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AHPPC statement regarding rapid antigen testing in current high community prevalence environments

AHPPC statement regarding rapid antigen testing in current high community prevalence environments

AHPPC statement

Date publication: 

20 January 2022

Destined audience: 

General public

AHPPC statement

Context

Omicron COVID-19, the variant of concern, has been found to be highly transmissible in the community despite high vaccination rates. This means that a high incidence of cases is expected to continue for a considerable time.

The testing capacity of PCR is limited. It has been further constrained due to inability for samples to be pooled given high positivity rates, high impact of community transmission on staff infections, furlough periods and supply chain constraints (e.g. for reagents

COVID-19 management currently relies on timely laboratory-PCR testing notification. The increased turnaround time for collection, PCR tests and results will lead delays in linkage to care and specific therapies and the identification of high-risk individuals. Rapid antigen testing is now being used more as a diagnostic tool than a screening test. Rapid antigen testing will require new methods to identify patients and contacts. This will ensure that patients at higher risk for severe disease and those who would benefit from treatment interventions are connected to care. PCR testing with the appropriate turnaround times will also be necessary.

Proposed use for rapid antigen testing (RAT).

The following three purposes can be served by rapid antigen tests:

  1. This test is used as a diagnostic alternative to PCR for COVID-19-prone individuals. A positive rapid antigen test should be considered a diagnosis for COVID-19 in most cases, especially in this high-prevalence environment.
  2. To manage outbreaks.
  3. To aid in the early identification of cases in high risk settings.

1 Using RAT to diagnose COVID-19-high risk patients as an alternative test to PCR

Cohort

Recommendation for Testing

Comment

People who reside in a household with a known COVID-19 Case

  • RAT on notification and Day 6.
  • Additional RAT for symptomatic patients

Positive RAT should not be taken as a confirmation of COVID-19, regardless of symptoms.

Employers should have a risk management program in place to ensure safe delivery of services.

  • Where essential services may be disrupted
    • Depending on the risk assessment and other mitigations, continue working if negative first Rat and asymptomatic, at least every second day up until Day 6.
  • In normal essential service settings:
    • Quarantine for seven days, with a Day 1 and Day 6 RAT test.
    • Staff should not visit the workplace if they are feeling unwell.

People who have been exposed to a COVID-19case at high risk

Symptomatic people (who have not been exposed to high-risk substances)

  • As soon as possible, get RAT
  • If negative, isolate the RAT and repeat it within 24 hours. Or, seek immediate PCR

Positive RAT should not be considered confirmed COVID-19.

  • If both RATs are positive, isolate the symptoms until they resolve.
  • You can isolate until you receive a negative PCR and your symptoms have resolved.

2 Using RAT for managing outbreaks

Cohort

Recommendation for Testing

Comment

High-risk environments (healthcare, aged and disability care, correctional institutions)

To determine the initial extent of a facility’s capacity, RAT testing can be used.

Confirmatory PCR testing for the initial case only. Day 6 and Day 12 of the RAT will be used to assess the outbreak progress. Day 12 swab to declare outbreak over may be PCR.

Other industries, businesses, organizations, etc.

Staff may be tested for RATs to determine the extent of transmission in work environments.

Industry should think about how they will respond to COVID-19 epidemics in their workplace. This may include a daily RAT to staff and other controls already in place.

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3 Using RAT to detect cases in high-risk environments early

Cohort

Recommendation for Testing

Comment

High community prevalence in residential aged and disability care facilities

  • Daily RAT for all staff (minimum two times weekly if there are supply constraints)
  • Visitors pay a RAT at each visit

This regime is subject to local consideration regarding community prevalence and availability.

Healthcare settings that manage very high-risk patients (e.g. Haematology unit, transplant ward, oncology ward, renal dialysunit

Other critical services (e.g. Other critical services (e.g.

In certain circumstances, consult with the Health authorities

The appropriate regime will be determined by the industry and setting. It should be able to manage business continuity of supply/service. However, other risk mitigants might be able to adequately manage risks. RAT may also be used in addition to these.

Other industries, businesses, organizations, etc.

Not recommended

Industry may decide to review and institute surveillance testing in accordance with its individual industry risk assessment.

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