SARS-CoV-2 rapid antigen tests provide benefits for epidemic control - observations from Austrian schools

Jitka Polechová; Kory D Johnson; Pavel Payne; Alex Crozier; Mathias Beiglböck; Pavel Plevka; Eva Schernhammer

doi:10.1016/j.jclinepi.2022.01.002

SARS-CoV-2 rapid antigen tests provide benefits for epidemic control - observations from Austrian schools

J Clin Epidemiol. 2022 May:145:14-19. doi: 10.1016/j.jclinepi.2022.01.002. Epub 2022 Jan 15.

Authors

Jitka Polechová¹, Kory D Johnson², Pavel Payne³, Alex Crozier⁴, Mathias Beiglböck⁵, Pavel Plevka³, Eva Schernhammer⁶

Affiliations

¹ Faculty of Mathematics, University of Vienna, Austria. Electronic address: jitka@univie.ac.at.
² Institute of Statistics and Mathematical Methods in Economics, TU Wien, Austria. Electronic address: kory.johnson@tuwien.ac.at.
³ Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
⁴ Division of Biosciences, University College London, London, UK.
⁵ Faculty of Mathematics, University of Vienna, Austria.
⁶ Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria.

Abstract

Objective: This paper motivates and justifies the use of antigen tests for epidemic control as distinct from a diagnostic test.

Study design and setting: We discuss the relative advantages of antigen and PCR tests, summarizing evidence from both the literature as well as Austrian schools, which conducted frequent, mass rapid antigen testing during the spring of 2021. While our report on testing predates Delta, we have updated the review with recent data on viral loads in breakthrough infections and more information about testing efficacy, especially in children.

Results: Rapid antigen tests detect proteins at the surface of virus particles, identifying the disease during its infectious phase. In contrast, PCR tests detect viral genomes: they can thus diagnose COVID-19 before the infectious phase but also react to remnants of the virus genome, even weeks after live virus ceases to be detectable in the respiratory tract. Furthermore, the logistics for administering the tests are different. Large-scale rapid antigen testing in Austrian schools showed low false-positive rates along with an approximately 10% lower effective reproduction number in the tested cohort.

Conclusion: Using antigen tests at least 2-3 times per week could become a powerful tool to suppress the COVID-19 pandemic.

Keywords: COVID-19; Large-scale testing; Lateral flow device; Public health; Repeat testing; SARS-CoV-2.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Austria / epidemiology
COVID-19* / diagnosis
COVID-19* / epidemiology
Child
Humans
Pandemics
SARS-CoV-2*
Schools
Sensitivity and Specificity