Prevalence of COVID-19 and Long COVID in Collegiate Student Athletes from Spring 2020 to Fall 2021: A Retrospective Survey (preprint)

Symptomatic COVID-19 and post-COVID conditions, also referred to as post-acute sequelae of SARS-CoV-2 (PASC) or Long COVID, have been widely reported in young, healthy people, but their prevalence has not yet been determined in student athletes. We surveyed a convenience sample of 18 collegiate school administrators, representing about 7,000 student athletes. According to their survey responses, 9.8% of student athletes tested positive for COVID-19 in spring 2020 and 25.4% tested positive in the academic year of fall 2020 to spring 2021. About 4% of student athletes who tested positive from spring 2020 to spring 2021 developed Long COVID, defined as new, recurring, or ongoing physical or mental health consequences occurring 4 or more weeks after SARS-CoV-2 infection. This study highlights that Long COVID occurs in healthy collegiate athletes and merits a larger study to determine population-wide prevalence.

COVID Testing in the Workplace: Return to Work Testing in an Occupational Cohort (preprint)

Background. The Omicron SARS-CoV-2 variant resulted in significant community-based transmission. Numerous occupational settings have employed surveillance testing strategies to minimize occupational exposure and return workers safely to work following isolation. Methods. From an occupational COVID-19 testing program, we obtained longitudinal (February 2021-January 2022) saliva-based RT-qPCR results and starting December 27th, 2021, daily on-site molecular over-the-counter (OTC) nasal swab-based isothermal nucleic acid amplification test (molecular OTC; Cue Health COVID-19 test) results. We quantified the fraction of tests with PCR cycle threshold (Ct) values <30 on each day post detection from suspected and confirmed Omicron infections (n=37), compared results to molecular OTC testing, and measured workplace and household transmission. We evaluated return-to-work timing using a post-isolation, two-test threshold of Ct >30, or two negative molecular OTC tests over a 24 hour period, or a single PCR test >30 plus negative molecular OTC test. Results. From the paired testing cohort, 37 (48%) individuals tested positive; all 37 were vaccinated. All individuals tested positive [≤]1 day after a previous negative test, and 19 (51.3%) remained PCR-positive with Ct values <30 at day 5. While 3 (8.1%) remained PCR-positive with a Ct value <30 on day 10, no individuals remained PCR-positive on day 12. The average time to PCR clearance/return-to-work was 7.94 days (median=9.5 days). Time to clearance for those boosted (n=8; 7.75 days) and those not yet boosted (8.04 days) did not differ (p=0.49). Peak viral load measured by PCR was 1.97 days from the initial positive test. There were no cases of transmission after returning to work. Conclusions. A large percentage of individuals remain contagious at day 5 post first positive test based on serial PCR testing and can continue until day 12. Early discontinuation of isolation can utilize a two test framework separated by 24 hours. Rapid onsite tests may be useful.

Pooling-in-a-pod: A Strategy for COVID-19 Testing to Facilitate Safe Return to School (preprint)

ABSTRACT The COVID-19 pandemic prompted widespread primary and secondary school closures. Routine testing of asymptomatic students and staff, as part of a comprehensive program, can help schools open safely. “Pooling-in-a-pod” is a public health surveillance strategy whereby testing cohorts (pods) are based on social relationships and physical proximity. Pooled testing provides one laboratory result for the entire pod, rather than separate results for each individual. Pooling-in-a-pod allowed for weekly on-site point-of-care testing of all staff and students at an independent preschool to grade 12 school in Washington, D.C. Staff and older students self-collected anterior nares samples, and trained staff collected samples from younger students. Overall, 12,885 samples were tested in 1,737 pools for 863 students and 264 staff between November 30, 2020, and April 30, 2021. The average pool size was 7.4 people. Sample collection to pool result time averaged 40 minutes. Direct testing cost per person per week was $$24.24, including swabs. Four surveillance test pools were positive. During the study period, daily new cases in Washington, D.C., ranged from 10 to 46 per 100,000 population. A post-launch survey found most parents (90.3%), students (93.4%), and staff (98.8%) were willing to participate in pooled testing with confirmatory tests for positive pool members. The school reported a 73.4% decrease in virtual learning after program initiation. Pooling-in-a-pod is a feasible and cost-effective surveillance strategy that was acceptable to staff and families and may be appropriate for some schools. School officials and policymakers can leverage this strategy to facilitate safe, sustainable, in-person schooling.

