Impact of national-scale targeted point-of-care symptomatic lateral flow testing on trends in COVID-19 infections and hospitalisations during the second epidemic wave in austria
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Institute for Advanced Studies Austria
Institute for Advanced Studies Department of Health Policy, London School of Economics Austria
Queen Mary University of London United Kingdom
The Big Data Institute, University of Oxford United Kingdom
Practice Dr. Lammel, Ramsau am Dachstein
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A428
In October 2020, amidst the second COVID-19 epidemic wave and before the second-national lockdown, Austria introduced a policy of population-wide point-of-care lateral flow antigen testing (POC-LFT). This study explores the impact of this policy by quantifying the association between trends in POC-LFT-activity with trends in PCR-positivity (as a proxy for symptomatic infection) and hospitalisations related to COVID-19 between October 22 and December 06, 2020.

We stratified 94 Austrian districts according to POC-LFT-activity (number of POC-LFTs performed per 100,000 inhabitants over the study period), into three population cohorts: (i) high(N=24), (ii) medium(N=45) and (iii) low(N=25). Across the cohorts we a) compared trends in POC-LFT-activity with PCR-positivity and hospital admissions; and, b) compared the epidemic growth rate before and after the epidemic peak.

The trend in POC-LFT activity was similar to PCR-positivity and hospitalisations trends across high, medium and low POCLFT activity cohorts. Compared to the low POC-LFT-activity cohort, the high-activity cohort had steeper pre-peak daily increase in PCR-positivity (2.24 more cases per day, per district and per 100,000 inhabitants; 95% CI: 2.0-2.7; p<0.001) and hospitalisations (0.10; 95% CI: 0.02, 0.18; p<0.15), and 6 days earlier peak of PCR-positivity. The high-activity cohort also had steeper daily reduction in the post-peak trend in PCR-positivity (-3.6; 95% CI: -4.8, -2.3; p<0.001) and hospitalisations (-0.2; 95% CI: -0.32, -0.08; p<0.05).

High POC-LFT-use was associated with increased and earlier case finding during the second Austrian COVID-19 epidemic wave, and early and significant reduction in cases and hospitalisations during the second national lockdown. A national policy promoting symptomatic POC-LFT in primary care, can capture trends in PCR-positivity and hospitalisations. Symptomatic POC-LFT delivered at scale and combined with immediate self-quarantining and contact tracing can thus be a proxy for epidemic status, and hence a useful tool that can replace large-scale PCR testing.

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