Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Intercollegiate Athletics Not Fully Mitigated With Daily Antigen Testing

  1. Gage K Moreno
  2. Katarina M Braun
  3. Ian W Pray
  4. Hannah E Segaloff
  5. Ailam Lim
  6. Keith Poulsen
  7. Jonathan Meiman
  8. James Borcher
  9. Ryan P Westergaard
  10. Michael K Moll
  11. Thomas C Friedrich
  12. David H O’Connor

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Abstract

Background

High-frequency, rapid-turnaround severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing continues to be proposed as a way of efficiently identifying and mitigating transmission in congregate settings. However, 2 SARS-CoV-2 outbreaks occurred among intercollegiate university athletic programs during the fall 2020 semester, despite mandatory directly observed daily antigen testing.

Methods

During the fall 2020 semester, athletes and staff in both programs were tested daily using Quidel’s Sofia SARS Antigen Fluorescent Immunoassay, with positive antigen results requiring confirmatory testing with real-time reverse-transcription polymerase chain reaction. We used genomic sequencing to investigate transmission dynamics in these 2 outbreaks.

Results

In the first outbreak, 32 confirmed cases occurred within a university athletics program after the index patient attended a meeting while infectious, despite a negative antigen test on the day of the meeting. Among isolates sequenced from that outbreak, 24 (92%) of 26 were closely related, suggesting sustained transmission following an initial introduction event. In the second outbreak, 12 confirmed cases occurred among athletes from 2 university programs that faced each other in an athletic competition, despite receipt of negative antigen test results on the day of the competition. Sequences from both teams were closely related and distinct from viruses circulating in the community for team 1, suggesting transmission during intercollegiate competition in the community for team 2.

Conclusions

These findings suggest that antigen testing alone, even when mandated and directly observed, may not be sufficient as an intervention to prevent SARS-CoV-2 outbreaks in congregate settings, and they highlight the importance of vaccination to prevent SARS-CoV-2 outbreak in congregate settings.

Article activity feed

  1. Version published to 10.1093/cid/ciab343
  2. ScreenIT

    SciScore for 10.1101/2021.03.03.21252838: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Laboratory Methods: We obtained a waiver of HIPAA Authorization and were approved to obtain the clinical samples along with a Limited Data Set by the Western Institutional Review Board (WIRB #1-1290953-1).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We used custom python scripts to filter and clean metadata.
    python
    suggested: (IPython, RRID:SCR_001658)
    Data availability: Source data after mapping to SARS-CoV-2 reference genome (Genbank: MN908947.3) have been deposited in the Sequence Read Archive (SRA) under bioproject PRJNA614504.
    Sequence Read Archive
    suggested: (DDBJ Sequence Read Archive, RRID:SCR_001370)

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    These interactions represent multiple breaches of the university’s mitigation strategy and combined with the limitations of the antigen testing protocol, resulted in sustained person-to-person viral spread throughout the team. In particular, the team continued to have physically distanced (6 feet apart) in-person meetings with cloth masks until all in-person team activities were suspended to prevent further spread. Per public health and university guidelines, attendees in these meetings were not quarantined, a step that may have prevented onward transmission during this outbreak. Roommates and household contacts of student-athletes could represent additional sources of infection in Outbreak 1. In some cases, housemates of infected team members were not required to quarantine due to the large size of the house and the university’s assessment that physical distancing was achievable in this area. Continuing indoor in-person meetings and not quarantining potential contacts represent possible breaches in university’s SARS-CoV-2 mitigation plan that, combined with the limitation of antigen testing, permitted viral spread throughout the team in Outbreak 1. In Outbreak 2, we used genomic sequencing to demonstrate that SARS-CoV-2 transmission likely occurred between two teams during athletic competition despite both teams receiving negative antigen results prior to competition. Supporting evidence for inter-collegiate transmission included detection of a unique mutation, Spike P26Y, t...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.03.03.21252838 on medRxiv