Comparison of SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction and BinaxNOW Rapid Antigen Tests at a Community Site During an Omicron Surge : A Cross-Sectional Study

Abstract

This study compares the performance of the BinaxNOW rapid antigen test versus reverse transcriptase polymerase chain reaction for community-based detection of infection with the Omicron variant of SARS-CoV-2 in San Francisco, California, during January 2022.

Abstract

Visual Abstract.

SARS-CoV-2 RT-PCR Versus BinaxNOW Rapid Antigen Test During Omicron Surge.

This study compares the performance of the BinaxNOW rapid antigen test versus reverse transcriptase polymerase chain reaction for community-based detection of infection with the Omicron variant of SARS-CoV-2 in San Francisco, California, during January 2022.

Abstract

Background:

SARS-CoV-2 rapid antigen tests are an important public health tool.

Objective:

To evaluate field performance of the BinaxNOW rapid antigen test (Abbott) compared with reverse transcriptase polymerase chain reaction (RT-PCR) for detecting infection with the Omicron variant of SARS-CoV-2.

Design:

Cross-sectional surveillance study.

Setting:

Free, walk-up, outdoor, urban community testing and vaccine site led by Unidos en Salud, serving a predominantly Latinx community highly impacted by COVID-19.

Participants:

Persons seeking COVID-19 testing in January 2022.

Measurements:

Simultaneous BinaxNOW and RT-PCR from nasal, cheek, and throat swabs, including cycle threshold (Ct) measures; a lower Ct value is a surrogate for higher amounts of virus.

Results:

Among 731 persons tested with nasal swabs, there were 296 (40.5%) positive results on RT-PCR; 98.9% were the Omicron variant. BinaxNOW detected 95.2% (95% CI, 91% to 98%) of persons who tested positive on RT-PCR with a Ct value below 30, 82.1% (CI, 77% to 87%) of those who tested positive on RT-PCR with a Ct value below 35, and 65.2% (CI, 60% to 71%) of all who were positive on RT-PCR. Among 75 persons with simultaneous nasal and cheek swabs, BinaxNOW using a cheek swab failed to detect 91% (20 of 22) of specimens that were positive on BinaxNOW with a nasal swab. Among persons with simultaneous nasal and throat swabs who were positive on RT-PCR with a Ct value below 30, 42 of 49 (85.7%) were detected by nasal BinaxNOW, 23 of 49 (46.9%) by throat BinaxNOW, and 44 of 49 (89.8%) by either.

Limitation:

Participants were a cross-sectional sample from a community-based sentinel surveillance site, precluding study of viral or symptom dynamics.

Conclusion:

BinaxNOW detected persons with high SARS-CoV-2 levels during the Omicron surge, enabling rapid responses to positive test results. Cheek or throat swabs should not replace nasal swabs. As currently recommended, high-risk persons with an initial negative BinaxNOW result should have repeated testing.

Primary Funding Source:

University of California, San Francisco.