Zigo Liliana, Wilkinson Alyson, Landry Megan, Castel Amanda D, Vyas Amita, McDonnell Karen, Nagaraj Nitasha Chaudhary, Goldman Lynn R
Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.
Office of the Dean, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States.
JMIR Form Res. 2023 Apr 27;7:e45003. doi: 10.2196/45003.
COVID-19 isolation recommendations have evolved over the course of the pandemic. Initially, the US Centers for Disease Control and Prevention required 10 days of isolation after a positive test result. In December 2021, this was reduced to a minimum of 5 days with symptom improvement, followed by 5 days of mask wearing. As a result, several institutions of higher education, including the George Washington University, required persons testing positive for COVID-19 to either submit a negative rapid antigen test (RAT) with symptom resolution to leave isolation after 5 days or to maintain a 10-day isolation period in the absence of a negative RAT and the presence of continued symptoms. RATs are tools that can be used both to shorten isolation periods and to ensure that persons testing positive for COVID-19 remain in isolation if infectious.
The purpose of this analysis is to report on the experience of implementing RAT policies, examine the number of days that isolation was reduced via RAT testing, determine the factors that predicted uploading a RAT, and determine RAT positivity percentages to illustrate the utility of using RATs to end isolation.
In this study, 880 individuals in COVID-19 isolation at a university in Washington, DC, uploaded 887 RATs between February 21 and April 14, 2022. Daily positivity percentages were calculated, and multiple logistic regression analyses examined the odds of uploading a RAT by campus residential living status (ie, on or off campus), student or employee designation, age, and days in isolation.
A total of 76% (669/880) of individuals in isolation uploaded a RAT during the study period. Overall, 38.6% (342/887) of uploaded RATs were positive. Uploaded RATs were positive 45.6% (118/259) of the time on day 5; 45.4% (55/121) on day 6; 47.1% (99/210) on day 7; and 11.1% (7/63) on day 10 or beyond. Adjusted logistic regression modeling indicated cases living on campus had increased odds of uploading a RAT (odds ratio [OR] 2.54, 95% CI 1.64-3.92), whereas primary student affiliation (OR 0.29, 95% CI 0.12-0.69) and days in isolation (OR 0.45, 95% CI 0.39-0.52) had decreased odds of uploading a RAT. Of the 545 cases with a negative RAT, 477 were cleared prior to day 10 of their isolation due to lack of symptoms and timely submission, resulting in a total of 1547 days of lost productivity saved compared to all being in isolation for 10 days.
RATs are beneficial, as they can support a decision to release individuals from isolation when they have recovered and maintain isolation for people who may still be infectious. Future isolation policies should be guided by similar protocols and research to reduce the spread of COVID-19 and minimize lost productivity and disruption to individuals' lives.
新冠疫情期间，新冠病毒病（COVID-19）的隔离建议不断演变。最初，美国疾病控制与预防中心要求在检测结果呈阳性后隔离10天。2021年12月，这一要求降至症状改善后至少隔离5天，随后再佩戴5天口罩。因此，包括乔治华盛顿大学在内的几所高等院校要求，COVID-19检测呈阳性的人员要么在症状缓解后提交快速抗原检测（RAT）阴性结果以在5天后解除隔离，要么在没有RAT阴性结果且仍有症状的情况下保持10天隔离期。RAT是一种工具，既可以用来缩短隔离期，也可以确保COVID-19检测呈阳性的人员在具有传染性时继续隔离。
本分析旨在报告实施RAT政策的经验，研究通过RAT检测缩短的隔离天数，确定预测上传RAT的因素，并确定RAT阳性率，以说明使用RAT结束隔离的效用。
在本研究中，2022年2月21日至4月14日期间，华盛顿特区一所大学的880名处于COVID-19隔离状态的人员上传了887份RAT检测结果。计算每日阳性率，并通过多因素逻辑回归分析，研究按校园居住状态（即校内或校外）、学生或员工身份、年龄和隔离天数划分的上传RAT的几率。
在研究期间，共有76%（669/880）的隔离人员上传了RAT检测结果。总体而言，上传的RAT检测结果中有38.6%（342/887）呈阳性。第5天上传的RAT检测结果阳性率为45.6%（118/259）；第6天为45.4%（55/121）；第7天为47.1%（99/210）；第10天及以后为11.1%（7/身63）。校正后的逻辑回归模型表明，在校内居住的病例上传RAT检测结果的几率增加（优势比[OR]2.54，95%置信区间1.64 - 3.92），而小学生身份（OR
0.29，95%置信区间0.12 - 0.69）和隔离天数（OR 0.45，95%置信区间0.39 - 0.52）上传RAT检测结果的几率降低。在545例RAT检测结果为阴性的病例中，477例因无症状且及时提交检测结果，在隔离第10天之前解除隔离，与全部隔离10天相比，总共节省了1547天的生产力损失。
RAT是有益的，因为它们可以支持在人员康复时做出解除隔离的决定，并使可能仍具传染性的人员继续隔离。未来的隔离政策应以类似的方案和研究为指导，以减少COVID-19的传播，并尽量减少生产力损失和对个人生活的干扰。