Reopening Schools Safely in the COVID-19 Pandemic Through the Use of Low-Cost Pooled Surveillance Testing (preprint)

Background: The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine Covid-19 testing that may ultimately reduce the overall viral burden in the community. Methods: We implemented a testing program that included students, faculty and staff from K-12 schools and universities participating in the SalivaClear™ pooled surveillance method (Mirimus Clinical Labs, Brooklyn, NY). Findings: Over 250,000 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities. Pool sizes of up to 24 samples were tested over a 20-week period. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (CT) values between pooled and individual samples) measures. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. In one instance, in-school transmission of the virus was determined within the main office and led to review and revision of heating, ventilating and air-conditioning systems. Interpretation: By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. Pooled testing is a fundamental component to the reopening of schools, minimizing transmission among students and faculty.Funding: Skoll Foundation generously provided funding to Mobilizing Foundation and Mirimus for these studies.Declaration of Interests: None.Ethics Approval Statement: The SUNY Downstate Health Sciences University Institutional Review Board (IRB) reviewed and approved the study protocol (IRB #1232938-3).

Pooled Surveillance Testing Program for Asymptomatic SARS-CoV-2 Infections in K-12 Schools and Universities (preprint)

The negative impact of continued school closures during the height of the COVID-19 pandemic warrants the establishment of new cost-effective strategies for surveillance and screening to safely reopen and monitor for potential in-school transmission. Here, we present a novel approach to increase the availability of repetitive and routine Covid-19 testing that may ultimately reduce the overall viral burden in the community. We describe implementation of a testing program that included students, faculty and staff from K-12 schools and universities participating in the SalivaClear pooled surveillance method (Mirimus Clinical Labs, Brooklyn, NY). Over 400,000 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities and tested in pools of up to 24 samples over a 20-week period during this pandemic. Peaks of positive cases were seen in the days following the Halloween, Thanksgiving and New Year holidays. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (CT) values between pooled and individual samples) measures. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. Pooled testing is a fundamental component to the reopening of schools, minimizing transmission among students and faculty.

Pooled Sample Testing for SARS-CoV-2 (preprint)

We tested an operationally efficient way to pool samples on a rapid, point-of-care PCR device and examined the limit of detection of SARS-CoV-2 for various pool sizes. Pooled testing maintained testing performance similar to individual sample PCR testing, offering the potential for scalable rapid testing at lower cost with less supplies.

A comparison of health care worker-collected foam and polyester nasal swabs in convalescent COVID-19 patients (preprint)

BackgroundThe exponential growth of COVID-19 cases and testing has created supply shortages at various points in the testing workflow. As of April 15, 2020 FDA recommendations only allowed for the use of nasopharyngeal, flocked mid turbinate, or foam nasal swabs, all of which are in very low supply. Polyester swabs are more readily available and mass producible. We compare the performance of polyester and foam swabs stored in different transport media. MethodsBoth polyester and foam nasal swabs were collected from convalescent COVID-19 patients at a single visit. Using the foam nasal swabs as the comparator, sensitivity of the polyester swabs in each media were calculated, three by three tables were constructed to measure concordance, and cycle threshold (Ct) values were compared. Findings126 visits had polyester and foam swabs stored in viral transport media (VTM), 51 had polyester and foam swabs stored in saline, and 63 had a foam swab in VTM and a polyester swab stored in a dry tube. Using nasal foam swabs as a comparator, polyester nasal swabs had a sensitivity of 86{middle dot}5% when both samples were stored in VTM, 86{middle dot}7% when both samples were stored in saline, and 72{middle dot}4% when the polyester swab was stored dry and the foam swab was stored in VTM. Polyester and foam Ct values from the same visit were correlated, but polyester swabs showed decreased performance for cases with a viral load near the detection threshold and higher Ct values on average. InterpretationPolyester nasal swabs showed a reduction in performance from foam nasal swabs, but may still provide a viable sample collection method given the current supply shortages and public health emergency. FundingLaboratory testing was conducted with financial support from Thermo Fisher Scientific.