Implementing SARS-CoV-2 Rapid Antigen Testing in the Emergency Ward of a Swiss University Hospital: The INCREASE Study

Caruana, Giorgia; Croxatto, Antony; Kampouri, Eleftheria; Kritikos, Antonios; Opota, Onya; Foerster, Maryline; Brouillet, René; Senn, Laurence; Lienhard, Reto; Egli, Adrian; Pantaleo, Giuseppe; Carron, Pierre-Nicolas; Greub, Gilbert

Following the Swiss Federal Office of Public Health (FOPH) authorization of the rapid antigen test (RAT), we implemented the use of the RAT in the emergency ward of our university hospital for patients’ cohorting. RAT triaging in association with RT-PCR allowed us to promptly isolate positive patients and save resources. Among 532 patients, overall sensitivities were 48.3% for Exdia and 41.2% for Standard Q(®), Panbio(TM) and BD Veritor™. All RATs exhibited specificity above 99%. Sensitivity increased to 74.6%, 66.2%, 66.2% and 64.8% for Exdia, Standard Q(®), Panbio(TM) and BD Veritor™, respectively, for viral loads above 10(5) copies/mL, to 100%, 97.8%, 96.6% and 95.6% for viral loads above 10(6) copies/mL and 100% for viral loads above 10(7) copies/mL. Sensitivity was significantly higher for patients with symptoms onset within four days (74.3%, 69.2%, 69.2% and 64%, respectively) versus patients with the evolution of symptoms longer than four days (36.8%, 21.1%, 21.1% and 23.7%, respectively). Among COVID-19 asymptomatic patients, sensitivity was 33%. All Immunoglobulin-A-positive patients resulted negative for RAT. The RAT might represent a useful resource in selected clinical settings as a complementary tool in RT-PCR for rapid patient triaging, but the lower sensitivity, especially in late presenters and COVID-19 asymptomatic subjects, must be taken into account.