Diagnostic accuracy of SARS-CoV-2 rapid antigen test from self-collected anterior nasal swabs in children compared to rapid antigen test and RT-PCR from nasopharyngeal swabs collected by healthcare workers: A multicentric prospective study.

Testing for SARS-CoV-2 is central to COVID-19 management. Rapid antigen test from self-collected anterior nasal swabs (SCANS-RAT) are often used in children but their performance have not been assessed in real-life. We aimed to compare this testing method to the two methods usually used: reverse transcription polymerase chain reaction from nasopharyngeal swabs collected by healthcare workers (HCW-PCR) and rapid antigen test from nasopharyngeal swabs collected by healthcare workers (HCW-RAT), estimating the accuracy and acceptance, in a pediatric real-life study. From September 2021 to January 2022, we performed a manufacturer-independent cross-sectional, prospective, multicenter study involving 74 pediatric ambulatory centers and 5 emergency units throughout France. Children ≥6 months to 15 years old with suggestive symptoms of COVID-19 or children in contact with a COVID-19-positive patient were prospectively enrolled. We included 836 children (median 4 years), 774 (92.6%) were symptomatic. The comparators were HCW-PCR for 267 children, and HCW-RAT for 593 children. The sensitivity of the SCANS-RAT test compared to HCW-RAT was 91.3% (95%CI 82.8; 96.4). Sensitivity was 70.4% (95%CI 59.2; 80.0) compared to all HCW-PCR and 84.6% (95%CI 71.9; 93.1) when considering cycle threshold <33. The specificity was always >97%. Among children aged ≥6 years, 90.9% of SCANS-RAT were self-collected without adult intervention. On appreciation rating (from 1, very pleasant, to 10, very unpleasant), 77.9% of children chose a score ≤3. SCANS-RAT have good sensitivity and specificity and are well accepted by children. A repeated screening strategy using these tests can play a major role in controlling the pandemic.

Diagnostic accuracy of SARS-CoV-2 rapid antigen test from self-collected anterior nasal swabs in children compared to rapid antigen test and RT-PCR from nasopharyngeal swabs collected by healthcare workers: A multicentric prospective study

Testing for SARS-CoV-2 is central to COVID-19 management. Rapid antigen test from self-collected anterior nasal swabs (SCANS-RAT) are often used in children but their performance have not been assessed in real-life. We aimed to compare this testing method to the two methods usually used: reverse transcription polymerase chain reaction from nasopharyngeal swabs collected by healthcare workers (HCW-PCR) and rapid antigen test from nasopharyngeal swabs collected by healthcare workers (HCW-RAT), estimating the accuracy and acceptance, in a pediatric real-life study. From September 2021 to January 2022, we performed a manufacturer-independent cross-sectional, prospective, multicenter study involving 74 pediatric ambulatory centers and 5 emergency units throughout France. Children ≥6 months to 15 years old with suggestive symptoms of COVID-19 or children in contact with a COVID-19–positive patient were prospectively enrolled. We included 836 children (median 4 years), 774 (92.6%) were symptomatic. The comparators were HCW-PCR for 267 children, and HCW-RAT for 593 children. The sensitivity of the SCANS-RAT test compared to HCW-RAT was 91.3% (95%CI 82.8;96.4). Sensitivity was 70.4% (95%CI 59.2;80.0) compared to all HCW-PCR and 84.6% (95%CI 71.9;93.1) when considering cycle threshold <33. The specificity was always >97%. Among children aged ≥6 years, 90.9% of SCANS-RAT were self-collected without adult intervention. On appreciation rating (from 1, very pleasant, to 10, very unpleasant), 77.9% of children chose a score ≤3. SCANS-RAT have good sensitivity and specificity and are well accepted by children. A repeated screening strategy using these tests can play a major role in controlling the pandemic.

Intégrer les ressources sanitaires libérales dans la gestion des crises sanitaires To integrate liberal health resources into the management of health crises

Les difficultés d’intégration des ressources sanitaires extrahospitalières, identifiées lors de la première phase de la pandémie à SARS-CoV-2 au printemps 2020, d’une part, et les attentes exprimées par les médecins libéraux justifiaient de poursuivre l’analyse de la gestion des rebonds épidémiques suivants et de l’évolution des modalités de réponses dans un triple objectif d’identifier les freins et leviers à l’intégration des ressources extrahospitalières, d’évaluer la pertinence des propositions formulées au décours de ce retour d’expérience initial et de soumettre au débat des pistes d’évolution. Si les conditions de l’exercice libéral induisent un fort ancrage local ou territorial, et, en corollaire, paraissent peu compatibles avec un engagement dans une réserve sanitaire nationale, les initiatives locales apparues au cours de cette pandémie témoignent d’opportunités pour organiser un renfort sanitaire territorial, relevant de l’articulation ou de l’intégration de ces professionnels de santé non hospitaliers selon leur discipline, spécialité, et volontariat. Une telle organisation, appelée à pleinement s’intégrer dans les plans et dispositifs de secours, suppose anticipation réglementaire et opérationnelle, couvrant tout à la fois le statut, la rémunération, la formation, l’entretien pratique et théorique de l’ensemble des acteurs concernés d’un même territoire. La place en première ligne des médecins (notamment généralistes) et autres professionnels de santé libéraux dans la détection des signaux faibles et le maintien de l’offre de soins et le renforcement des capacitaires notamment en termes de compétences que ces ressources sanitaires extrahospitalières peuvent apporter, motivent le modèle organisationnel soumis ici au débat, issu des remontées du terrain à l’occasion de cette pandémie qui aura ébranlé notre système de santé dans toutes ses dimensions et interroge aujourd’hui notre capacité collective à en tirer les leçons pour l’avenir.