Validating and modeling the impact of high-frequency rapid antigen screening on COVID-19 spread and outcomes (preprint)

High frequency screening of populations has been proposed as a strategy in facilitating control of the COVID-19 pandemic. We use computational modeling, coupled with clinical data from rapid antigen tests, to predict the impact of frequent viral antigen rapid testing on COVID-19 spread and outcomes. Using patient nasal or nasopharyngeal swab specimens, we demonstrate that the sensitivity/specificity of two rapid antigen tests compared to quantitative real-time polymerase chain reaction (qRT-PCR) are 80.0%/91.1% and 84.7%/85.7%, respectively; moreover, sensitivity correlates directly with viral load. Based on COVID-19 data from three regions in the United States and São José do Rio Preto, Brazil, we show that high frequency, strategic population-wide rapid testing, even at varied accuracy levels, diminishes COVID-19 infections, hospitalizations, and deaths at a fraction of the cost of nucleic acid detection via qRT-PCR. We propose large-scale antigen-based surveillance as a viable strategy to control SARS-CoV-2 spread and to enable societal re-opening.

The impact of high frequency rapid viral antigen screening on COVID-19 spread and outcomes: a validation and modeling study (preprint)

High frequency screening of populations has been proposed as a strategy in facilitating control of the COVID-19 pandemic. Here we develop a model to evaluate the impact of rapid testing on COVID-19 spread and outcomes, inspired by our clinically validated direct antigen rapid test (DART) for detection of SARS-CoV-2 spike glycoprotein. Using patient nasopharyngeal swab specimens we demonstrate that the DART sensitivity and specificity are 84.7% and 85.7%, respectively; moreover, sensitivity increases proportionally with higher viral loads. Based on surveillance data on COVID-19 from the United States and Sao Jose do Rio Preto, Brazil we show that frequent and strategic population-wide rapid testing, even at varied accuracy levels, is more effective than virus detection via polymerase chain reaction at reducing COVID-19 infections, hospitalizations, and deaths. While current policy emphasizes testing accuracy, we propose large-scale antigen-based surveillance as a vital strategy to control SARS-CoV-2 spread and to enable societal re-opening.