Daily use of lateral flow devices by contacts of confirmed COVID-19 cases to enable exemption from isolation compared with standard self-isolation to reduce onward transmission of SARS-CoV-2 in England: a randomised, controlled, non-inferiority trial

Love, Nicola; Ready, Derren; Turner, Charlie; Verlander, Neville Q.; French, Clare E; Martin, Alex F; Sorensen, Tina B; Metelmann, Soeren; Denford, Sarah; Rubin, G James; Yardley, Lucy; Amlôt, Richard; Hopkins, Susan; Oliver, Isabel

doi:10.1016/s2213-2600(22)00267-3

Cited by 12 publications

(32 citation statements)

References 19 publications

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“…A randomised, controlled, non-inferiority trial reported that daily lateral flow device testing with 24h exemption from self-isolation appeared to be non-inferior to standard self-isolation (10 days) in reducing onward transmission of SARS-CoV-2 for contacts of confirmed COVID-19 cases. 49 Another cluster-randomised, controlled trial reported that daily contact testing of school-based contacts was non-inferior to self-isolation of 10 days for control of COVID-19 transmission. 50 These findings are consistent with our results on the comparison of removal of isolation based on negative antigen testing and ten-day isolation in confirmed COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different isolation periods for preventing the spread of COVID-19: a rapid systematic review and a modelling study

Gao

Zhao

Zhang

et al. 2023

Preprint

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Background: The optimal isolation duration for COVID-19 patients remains unclear. To support an update of WHO Living Clinical management guidelines for COVID-19 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2022.2), this rapid systematic review and modelling study addresses the effects of different isolation periods for preventing onward transmission leading to hospitalization and death among secondary cases. Methods: We searched World Health Organization (WHO) COVID-19 database for clinical studies evaluating the impact of isolation periods for COVID-19 patients up to July 28, 2022. We performed random-effects meta-analyses to summarize testing rates of persistent test positivity rates after COVID-19 infection. We developed a model to compare the effects of the five-day isolation and removal of isolation based on a negative antigen test with ten-day isolation on onward transmission leading to hospitalization and death. We assumed that patients with a positive test are infectious and those with a negative test are not. If the test becomes negative, patients will stay negative. The model included estimates of test positivity rates, effective reproduction number, and hospitalization rate or case fatality rate. Findings: Twelve studies addressing persistent test positivity rates including 2799 patients proved eligible. Asymptomatic patients (27.1%, 95% CI: 15.8% to 40.0%) had a significantly lower rapid antigen test (RAT) positive rate than symptomatic patients (68.1%, 95% CI: 40.6% to 90.3%) on day 5. The RAT positive rate was 21.5% (95% CI: 0 to 64.1%; moderate certainty) on day 10. Our modelling study suggested that the risk difference (RD) for asymptomatic patients between five-day isolation and ten-day isolation in hospitalization (2 more hospitalizations of secondary cases per 1000 patients isolated, 95% uncertainty interval (UI) 2 more to 3 more) and mortality (1 more per 1000 patients, 95% UI 0 to 1 more) of secondary cases proved very small (very low certainty). For symptomatic patients, the potential impact of five- versus ten-day isolation was much greater in hospitalizations (RD 19 more per 1000 patients, 95% UI 14 more to 24 more; very low certainty) and mortality (RD 5 more per 1000 patients, 95% UI 4 more to 6 more; very low certainty). There may be no difference between removing isolation based on a negative antigen test and ten-day isolation in the onward transmission leading to hospitalization or death, but the average isolation period (mean difference -3 days) will be shorter for the removal of isolation based on a negative antigen test (moderate certainty). Interpretation: Five versus 10 days of isolation in asymptomatic patients may result in a small amount of onward transmission and negligible hospitalization and mortality, but in symptomatic patients concerning transmission and resulting hospitalization and mortality. The evidence is, however, very uncertain.

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Section: Discussionmentioning

confidence: 99%

Comparison of different isolation periods for preventing the spread of COVID-19: a rapid systematic review and a modelling study

Gao

Zhao

Zhang

et al. 2023

Preprint

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“…This was compared to a minimum of 13 days isolation at the start of the pandemic [ 24 ]. One trial found that daily contact testing was noninferior to self-isolating, indicating that the use of RATs could reduce secondary infections while also reducing the adverse effects of self-isolation [ 25 ▪▪ ]. Tests by polymerase chain reaction could report positive results for up to 33 days [ 26 ] and as such RATs became indicative of actively contagious individuals.…”

Section: Rapid Antigen Testingmentioning

confidence: 99%

Nonpharmaceutical interventions for managing SARS-CoV-2

Murphy

Wong

Cowling

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewInitial response strategies to the COVID-19 pandemic were heavily reliant on nonpharmaceutical interventions (NPIs), a set of measures implemented to slow or even stop the spread of infection. Here, we reviewed key measures used during the COVID-19 pandemic.Recent findingsSome NPIs were successful in reducing the transmission of SARS-CoV-2. Personal protective measures such as face masks were widely used, and likely had some effect on transmission. The development and production of rapid antigen tests allowed self-diagnosis in the community, informing isolation and quarantine measures. Community-wide measures such as school closures, workplace closures and complete stay-at-home orders were able to reduce contacts and prevent transmission. They were widely used in the pandemic and contributed to reduce transmission in the community; however, there were also negative unintended consequences in the society and economy.SummaryNPIs slowed the spread of SARS-CoV-2 and are essential for pandemic preparedness and response. Understanding which measures are more effective at reducing transmission with lower costs is imperative.

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“…Love and colleagues 5 reported that 80% of those in the daily testing group submitted at least one LFD result, but did not report compliance with daily testing for 7 days. Behavioural change might have mitigated any effect of poor compliance with testing, with 5946 (57%) of 10 443 of participants in the daily testing group who remained negative reporting reduced non-household contacts despite this not being a requirement.…”

mentioning

confidence: 99%

“…Lateral flow devices (LFDs) have been deployed to attempt to limit self-isolation to those who are infectious, but the guidelines for their use have been driven largely by mathematical modelling, 3 based on limited real-world data and a number of key assumptions. In two UK studies published in The Lancet Respiratory Medicine , Seran Hakki and colleagues 4 sought to characterise the window of SARS-CoV-2 infectiousness and correlate LFD results with infectiousness, whereas Nicola K Love and colleagues 5 assessed the use of daily LFD testing in COVID-19 contacts to circumvent the need for universal self-isolation.…”

mentioning

confidence: 99%

“…Love and colleagues 5 conducted a randomised controlled trial of 54 923 adult COVID-19 contacts identified from the NHS Test and Trace programme. They concluded that daily LFD testing for 7 days, with a 24-h exemption from self-isolation if the LFD result was negative, was a safe alternative to 10 days of self-isolation in preventing community SARS-CoV-2 transmission.…”

mentioning

confidence: 99%

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