Abstract
BackgroundRapid antigen tests hold much promise for use in the school environment. However, the performance of these tests in non-clinical settings and among one of the main target populations in schools—asymptomatic children—is unclear. To address this gap, we examined the positive and negative concordance between the BinaxNOW™ rapid SARS-CoV-2 antigen assay and an RT-PCR test among children at a community-based Covid-19 testing site.MethodsWe conducted rapid antigen (BinaxNOW™) and oral fluid RT-PCR (Curative Labs) tests on children presenting at a walk-up testing site in Los Angeles County from November 25, 2020 to December 9, 2020. Positive concordance was determined as the fraction of RT-PCR positive participants that were also antigen positive. Negative concordance was determined as the fraction of RT-PCR negative participants that were also antigen negative. Multivariate logistic regression models were used to examine the association between positive or negative concordance and participant age, race-ethnicity, sex at birth, symptoms and Ct values.Results226 children tested positive on RT-PCR; 127 children or 56.2% (95% CI: 49.5% to 62.8%) of these also tested positive on the rapid antigen test. Positive concordance was higher among symptomatic children (64.4%; 95% CI: 53.4% to 74.4%) compared to asymptomatic children (51.1%; 95% CI: 42.5% to 59.7%). Positive concordance was negatively associated with Ct values and was 93.8% (95% CI: 69.8% to 99.8%) for children with Ct values less than or equal to 25. 548 children tested negative on RT-PCR; 539 or 98.4% (95% CI: 96.9% to 99.2%) of these also tested negative on the rapid antigen test. Negative concordance was higher among asymptomatic children.ConclusionsRapid antigen testing can successfully identify most COVID infections in children with viral load levels likely to be infectious. Serial rapid testing may help compensate for limited sensitivity in early infection.
Highlights
The COVID-19 pandemic has profoundly changed the way we live
226 children tested positive on reverse transcriptase-polymerase chain reaction (RT-PCR); 127 children or 56.2% of these tested positive on the rapid antigen test
Positive concordance was higher among symptomatic children (64.4%; 95% CI: 53.4% to 74.4%) compared to asymptomatic children (51.1%; 95% CI: 42.5% to 59.7%)
Summary
The COVID-19 pandemic has profoundly changed the way we live. It has led to shutdowns of many sectors across the country, including in-person learning in schools. Rapid testing allows for quick identification of potentially infectious individuals so that they can be isolated and removed from the school environment. Rapid antigen tests hold much promise for use in the school environment They have been approved only for use among symptomatic individuals, primarily adults, in clinical settings. The performance of these tests in non-clinical settings and among one of the main target populations in schools—asymptomatic children—is unclear. To address this gap, we examined the positive and negative concordance between the BinaxNOWTM rapid SARS-CoV-2 antigen assay and an RT-PCR test among children at a community-based Covid-19 testing site
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