your employer should provide you with information about how the screening will be carried out and have procedures for implementing the effort. There should also be procedures for how you should proceed if the test indicates that you have COVID-19. Antigen tests do not provide as reliable answers as a PCR test, because they are not as sensitive. Among other things, this means that a person may have COVID-19 even if the test result is negative. It also means that some people who do not have the disease may get a “false positive” test result.
Important things to consider when self-testing is used in screening
If your employer chooses to use antigen tests in the form of self tests, you take the test and read the results yourself. If your self test shows that you have COVID-19, you need to isolate yourself and contact the healthcare service as soon as possible. In most cases, you do this by booking a follow-up PCR test. Your workplace may have procedures for how this should be done. Otherwise, you can see what procedures apply in your region by going to the 1177.se website.
Screening does not identify everyone who is about to fall ill with COVID-19 or who already has the disease. That is why it is important that you continue to follow the infection control measures that are in place at your workplace. You should also continue to follow the guidelines and recommendations of the Public Health Agency of Sweden to reduce the spread of COVID-19, even if the test shows that you do not have COVID-19.
Screening can identify people with COVID-19 who do not experience symptoms. If you have symptoms that may be due to COVID-19, always stay at home and make an appointment for testing via 1177.se. For people who work in schools/education, see the section further down the page about screening in school environments and other educational activities.
Within the framework of their work environment responsibility, employers must regularly carry out risk assessments and introduce protective measures to reduce the risk of spreading COVID-19 at the workplace. If there is currently an extensive spread of infection in the community, regular screening is one measure that can be considered. However, screening should not replace testing when the existence of disease is suspected. Such testing is always carried out via the healthcare services.
Regular screening with antigen tests (i.e., several times a week) increases the possibility of detecting people who have COVID-19, but who do not experience any symptoms. Then infection control measures can be put in place at an early stage and prevent further spread of infection.
It is important to have procedures in place
Employers planning to introduce organised screening must develop an action plan and procedures for managing screening and test results. When using antigen tests, it is important to be aware of the limitations of the test. If your business/organisation is not within the healthcare field and you are planning to introduce screening at your workplace, you need to get support from your occupational healthcare provider or an equivalent healthcare provider.
It is also important to have procedures in place that clarify how a test result that shows that an employee has COVID-19 should be handled. A positive test result from a screening conducted with antigen tests must be confirmed with a PCR test. In the meantime, the person who received the positive result should behave as if they have COVID-19.
If you or someone in your family has fallen ill (in Swedish)
Antigen tests in the form of self tests can be used for screening
There are various ways to conduct a screening. With an antigen test, both the testing and the reading of the test results can be carried out on-site. This can either be done under the auspices of the healthcare service or with so-called “self tests”, where the person takes the test and reads the results themselves. When screening is carried out under the auspices of the healthcare service, a responsible doctor must prescribe testing and handle the test results. This requirement does not apply when using self tests, as these are not covered by the Health and Medical Services Act.
The Public Health Agency of Sweden recommends that the employer have procedures in place so that employees can rapidly gain access to a doctor for advice on how to handle positive test results from self tests. If the test shows that an employee has COVID-19, they are responsible for contacting a doctor immediately. As a rule, the employee does this by making an appointment for testing via 1177.se or according to the procedures of their workplace.
The employer must also inform employees about what applies with regard to testing.
Screening is a voluntary effort that is regulated between employers and employees. Some groups do not need to be included in screenings. This generally applies to people who have had COVID-19 within the last six months and people who have been vaccinated with at least one dose and at least three weeks have passed since the date of vaccination
The Public Health Agency of Sweden’s guidance provides support to actors who intend to use antigen tests for screening purposes in workplaces. Guidelines and procedures for how antigen testing is to be carried out in practice need to be developed locally or regionally. Read more in the Guide for the use of COVID-19 antigen tests (in Swedish).
The Guide for the analysis of COVID-19 (in Swedish) contains information about the legal requirements imposed on actors who plan to use antigen tests in their businesses or organisations.
Guide for the analysis of COVID-19 (in Swedish)
Those who are engaged in school or other educational activities should read the section below for more information.
Screening in school environments and other educational activities
Screening in a school environment is done as a preventive measure, without a suspicion of infection. This is different from widespread testing performed on a larger group (such as an entire school class) as part of infection tracing tied to a confirmed case of infection.
Following dialogue with the Swedish National Agency for Education, the Public Health Agency of Sweden currently considers that the risks and uncertainties surrounding the use of regular screening among pupils outweigh the possible benefits. This is particularly true of the screening of younger pupils. The reasons for this conclusion are as follows:
- There is still a lack of knowledge regarding whether screening schoolchildren can be an important tool in preventing the spread of infection and reducing sickness absences at school.
- The screening of children can involve tension, discomfort and anxiety.
Screening can be a complementary measure that is made available, especially among older pupils in the senior level of comprehensive school or upper secondary school. However, screening should not be used as a general tool in a school and educational environment.
In cases where regular screening is carried out, the school’s principal, head teacher, or another person responsible for the school’s operations must develop an action plan.
Cases of COVID-19 in schools can entail difficult trade-offs for the principal, school management, the head teacher, and other school staff. That is why the Public Health Agency of Sweden has produced information on how COVID-19 can be handled in schools. This information is primarily aimed at head teachers, principals and managers of primary, secondary and upper secondary schools.
Read more about infection tracing and testing in connection with infection tracing in a school environment (in Swedish).
Read more about information about COVID-19 for higher education institutions and other adult education providers (in Swedish).
School or educational activities planning to introduce screening can read more in the Guide for the use of antigen tests in screening (in Swedish).
Various test methods when using antigen tests
The tests used in screening are all so-called “rapid tests”, where you get the test result within 30 minutes and read them on-site. It is mainly antigen tests that are used in screening, but other tests that show whether a person has COVID-19 can also be used.