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Excessive-Throughput, Laboratory-Primarily based Antigen Exams Deal with An Unmet Want In The World COVID-19 Pandemic

The COVID-19 pandemic continues to rage, with greater than 5 million deaths worldwide. The pressing, international nature of the pandemic has led to nice innovation with novel vaccines and diagnostics, together with SARS-CoV-2 antigen and molecular-based exams. The extremely transmissible SARS-CoV-2 omicron and delta variants are spreading all through the world, together with amongst totally vaccinated people. These, and future variants more likely to emerge, are driving the necessity for large-scale SARS-CoV-2 testing, for security at locations of labor and schooling and through journey. Nonetheless, there’s a lack of know-how amongst physicians, microbiologists, public well being officers, and occasion organizers in regards to the existence of low-cost, high-throughput, laboratory-based SARS-CoV-2 antigen exams, and the position that this expertise might play within the protected resumption of regular actions.

SARS-CoV-2 testing is a fast-evolving area. On this Forefront article, we spotlight finest use instances of high-throughput antigen testing and embody examples of the place this can be utilized successfully.

Sorts Of SARS-CoV-2 Exams

A SARS-CoV-2 check checks specimens out of your nostril or your mouth to seek out out in case you are presently contaminated with the virus that causes COVID-19. Viral exams might be carried out in a laboratory, at a testing web site, at dwelling, or anyplace else. Two predominant varieties of viral exams are used: nucleic acid amplification exams and antigen exams.

Nucleic Acid Amplification Exams

Antigen Exams

Antigen testing instantly detects the presence of viral proteins and serves as an alternative choice to molecular approaches. The strategies used for detecting the viral proteins (or antigens) could also be utilized in two methods: within the laboratory, the place many affected person samples might be examined concurrently utilizing an automatic machine (high-throughput antigen testing), and on the point-of-care, the place samples are examined individually usually with out the necessity for extra tools. There are two predominant varieties of antigen exams:

Excessive-throughput antigen testing: Extra just lately, high-throughput laboratory-based SARS-CoV-2 antigen testing has grow to be obtainable; it’s sometimes employed by hospital laboratories and reference amenities. On this position, these exams are higher used for fast testing inside a facility the place the check is employed or for high-volume testing the place turnaround instances of fewer than 24 hours is fascinating. These platforms could supply improved sensitivity and specificity in comparison with their point-of-care counterparts—counting on chemiluminescent immunoassay strategies that may be automated to allow high-throughput capability starting from a number of hundred to 1000’s of samples per day, relying on the instrument. Outcomes are produced in lower than an hour per pattern and might be transmitted electronically to affected person medical data, much like different laboratory-based check outcomes. These devices can check samples as they arrive in fairly than being run in giant batches.

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Excessive-throughput antigen testing as an idea shouldn’t be new and has routinely been used for HIV and hepatitis B virus screening for years. At current, in the US, nevertheless, solely two high-throughput antigen assays have obtained emergency use authorization.

P-of-care antigen testing: Present emergency use licensed point-of-care SARS-CoV-2 antigen exams use a lateral movement assay (LFA) method. LFA exams detect the presence of a selected substance in a pattern with out costly or difficult tools; that is completed by incorporating detection antibodies onto a bit of absorptive paper, which produce a readable line when there’s a optimistic end result. Comparable strategies are used for over-the-counter being pregnant screening, in addition to Group A Streptococcus, human immunodeficiency virus (HIV), and influenza A/B testing. Utilizing this testing format, point-of-care antigen testing is usually employed for dwelling, office, faculty, and bedside testing in medical settings. For COVID-19, point-of-care antigen exams goal SARS-CoV-2 nucleocapsid proteins, and outcomes are decided by visible interpretation or by an instrument. These exams are fast (15–half-hour), usually broadly obtainable (together with over-the-counter), and comparatively cheap.

As faculties, journey, and companies reopened within the latter half of 2021, point-of-care antigen check use considerably elevated, and plenty of international locations together with the US elevated manufacturing. Nonetheless, regardless of these optimistic attributes, point-of-care antigen testing has a number of limitations. First, and most obvious, is the decrease sensitivity and specificity in comparison with molecular strategies; nevertheless, more moderen information counsel antigen outcomes could higher approximate how infectious somebody could also be. To this finish, point-of-care antigen strategies are finest used inside a number of days of symptom onset, in serial testing for asymptomatic screening, and maybe for clearing people from COVID-19 isolation. Like all point-of-care check, there are limits in operationalizing this for giant numbers of individuals being examined on the similar time, as they require a system or individual to course of every check individually.

Function Of Excessive-Throughput SARS-Cov-2 Antigen Testing

Whereas every of the SARS-CoV-2 diagnostic exams fills a necessity within the testing panorama, there are circumstances by which there are clear benefits to broader use of high-throughput antigen testing.


