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Prevalence of Positive Rapid Antigen Tests After 7-Day Isolation Following SARS-CoV-2 Infection in College Athletes During Omicron Variant Predominance

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

Question  Is the 5-day isolation period after SARS-CoV-2 infection that has been recommended by the US Centers for Disease Control and Prevention sufficient for infected individuals to receive negative test results?

Findings  In this case series, 268 collegiate student athletes who tested positive for SARS-CoV-2 underwent rapid antigen testing starting 7 days after the initial positive test. At 7 days, the results of testing were still positive in 27% of the individuals tested, with a higher percent positive in symptomatic individuals and those infected with the Omicron BA.2 variant.

Meaning  The findings of this study suggest that use of rapid antigen testing to aid in the decision to end isolation may be needed to prevent individuals with infection from leaving isolation prematurely.

Abstract

Importance  The US Centers for Disease Control and Prevention shortened the recommended isolation period for SARS-CoV-2 infection from 10 days to 5 days in December 2021. It is unknown whether an individual with the infection may still have a positive result to a rapid antigen test and potentially be contagious at the end of this shortened isolation period.

Objective  To estimate the proportion of individuals with SARS-CoV-2 infection whose rapid antigen test is still positive starting 7 days postdiagnosis.

Design, Setting, and Participants  This case series analyzed student athletes at a National Collegiate Athletic Association Division I university campus who tested positive for SARS-CoV-2 between January 3 and May 6, 2022. Individuals underwent rapid antigen testing starting 7 days postdiagnosis to determine whether they could end their isolation period.

Exposures  Rapid antigen testing 7 days after testing positive for SARS-CoV-2.

Main Outcomes and Measures  Rapid antigen test results, symptom status, and SARS-CoV-2 variant identification via campus wastewater analysis.

Results  A total of 264 student athletes (140 [53%] female; mean [SD] age, 20.1 [1.2] years; range, 18-25 years) representing 268 infections (177 [66%] symptomatic, 91 [34%] asymptomatic) were included in the study. Of the 248 infections in individuals who did a day 7 test, 67 (27%; 95% CI, 21%-33%) tests were still positive. Patients with symptomatic infections were significantly more likely to test positive on day 7 vs those who were asymptomatic (35%; 95% CI, 28%-43% vs 11%; 95% CI, 5%-18%; P < .001). Patients with the BA.2 variant were also significantly more likely to test positive on day 7 compared with those with the BA.1 variant (40%; 95% CI, 29%-51% vs 21%; 95% CI, 15%-27%; P = .007).

Conclusions and Relevance  In this case series, rapid antigen tests remained positive in 27% of the individuals after 7 days of isolation, suggesting that the Centers for Disease Control and Prevention–recommended 5-day isolation period may be insufficient in preventing ongoing spread of disease. Further studies are needed to determine whether these findings are present in a more heterogeneous population and in subsequent variants.

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Article Information

Accepted for Publication: August 30, 2022.

Published: October 18, 2022. doi:10.1001/jamanetworkopen.2022.37149

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

Corresponding Author: Calvin E. Hwang, MD, Stanford University School of Medicine, 341 Galvez St, Lower Level, Stanford, CA 94305 (highlndr@stanford.edu).

Author Contributions: Dr Hwang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Tsao, Kussman, Abrams, Hwang.

Acquisition, analysis, or interpretation of data: Tsao, Kussman, Segovia, Boehm, Hwang.

Drafting of the manuscript: Tsao, Boehm, Hwang.

Critical revision of the manuscript for important intellectual content: Kussman, Segovia, Abrams, Hwang.

Statistical analysis: Tsao, Segovia, Hwang.

Obtained funding: Boehm.

Administrative, technical, or material support: Kussman.

Supervision: Kussman.

Conflict of Interest Disclosures: Dr Kussman reported receiving speaking fees from Fresno Madera Medical Society outside the submitted work. Dr Abrams reported owning stock or stock options from AxGen and Cytonics; serving as an unpaid board or committee member for the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; receiving cadaver instruction and equipment for educational purposes from Arthrex and Stryker; receiving consulting fees from Bioventus Inc, Cytonics, Fidia Pharma, and RubiconMD; and serving as an unpaid consultant for TeachAids. No other disclosures were reported.

Funding/Support: The study was funded by the Stanford University Provost’s office.

Role of the Funder/Sponsor: The Stanford University Provost’s office had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the Stanford University Provost’s office for funding for the wastewater data collection.

