Evaluation of real-life use of Point-Of-Care Rapid Antigen TEsting for SARS-CoV-2 in schools for outbreak control (EPOCRATES)

We evaluated the use of rapid antigen detection tests (RADT) for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in school settings to determine RADT performance characteristics compared to PCR. Methods: We did a real-world, prospective observational cohort study where recruited high-school students and staff from two high-schools in Montreal (Canada) were followed from January 25th to June 10th, 2021. Twenty-five percent of asymptomatic participants were tested weekly by RADT (nasal) and PCR (gargle). Class contacts of a case were tested. Symptomatic participants were tested by RADT (nasal) and PCR (nasal and gargle). The number of cases/outbreak and number of outbreaks were compared to other high schools in the same area. Results: Overall, 2,099 students and 286 school staff members consented to participate. The overall RADT specificity varied from 99.8 to 100%, with a lower sensitivity, varying from 28.6% in asymptomatic to 83.3% in symptomatic participants. The number of outbreaks was not different in the 2 participating schools compared to other high schools in the same area, but included a greater proportion of asymptomatic cases. Returning students to school after a 7-day quarantine, with a negative PCR on D6-7 after exposure, did not lead to subsequent outbreaks, as shown by serial testing. Of cases for whom the source was known, 37 of 57 (72.5%) were secondary to household transmission, 13 (25%) to intra-school transmission and one to community contacts between students in the same school. Conclusion: RADT did not perform well as a screening tool in asymptomatic individuals. Reinforcing policies for symptom screening when entering schools and testing symptomatic individuals with RADT on the spot may avoid subsequent significant exposures in class.