Use of Rapid Antigen Tests to End Isolation in a University Setting: Observational Study

Liliana Zigo; Alyson Wilkinson; Megan Landry; Amanda D Castel; Amita Vyas; Karen McDonnell; Nitasha Chaudhary Nagaraj; Lynn R Goldman

doi:10.2196/45003

Use of Rapid Antigen Tests to End Isolation in a University Setting: Observational Study

JMIR Form Res. 2023 Apr 27:7:e45003. doi: 10.2196/45003.

Authors

Liliana Zigo^#¹, Alyson Wilkinson^#², Megan Landry^#², Amanda D Castel^#¹, Amita Vyas^#³, Karen McDonnell^#³, Nitasha Chaudhary Nagaraj^#³, Lynn R Goldman^#^{2

4}

Affiliations

¹ Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.
² Office of the Dean, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.
³ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.
⁴ Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.

^# Contributed equally.

PMID: 37040562
PMCID: PMC10176128
DOI: 10.2196/45003

Abstract

Background: COVID-19 isolation recommendations have evolved over the course of the pandemic. Initially, the US Centers for Disease Control and Prevention required 10 days of isolation after a positive test result. In December 2021, this was reduced to a minimum of 5 days with symptom improvement, followed by 5 days of mask wearing. As a result, several institutions of higher education, including the George Washington University, required persons testing positive for COVID-19 to either submit a negative rapid antigen test (RAT) with symptom resolution to leave isolation after 5 days or to maintain a 10-day isolation period in the absence of a negative RAT and the presence of continued symptoms. RATs are tools that can be used both to shorten isolation periods and to ensure that persons testing positive for COVID-19 remain in isolation if infectious.

Objective: The purpose of this analysis is to report on the experience of implementing RAT policies, examine the number of days that isolation was reduced via RAT testing, determine the factors that predicted uploading a RAT, and determine RAT positivity percentages to illustrate the utility of using RATs to end isolation.

Methods: In this study, 880 individuals in COVID-19 isolation at a university in Washington, DC, uploaded 887 RATs between February 21 and April 14, 2022. Daily positivity percentages were calculated, and multiple logistic regression analyses examined the odds of uploading a RAT by campus residential living status (ie, on or off campus), student or employee designation, age, and days in isolation.

Results: A total of 76% (669/880) of individuals in isolation uploaded a RAT during the study period. Overall, 38.6% (342/887) of uploaded RATs were positive. Uploaded RATs were positive 45.6% (118/259) of the time on day 5; 45.4% (55/121) on day 6; 47.1% (99/210) on day 7; and 11.1% (7/63) on day 10 or beyond. Adjusted logistic regression modeling indicated cases living on campus had increased odds of uploading a RAT (odds ratio [OR] 2.54, 95% CI 1.64-3.92), whereas primary student affiliation (OR 0.29, 95% CI 0.12-0.69) and days in isolation (OR 0.45, 95% CI 0.39-0.52) had decreased odds of uploading a RAT. Of the 545 cases with a negative RAT, 477 were cleared prior to day 10 of their isolation due to lack of symptoms and timely submission, resulting in a total of 1547 days of lost productivity saved compared to all being in isolation for 10 days.

Conclusions: RATs are beneficial, as they can support a decision to release individuals from isolation when they have recovered and maintain isolation for people who may still be infectious. Future isolation policies should be guided by similar protocols and research to reduce the spread of COVID-19 and minimize lost productivity and disruption to individuals' lives.

Keywords: COVID-19; age; antigen test; college; isolation; policy; productivity; rapid antigen test; students; symptoms; testing; tool; university; university students; utility.

©Liliana Zigo, Alyson Wilkinson, Megan Landry, Amanda D Castel, Amita Vyas, Karen McDonnell, Nitasha Chaudhary Nagaraj, Lynn R Goldman. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.04.2023.