Evaluation of Real-life Use of Point-of-care Rapid Antigen Testing for SARS-CoV-2 in Schools (EPOCRATES): a cohort study.

Background: SARS-CoV-2 transmission has an impact on education. In this study, we assessed the performance of rapid antigen detection tests (RADTs) versus polymerase chain reaction (PCR) for the diagnosis of SARS-CoV-2 infection in school settings, and RADT use for monitoring exposed contacts.
Methods: In this real-world, prospective observational cohort study, high-school students and staff were recruited from 2 high schools in Montréal, Canada, and followed from Jan. 25 to June 10, 2021. Twenty-five percent of asymptomatic participants were tested weekly by RADT (nasal) and PCR (gargle). Class contacts of cases were tested. Symptomatic participants were tested by RADT (nasal) and PCR (nasal and gargle). The number of cases and outbreaks were compared with those of other high schools in the same area.
Results: Overall, 2099 students and 286 school staff members consented to participate. The overall specificity of RADTs varied from 99.8% to 100%, with a lower sensitivity, varying from 28.6% in asymptomatic to 83.3% in symptomatic participants. Secondary cases were identified in 10 of 35 classes. Returning students to school after a 7-day quarantine, with a negative PCR result on days 6-7 after exposure, did not lead to subsequent outbreaks. Of cases for whom the source was known, 37 of 51 (72.5%) were secondary to household transmission, 13 (25.5%) to intraschool transmission, and 1 to community contacts between students in the same school.
Interpretation: Rapid antigen detection tests did not perform well compared with PCR in asymptomatic individuals. Reinforcing policies for symptom screening when entering schools and testing symptomatic individuals with RADTs on the spot may avoid subsequent substantial exposures in class. Preprint: medRxiv - doi.org/10.1101/2021.10.13.21264960.
Competing Interests: Competing interests: Ana Blanchard reports project grants from Réseau de recherche en Santé Respiratoire du Québec and Cystic Fibrosis Foundation (payments to Centre Hospitalier Universitaire Sainte-Justine). Annie-Claude Labbé reports honoraria for a lecture from Hologic, speakers honoraria from Merck and Pfizer, and provision of reagents for SARS-CoV-2 testing from Seegene, DiaSorin and Roche Diagnostics, as part of another study. Kate Zinszer reports grant funding from the Public Health Agency of Canada, Canadian Institutes of Health Research and Fonds de Recherche du Québec — Santé. Caroline Quach reports a project grant from Ministère de la Santé et des Services sociaux — Québec (payments to Centre Hospitalier Universitaire Sainte-Justine). No other competing interests were declared.
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