Effectiveness and use of reverse transcriptase polymerase chain reaction point of care testing in a large‐scale COVID‐19 surveillance system

Abstract

Background: Rapid COVID-19 testing platforms can identify infected individuals at the point of care (POC), allowing immediate isolation of infected individuals and reducing the risk of transmission. While lab-based nucleic acid amplification testing (NAAT) is often considered the gold standard to detect SARS-CoV-2 in the community, results typically take 2-7 days to return, rendering POC testing a critical diagnostic tool for infection control. The National Football League (NFL) and NFL Players Association deployed a new POC testing strategy using a newly available reverse transcriptase polymerase chain reaction (RT-PCR) rapid test during the 2020 season, and evaluated diagnostic effectiveness compared to other available devices using real-world population surveillance data. Methods: RT-PCR POC test results were compared to NAAT results from same-day samples by calculation of positive and negative concordance. Sensitivity analyses were performed for three subgroups: (1) individuals symptomatic at time of positive test; (2) individuals tested during the pilot phase of rollout; and (3) individuals tested daily.Results: Among 4989 same-day POC/NAAT pairs, 4957 (99.4%) were concordant, with 93.1% positive concordance and 99.6% negative concordance. Based on adjudicated case status, the false negative rate was 0.2% and false positive rate was 2.9%.In 43 instances, the immediate turnaround of results by POC allowed isolation of infected individuals 1 day sooner than lab-based testing. Positive/negative concordance in sensitivity analyses were relatively stable. Conclusion: RT-PCR POC testing provided timely results that were highly concordant with lab-based NAAT in population surveillance. Expanded use of effective RT-PCR POC can enable rapid isolation of infected individuals and reduce COVID-19 infection in the community.

International biathlon season during the COVID-19 pandemic was based on frequent on-site PCR-testing protocol with rapid result management

“…In the face of the global COVID-19 pandemic, many sports events promoted the safety of the athletes and staff through different sets of tests and rules, with various outcomes (3)(4)(5)(6)(7)(8)(9)(10). This study shows that it is possible to prevent spreading of SARS-CoV-2, a virus that can be transmitted both via respiratory droplets and aerosols, in a series of large international sports events during the most intensive period of a pandemic.…”

“…Typically, this was done in a stepwise fashion, with timeframes and restrictions varying markedly across nations and sports systems (2). The resumption of competition and training activity has been described in professional level team sports such as soccer, football, hockey, basketball and baseball but to a smaller extent in professional level individual sports (2)(3)(4)(5)(6)(7)(8)(9). In professional golf, several risk reduction and mitigation measures on players and staff have been succesfully implemented enabling return to competition (10).…”

Tactical Considerations for Designing Real-World Studies: Fit-for-Purpose Designs That Bridge Research and Practice

“…Consider how large, closed-cohort occupational health programs for professional athletes were used to further understanding about COVID-19 transmission, 38 the effectiveness of COVID-19 diagnostic tests approved under Emergency Use Authorizations, 39 , 40 the impact of post-recovery viral shedding on test results and transmission, 41 and the ability of vaccine boosters to prevent incident infection. 42 This RWE was useful due to its timeliness, relevance, and on-going quality controls conducted as part of this evidence hub, including linked data from wearable devices, daily diagnostic results, contact tracing, and infection/vaccine history.…”

“…45,55 These evidence hubs integrate information from electronic medical records (EMR) with player participation, game statistics, sideline clinician reports, equipment data, and wearable devices, and utilize regular quality reviews to support the reliability of ongoing research findings. 56,57 During the COVID-19 pandemic, these hubs were recrafted to provide a clinical foundation and longitudinal diagnostic data from frequent COVID-19 surveillance testing within a closed cohort, [38][39][40] serological testing for SARS-CoV-2 antibodies, 41 and genomic sequencing performed for all infections to determine the SARS-CoV-2 variant and vaccination history. 42 These RWD formed the basis for timely reliable evidence, including demonstrating that recovered individuals who continued to test positive for SARS-CoV-2 following discontinuation of isolation were not infectious to others, 41 understanding the viral trajectory of illness, 58,59 and demonstrating that booster vaccinations were associated with a significant reduction in incident infections during the Omicron wave.…”

White paper on pandemic preparedness in the blood supply

“…New polymerase chain reaction tests for COVID‐19 were developed [23]. On the outset of the pandemic the possibility the virus could be transfusion‐transmitted was unknown, therefore, a test was prepared in anticipation of a need.…”