AUTHOR=Neukam Karin , Lucero Alicia , Gutiérrez-Valencia Alicia , Amaya Lucas , Echegoyen Natalia , Martelli Antonella , Videla Cristina , Di Lello Federico A. , Martínez Alfredo P. 

TITLE=Point-of-care detection of SARS-CoV-2 antigen among symptomatic vs. asymptomatic persons: Testing for COVID-19 vs. infectivity

JOURNAL=Frontiers in Public Health

VOLUME=10

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.995249

DOI=10.3389/fpubh.2022.995249

ISSN=2296-2565

ABSTRACT=<sec><title>Background</title><p>Management of the coronavirus disease 2019 (COVID-19) pandemic caused by a novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requires rapid and simple methods to detect COVID-19 patients and identify potential infectors. This study aimed to evaluate the utility of a point-of-care (PoC) rapid antigen diagnostic test (Ag-RDT) in these settings.</p></sec><sec><title>Patients and methods</title><p>Individuals who consecutively presented for SARS-CoV-2 testing at a tertiary care center in Buenos Aires, Argentina, underwent PoC Ag-RDT testing and real-time RT-PCR (qRT-PCR) on the same day during June 2021.</p></sec><sec><title>Results</title><p>Of 584 included subjects, 108 (18.5%) were symptomatic for COVID-19 while the remaining presented for miscellaneous reasons unrelated to possible or confirmed contact with a SARS-CoV-2-infected individual. A positive Ag-RDT result was obtained in 26 (24.1%) symptomatic and 7 (1.5%) asymptomatic persons (<italic>p</italic> &lt; 0.001), which was concordant with qRT-PCR in 105/108 [97.2%, Cohen's kappa coefficient (κ) = 0.927] symptomatic and 467/476 (98.1% κ = 0.563) asymptomatic participants, with a positive percentage agreement (PPA; 95% confidence interval) of 89.7% (71.5–97.3%) and 42.9% (18.8–70.4%), respectively. None of the 11 false-negative diagnoses showed a C<sub>t</sub>-value ≤20. Considering only failures with a C<sub>t</sub>-value below 31 as hypothetical infectivity threshold of 10<sup>5</sup> SARS-CoV-2 RNA copies/mL, concordance was observed in 98.1% (κ = 0.746) in the asymptomatic population, accounting for a PPA of 66.7% (30.9–91%).</p></sec><sec><title>Conclusions</title><p>PoC Ag-RDT accurately detected active SARS-CoV-2 infection and showed acceptable diagnostic performance in asymptomatic persons potentially spreading infectious virus. Ag-RDT may therefore be useful to slow down or stop transmission by enabling adequate decisions on isolation at a public health level.</p></sec>