The impact of high frequency rapid viral antigen screening on COVID-19 spread and outcomes: a validation and modeling study

Nash, B.; Badea, A.; Reddy, A.; Bosch, M.; Salcedo, N.; Gomez, A. R.; Versiani, A.; Dutra, G. C.; Lopes dos Santos, T. M. I.; Milhim, B. H. G. A.; Moraes, M. M.; Campos, G. R. F.; Quieroz, F.; Reis, A. F. N.; Nogueira, M. L.; Naumova, E. N.; Bosch, I.; Herrera, B. B.

High frequency screening of populations has been proposed as a strategy in facilitating control of the COVID-19 pandemic. Here we develop a model to evaluate the impact of rapid testing on COVID-19 spread and outcomes, inspired by our clinically validated direct antigen rapid test (DART) for detection of SARS-CoV-2 spike glycoprotein. Using patient nasopharyngeal swab specimens we demonstrate that the DART sensitivity and specificity are 84.7% and 85.7%, respectively; moreover, sensitivity increases proportionally with higher viral loads. Based on surveillance data on COVID-19 from the United States and Sao Jose do Rio Preto, Brazil we show that frequent and strategic population-wide rapid testing, even at varied accuracy levels, is more effective than virus detection via polymerase chain reaction at reducing COVID-19 infections, hospitalizations, and deaths. While current policy emphasizes testing accuracy, we propose large-scale antigen-based surveillance as a vital strategy to control SARS-CoV-2 spread and to enable societal re-opening.