Context
The Omicron COVID-19 variant of concern has demonstrated significant community transmission, despite high rates of vaccination. As a result, a high case burden is expected for a significant period of time.
PCR testing capacity is finite and has been further constrained by the inability to pool samples given high positivity rates, the impact of high community transmission on staff infections and furlough periods, and supply chain constraints (e.g. for reagents).
Current management of COVID-19 relies on timely laboratory PCR testing notification. Increased turnaround times for collection, PCR testing and results will lead to delayed linkage to care and specific therapies, and identification of high-risk contacts. A shift to the increased use of rapid antigen testing as an alternative diagnostic rather than a screening test is therefore required. In moving to rapid antigen testing, new approaches will be required to identify cases and contacts, to ensure that those patients at increased risk of more severe disease, and those that would benefit from treatment interventions are linked to care, and that PCR testing with appropriate turnaround times is available as needed.
Proposed use of rapid antigen testing (RAT)
It is proposed that rapid antigen tests can be used for the following 3 purposes:
- As a diagnostic test as an alternative to PCR for those at high risk of having COVID-19. In most circumstances in the current high-prevalence environment, a positive rapid antigen test should be accepted as a diagnosis of COVID-19.
- To manage outbreaks.
- To help early identification of cases in high-risk settings.
1 – Using RAT as a diagnostic test as an alternative to PCR for those at high risk of having COVID-19
Cohort | Testing Recommendation | Comment |
|---|---|---|
People residing in the household with a known COVID-19 case |
Positive RAT should be considered confirmed COVID-19 case regardless of symptoms. | If essential for safe service delivery will require risk management plan in place by employer including:
|
People who have had a high-risk exposure to a known COVID-19 case | ||
Symptomatic people (who have not had a high-risk exposure) |
Positive RAT should be considered confirmed COVID-19 case. |
|
2 – Using RAT to manage outbreaks
Cohort | Testing Recommendation | Comment |
|---|---|---|
High-risk settings (healthcare, aged care, disability care, correctional facilities) | RAT testing to identify initial extent in the facility. | Confirmatory PCR test for initial case(s) only. Subsequent Day 6 and Day 12 RAT to assess outbreak progress. Day 12 swab to declare the outbreak over may be PCR. |
Other industry, businesses, organisations, etc | RAT testing of staff may help to identify the extent of transmission in workplace settings. | Industry should consider how they will respond to COVID-19 outbreaks in their workplace. This may include daily RAT for staff in addition to other controls already in place. |
3 – Using RAT to detect cases early in high-risk settings
Cohort | Testing Recommendation | Comment |
|---|---|---|
Residential aged and disability care settings where there is high community prevalence |
| This regime is subject to local consideration of community prevalence and availability of RAT. |
Healthcare settings managing very high-risk patients (e.g. transplant ward, haematology unit, oncology ward, renal dialysis unit) | ||
Other critical services (e.g. other parts of healthcare services, emergency services) | In specific circumstances, in consultation with Health authorities | Suitable regime determined by respective industry and settings to manage business continuity of supply/service, noting that other risk mitigants may adequately manage risks and RAT may be used supplementary to these. |
Other industry, businesses, organisations, etc | Not routinely recommended | Industry may review and introduce surveillance testing according to individual industry risk assessment. |