Worldwide journey continues to be monitored intently, with many international locations requiring destructive SARS-CoV-2 check outcomes at level of entry. With concern for the worldwide unfold of rising, extremely infectious variants, SARS-CoV-2 testing necessities for worldwide journey are more likely to proceed. Nonetheless, handy, cheap testing with cheap turnaround instances for worldwide air journey shouldn’t be but hardwired in lots of international locations. Some airways require a destructive check end result inside 72 hours of boarding; nevertheless, a turnaround time of lower than 72 hours shouldn’t be assured by many testing websites utilizing molecular exams and could also be significantly difficult throughout instances of excessive group COVID-19 charges when check demand is excessive. It is usually more and more acknowledged that over-the-counter, at-home, point-of-care antigen exams are usually not appropriate for pre-travel check verification, as usually the individual shouldn’t be noticed taking the pattern and decoding the check; subsequently, there isn’t any approach to make sure the check was taken and interpreted accurately. Some airways, nevertheless, have resorted to permitting serial antigen testing when assortment is supervised by way of video conferencing. Nonetheless, SARS-CoV-2 high-throughput antigen testing overcomes many of those limitations with automated stories; it’s used as a cheap testing technique in airports world wide. One such instance is Japan’s Narita Worldwide airport, the place a number of thousand pre-flight exams are carried out on web site on the airport each day.

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The necessity for preschoolers, school-age and older college students, and educators to securely attend in-person courses has been highlighted through the pandemic. Speedy point-of-care antigen testing has been embraced by many colleges; nevertheless, testing applications have been largely constrained by provide chains and lack of excessive throughput. Excessive-throughput antigen exams have a transparent position to play in permitting for protected academic and caregiving interactions. Throughout spring 2021, Portugal applied a large testing program for daycare facilities, schooling, and instructing institutions, to permit kids and college students to return to face-to-face academic actions. In such preparations, college students and academics in areas with excessive group SARS-CoV-2 positivity charges bear periodic screening, and the varsity or schooling setting receives centralized end result stories from high-throughput SARS-CoV-2 lab-based testing—thereby streamlining the testing course of and making it cheaper.

Different makes use of for high-throughput antigen testing embody places of work and locations of labor, social occasions resembling weddings, and public gatherings resembling concert events—the place having capabilities to check giant numbers of individuals in a brief area of time in a scientific approach can be extremely useful.

Well being Care Employee Return To Work

Current Facilities for Illness Management and Prevention pointers have indicated well being care employees must have a destructive SARS-CoV-2 end result previous to returning to work. Some state public well being departments have additional clarified antigen testing is appropriate. The usage of antigen testing is of nice curiosity, provided that destructive outcomes counsel viral hundreds are usually not more likely to transmit SARS-CoV-2, particularly with correct masking precautions. In distinction, reliance on NAATs prolongs well being care employee isolation, which negatively contributes to the staffing shortages confronted by many hospitals through the omicron surge.  

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Obstacles To Use Of Excessive-Throughput SARS-Cov-2 Antigen Testing In US

Sure insurance policies and procedures have contributed to a lack of know-how about the advantages of high-throughput antigen testing. Firstly, it’s only just lately that the US has targeted on the necessary position of antigen testing—{that a} optimistic check displays when persons are at their most infectious or contagious and when they’re probably the most susceptible to transmitting an infection to others and has a task as a device to scale back unfold in our communities. Provide chains for fast antigen exams stay a crucial drawback, with producers having stock however few employees or couriers to ship out kits. There’s additionally a necessity to advertise high-throughput antigen testing in laboratories and enhance consciousness and understanding of a majority of these exams among the many public, together with these with testing wants resembling occasion organizers. Antigen testing has grow to be synonymous with fast point-of-care platforms; subsequently, companies, faculties, and even medical laboratories ought to concentrate on these high-throughput methods to enhance testing calls for.

Coverage modifications are additionally crucial, together with fast evaluate on the Meals and Drug Administration to permit high-throughput antigen exams to get to market. Though molecular stays the accepted normal for particular person affected person diagnostics, the bias towards molecular exams—coupled with the dearth of recognition of the precise position of antigen exams, which may detect when persons are at their most infectious—actually hindered creating accessible, fast, and high-throughput platforms. Lastly, extra analysis is required to higher characterize the position of viral load with infectivity when decided by molecular or antigen-based strategies. This data then must be communicated successfully, to extend consciousness and understanding of this testing technique.

Future Of The COVID-19 Pandemic And Testing

North America and Europe could also be on the peak of the present omicron surge, and inhabitants case charges will probably lower shortly. Nonetheless, there stays a big want for long-term COVID-19 testing technique infrastructure, to handle a COVID-19 pandemic future and the potential for extra new variants rising. Embracing all diagnostic modalities and deploying them the place they’ve optimum impression is vital as we transition from the pandemic towards endemic testing.

Creator’s Notice

Dr. Rock is an unbiased medical adviser offering recommendation and providers to Siemens Healthineers, associated to SARS-CoV-2 testing. Dr. Tran is a paid guide for Roche Diagnostics and Roche Molecular Methods. He’s additionally a co-owner/inventor of a machine-learning software program firm, MILO-ML, LLC.


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