References
1.
Centers for Disease Control and Prevention. Ending isolation and precautions for people with COVID-19: interim guidance. March 31, 2022. Accessed June 20, 2022. https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html
2.
Clemente-Suárez  VJ , Navarro-Jiménez  E , Moreno-Luna  L ,  et al.  The impact of the COVID-19 pandemic on social, health, and economy.   Sustain Sci Pract Policy. 2021;13(11):6314. doi:10.3390/su13116314 Google ScholarCrossref
3.
Patel  J , Fernandes  G , Sridhar  D .  How can we improve self-isolation and quarantine for covid-19?   BMJ. 2021;372(625):n625. doi:10.1136/bmj.n625 PubMedGoogle ScholarCrossref
4.
Meyerowitz  EA , Richterman  A , Gandhi  RT , Sax  PE .  Transmission of SARS-CoV-2: a review of viral, host, and environmental factors.   Ann Intern Med. 2021;174(1):69-79. doi:10.7326/M20-5008 PubMedGoogle ScholarCrossref
5.
Peeling  RW , Heymann  DL , Teo  YY , Garcia  PJ .  Diagnostics for COVID-19: moving from pandemic response to control.   Lancet. 2022;399(10326):757-768. doi:10.1016/S0140-6736(21)02346-1 PubMedGoogle ScholarCrossref
6.
Schrom  J , Marquez  C , Pilarowski  G ,  et al.  Comparison of SARS-CoV-2 reverse transcriptase polymerase chain reaction and BinaxNOW rapid antigen tests at a community site during an omicron surge: a cross-sectional study.   Ann Intern Med. 2022;175(5):682-690. doi:10.7326/M22-0202 PubMedGoogle ScholarCrossref
7.
Rao  SN , Manissero  D , Steele  VR , Pareja  J .  A systematic review of the clinical utility of cycle threshold values in the context of COVID-19.   Infect Dis Ther. 2020;9(3):573-586. doi:10.1007/s40121-020-00324-3 PubMedGoogle ScholarCrossref
8.
Bruce  EA , Mills  MG , Sampoleo  R ,  et al.  Predicting infectivity: comparing four PCR-based assays to detect culturable SARS-CoV-2 in clinical samples.   EMBO Mol Med. 2022;14(2):e15290. doi:10.15252/emmm.202115290 PubMedGoogle ScholarCrossref
9.
Tsao  J , Kussman  AL , Costales  C , Pinsky  BA , Abrams  GD , Hwang  CE .  Accuracy of rapid antigen vs reverse transcriptase-polymerase chain reaction testing for SARS-CoV-2 infection in college athletes during prevalence of the omicron variant.   JAMA Netw Open. 2022;5(6):e2217234. doi:10.1001/jamanetworkopen.2022.17234 PubMedGoogle ScholarCrossref
10.
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 published online February 2, 2022. doi:10.1101/2022.02.01.22269931Google Scholar
11.
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
12.
Boehm  AB , Hughes  B , Wolfe  MK , White  BJ , Duong  D , Chan-Herur  V .  Regional replacement of SARS-CoV-2 variant Omicron BA.1 with BA.2 as observed through wastewater surveillance.   Environ Sci Technol Lett. 2022;9(6):575-580. doi:10.1021/acs.estlett.2c00266 PubMedGoogle ScholarCrossref
13.
Wolfe  MK , Topol  A , Knudson  A ,  et al.  High-frequency, high-throughput quantification of SARS-CoV-2 RNA in wastewater settled solids at eight publicly owned treatment works in Northern California shows strong association with COVID-19 incidence.   mSystems. 2021;6(5):e0082921. doi:10.1128/mSystems.00829-21 PubMedGoogle ScholarCrossref
14.
Wolfe  M , Hughes  B , Duong  D ,  et al.  Detection of SARS-CoV-2 variants Mu, Beta, Gamma, Lambda, Delta, Alpha, and Omicron in wastewater settled solids using mutation-specific assays is associated with regional detection of variants in clinical samples.   Appl Environ Microbiol. 2022;88(8):e0004522. doi:10.1128/aem.00045-22 PubMedGoogle ScholarCrossref
15.
Bouton  TC , Atarere  J , Turcinovic  J ,  et al.  Viral dynamics of Omicron and Delta SARS-CoV-2 variants with implications for timing of release from isolation: a longitudinal cohort study.   medRxiv. Preprint published online April 5, 2022. doi:10.1101/2022.04.04.22273429 Google Scholar
16.
Earnest  R , Chen  C , Chaguza  C , Grubaugh  ND , Wilson  MS .  Daily rapid antigen testing in a university setting to inform COVID-19 isolation duration policy.   medRxiv. Preprint published online March 13, 2022. doi:10.1101/2022.03.11.22272264 Google Scholar
17.
Cosimi  LA , Kelly  C , Esposito  S ,  et al.  Evaluation of the role of home rapid antigen testing to determine isolation period after infection with SARS-CoV-2.   bioRxiv. Published online March 6, 2022. doi:10.1101/2022.03.03.22271766 Google Scholar
18.
Yu  AT , Hughes  B , Wolfe  MK ,  et al.  Estimating relative abundance of 2 SARS-CoV-2 variants through wastewater surveillance at 2 large metropolitan sites, United States.   Emerg Infect Dis. 2022;28(5):940-947. doi:10.3201/eid2805.212488 PubMedGoogle ScholarCrossref
19.
Kirby  AE , Welsh  RM , Marsh  ZA ,  et al; New York City Department of Environmental Protection.  Notes from the field: early evidence of the SARS-CoV-2 B.1.1.529 (Omicron) variant in community wastewater—United States, November-December 2021.   MMWR Morb Mortal Wkly Rep. 2022;71(3):103-105. doi:10.15585/mmwr.mm7103a5 PubMedGoogle ScholarCrossref
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