Point of care nucleic acid testing for SARS-CoV-2 in hospitalised patients: a clinical validation trial and implementation study.

Collier, Dami A.; Assennato, Sonny M.; Warne, Ben; Sithole, Nyarie; Sharrocks, Katherine; Ritchie, Allyson; Ravji, Pooja; Routledge, Matthew; Sparkes, Dominic; Skittrall, Jordan; Smielewska, Anna; Ramsey, Isobel; Goel, Neha; Curran, Martin; Enoch, David; Tassell, Rhys; Lineham, Michelle; Vaghela, Devan; Leong, Clare; Mok, Hoi Ping; Bradley, John; Smith, Kenneth GC.; Mendoza, Vivienne; Demiris, Nikos; Besser, Martin; Dougan, Gordon; Lehner, Paul J.; Siedner, Mark J.; Zhang, Hongyi; Waddington, Claire S.; Lee, Helen; Gupta, Ravindra K.

Summary There is urgent need for rapid SARS-CoV-2 testing in hospital to limit nosocomial spread. We report an evaluation of point of care (POC) nucleic acid amplification testing (NAAT) in 149 participants with parallel combined nasal/throat swabbing for POC versus standard lab RT-PCR testing. Median time to result is 2.6 (IQR 2.3 to 4.8) versus 26.4 hours (IQR 21.4 to 31.4, p<0.001) with 32 (21.5%) positive and 117 (78.5%) negative. Cohen's kappa correlation between tests is 0.96 (95%CI 0.91, 1.00). When comparing nearly 1000 tests pre- and post- implementation, median time to definitive bed placement from admission is 23.4 (8.6-41.9) versus 17.1 hours (9.0-28.8), p=0.02. Mean length of stay on COVID-19 ‘holding’ wards is 58.5 versus 29.9 hours (p<0.001). POC testing increases isolation room availability, avoids bed closures, allows discharge to care homes and expedites access to hospital procedures. POC testing could mitigate the impact of COVID-19 on hospital systems.