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Duration of Symptoms and Association With Positive Home Rapid Antigen Test Results After Infection With SARS-CoV-2

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Current US Centers for Disease Control and Prevention COVID-19 guidance for nonimmunocompromised individuals allows ending isolation after 5 days if the individual is asymptomatic or afebrile with improving symptoms.1 Culturable virus, currently the best proxy for transmissibility, is reported after day 5.2 It has been proposed that rapid antigen tests (RATs) might assist in determining isolation periods. However, while RATs correlate with culture positivity during early infection,3,4 there are minimal data after day 5, when persistent RAT positivity has been reported.5,6 We sought to compare rates of RAT positivity, COVID-19 symptoms, and positive viral culture starting day 6 after a COVID-19 diagnosis.

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Article Information

Accepted for Publication: June 19, 2022.

Published: August 3, 2022. doi:10.1001/jamanetworkopen.2022.25331

Correction: This article was corrected on September 23, 2022, to fix an error in the Figure.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Cosimi LA et al. JAMA Network Open.

Corresponding Authors: Lisa A. Cosimi, MD, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (lcosimi@bwh.harvard.edu); Deborah T. Hung, MD, PhD, Broad Institute, 415 Main St, Cambridge, MA 02142 (dhung@broadinstitute.org).

Author Contributions: Drs Cosimi and Hung had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Cosimi, Seitz, Connor, Hung.

Acquisition, analysis, or interpretation of data: Cosimi, Kelly, Esposito, Seitz, Turcinovic.

Drafting of the manuscript: Cosimi, Esposito, Connor.

Critical revision of the manuscript for important intellectual content: Cosimi, Kelly, Seitz, Turcinovic, Connor, Hung.

Statistical analysis: Cosimi.

Obtained funding: Hung.

Administrative, technical, or material support: Kelly, Esposito.

Supervision: Cosimi, Connor, Hung.

Conflict of Interest Disclosures: Dr Connor reported receiving personal fees from Cell Signaling Technologies, outside the submitted work. Dr Hung reported being a founder of, consultant to, equity holder in, and inventor of technology licensed to Sherlock Biosciences and serving on the scientific advisory board for Proof Diagnostics, outside the submitted work. No other disclosures were reported.

Funding/Support: Costs of this study were covered by operating funds of the Broad Institute of MIT and Harvard. Support for viral culture efforts was also provided by the Massachusetts Consortium on Pathogen Readiness (Dr Connor) and the China Evergrande Group to support viral culture efforts.

Role of the Funder/Sponsor: The Broad Institute’s Environmental Health and Safety Office informed individuals testing positive for COVID-19 of the opportunity to volunteer and consent for the study. The institute’s Procurement and Shipping Office mailed RATs to enrolled individuals.

Additional Contributions: We thank Jesse Souweine, MBA, Kelley Friedman, BS, Michael Nashed, BS, Stacy Gabriel, PhD, and Nicholas Fitzgerald, BS, from the Broad Insitute, Cambridge, Massachusetts, for logistical and organizational support. We thank Cole Sher-Jan, BS, at Boston University, Boston, Massachusetts, for help with rtPCR assays and sample logistics. None received compensation for this work outside of the their usual salaries.

References
1.
Centers for Disease Control and Prevention. Quarantine and isolation. Centers for Disease Control and Prevention. Updated March 30, 2022. Accessed February 22, 2022. https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html
2.
Boucau  J , Marino  C , Regan  J ,  et al.  Duration of viable virus shedding in SARS-CoV-2 Omicron variant infection.   medRxiv. Preprint posted online March 2, 2022. doi:10.1101/2022.03.01.22271582 Google Scholar
3.
Pekosz  A , Parvu  V , Li  M ,  et al.  Antigen-based testing but not real-time polymerase chain reaction correlates with severe acute respiratory syndrome coronavirus 2 viral culture.   Clin Infect Dis. 2021;73(9):e2861-e2866. doi:10.1093/cid/ciaa1706 PubMedGoogle ScholarCrossref
4.
Korenkov  M , Poopalasingam  N , Madler  M ,  et al. Evaluation of a rapid antigen test to detect SARS-CoV-2 infection and identify potentially infectious individuals. J Clin Microbiol. 2021;59(9):e0089621. doi:10.1128/JCM.00896-21Crossref
5.
Landon  E , Bartlett  AH , Marrs  R , Guenette  C , Weber  SG , Mina  MJ . High rates of rapid antigen test positivity after 5 days of isolation for COVID-19. medRxiv. Preprint posted online February 2, 2022. doi:10.1101/2022.02.01.22269931
6.
Lefferts  B , Blake  I , Bruden  D ,  et al.  Antigen test positivity after COVID-19 isolation—Yukon-Kuskokwim Delta Region, Alaska, January-February 2022.   MMWR Morb Mortal Wkly Rep. 2022;71(8):293-298. doi:10.15585/mmwr.mm7108a3 PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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