Rapid antigen testing for COVID-19: Decreasing diagnostic reliability, potential detrimental effects and a lack of evidence to support continued public funding of community-based testing

Abstract

Rapid antigen testing continues to be broadly recommended across the world for the prevention of transmission of SARS-CoV-2. We explore existing recommendations in the United States, evidence of decreasing diagnostic reliability of individual tests and potential benefits and harms of non-targeted testing. Recent research has found multiple commonly-used rapid antigen tests to now have diagnostic sensitivities below 30%, with sensitivities at or near 0% the first 48 hours of infection, using polymerase chain reaction (PCR) test positivity as the gold standard. Reliance on tests with low sensitivity could paradoxically increase transmission risk through false assurance. Furthermore, widespread testing has substantial direct and indirect costs, while its effectiveness for diminishing COVID-19 disease burden or improving overall community health is unclear. Because benefit has not been demonstrated with high-quality evidence, we argue against 1. The continued recommendations for and 2. Public funding of widespread community-based rapid antigen testing.