Christina DeFilippo Mack1, Michael Osterholm2, Erin B Wasserman1, Natalia Petruski-Ivleva1, Deverick J Anderson3, Emily Myers4, Navdeep Singh5, Patti Walton6, Gary Solomon4, Christopher Hostler7, Jimmie Mancell8, Allen Sills4. 1. IQVIA, Durham, North Carolina (C.D.M., E.B.W., N.P.). 2. University of Minnesota, Minneapolis, Minnesota (M.O.). 3. Duke University School of Medicine, Durham, North Carolina, and Infection Control Education for Major Sports, Chapel Hill, North Carolina (D.J.A.). 4. National Football League, New York, New York (E.M., G.S., A.S.). 5. Eden Medical Center, Castro Valley, California (N.S.). 6. Williamson Medical Center, Franklin, Tennessee (P.W.). 7. Duke University School of Medicine and Durham VA Health Care System, Durham, North Carolina, and Infection Control Education for Major Sports, Chapel Hill, North Carolina (C.H.). 8. University of Tennessee Health Science Center, Memphis, Tennessee (J.M.).
Abstract
BACKGROUND: Evidence to understand effective strategies for surveillance and early detection of SARS-CoV-2 is limited. OBJECTIVE: To describe the results of a rigorous, large-scale COVID-19 testing and monitoring program. DESIGN: The U.S. National Football League (NFL) and the NFL Players Association (NFLPA) instituted a large-scale COVID-19 monitoring program involving daily testing using 2 reverse transcription polymerase chain reaction (RT-PCR) platforms (Roche cobas and Thermo Fisher QuantStudio), a transcription-mediated amplification platform (Hologic Panther), and an antigen point-of-care (aPOC) test (Quidel Sofia). SETTING: 32 NFL clubs in 24 states during the 2020 NFL season. PARTICIPANTS: NFL players and staff. MEASUREMENTS: SARS-CoV-2 test results were described in the context of medically adjudicated status. Cycle threshold (Ct) values are reported when available. RESULTS: A total of 632 370 tests administered across 11 668 persons identified 270 (2.4%) COVID-19 cases from 1 August to 14 November 2020. Positive predictive values ranged from 73.0% to 82.0% across the RT-PCR platforms. High Ct values (33 to 37) often indicated early infection. For the first positive result, the median Ct value was 32.77 (interquartile range, 30.02 to 34.72) and 22% of Ct values were above 35. Among adjudicated COVID-19 cases tested with aPOC, 42.3% had a negative result. Positive concordance between aPOC test result and adjudicated case status increased as viral load increased. LIMITATIONS: Platforms varied by laboratory, and test variability may reflect procedural differences. CONCLUSION: Routine RT-PCR testing allowed early detection of infection. Cycle threshold values provided a useful guidepost for understanding results, with high values often indicating early infection. Antigen POC testing was unable to reliably rule out COVID-19 early in infection. PRIMARY FUNDING SOURCE: The NFL and the NFLPA.
BACKGROUND: Evidence to understand effective strategies for surveillance and early detection of SARS-CoV-2 is limited. OBJECTIVE: To describe the results of a rigorous, large-scale COVID-19 testing and monitoring program. DESIGN: The U.S. National Football League (NFL) and the NFL Players Association (NFLPA) instituted a large-scale COVID-19 monitoring program involving daily testing using 2 reverse transcription polymerase chain reaction (RT-PCR) platforms (Roche cobas and Thermo Fisher QuantStudio), a transcription-mediated amplification platform (Hologic Panther), and an antigen point-of-care (aPOC) test (Quidel Sofia). SETTING: 32 NFL clubs in 24 states during the 2020 NFL season. PARTICIPANTS: NFL players and staff. MEASUREMENTS: SARS-CoV-2 test results were described in the context of medically adjudicated status. Cycle threshold (Ct) values are reported when available. RESULTS: A total of 632 370 tests administered across 11 668 persons identified 270 (2.4%) COVID-19 cases from 1 August to 14 November 2020. Positive predictive values ranged from 73.0% to 82.0% across the RT-PCR platforms. High Ct values (33 to 37) often indicated early infection. For the first positive result, the median Ct value was 32.77 (interquartile range, 30.02 to 34.72) and 22% of Ct values were above 35. Among adjudicated COVID-19 cases tested with aPOC, 42.3% had a negative result. Positive concordance between aPOC test result and adjudicated case status increased as viral load increased. LIMITATIONS: Platforms varied by laboratory, and test variability may reflect procedural differences. CONCLUSION: Routine RT-PCR testing allowed early detection of infection. Cycle threshold values provided a useful guidepost for understanding results, with high values often indicating early infection. Antigen POC testing was unable to reliably rule out COVID-19 early in infection. PRIMARY FUNDING SOURCE: The NFL and the NFLPA.
Authors: Jacqueline Dinnes; Pawana Sharma; Sarah Berhane; Susanna S van Wyk; Nicholas Nyaaba; Julie Domen; Melissa Taylor; Jane Cunningham; Clare Davenport; Sabine Dittrich; Devy Emperador; Lotty Hooft; Mariska Mg Leeflang; Matthew Df McInnes; René Spijker; Jan Y Verbakel; Yemisi Takwoingi; Sian Taylor-Phillips; Ann Van den Bruel; Jonathan J Deeks Journal: Cochrane Database Syst Rev Date: 2022-07-22
Authors: Christina D Mack; Erin B Wasserman; Christopher J Hostler; Gary Solomon; Deverick J Anderson; Patti Walton; Kalyani Hawaldar; Emily Myers; Michele Best; Daniel Eichner; Thom Mayer; Allen Sills Journal: Pharmacoepidemiol Drug Saf Date: 2022-03-11 Impact factor: 2.890