Implementing a SARS CoV2 Antigen Testing Program (COVID-ATP) in Healthcare Organisations

Objectives: The COVID-19 pandemic has had a profound impact on population health, with the prevalence and severity of the illness being higher in cancer patients and others who suffer from a weakened immune system. All cancer and other clinics where patients with immunosuppressive state are treated, such as transplant and rheumatology clinics, should consider routine staff and patient testing. This is because people infected with COVID-19 may have very mild or no symptoms while they can still transmit the virus to others, acting as super spreaders. The goal of the study is to determine the prevalence of SARS-CoV-2 in asymptomatic healthcare workers and patients, as well as the impact of preventative measures, at a private oncology provider in the United Kingdom. The learnings from this study are applicable to other healthcare organisations who are looking to implement a preventative testing program for SARS-CoV-2.

Study Design: In this study, Asymptomatic staff and patients entered a prospective screening program, the SARS-CoV-2 Antigen Testing Program (COVID-ATP), consisting of the nationally approved real time Polymerase-Chain-Reaction (RT-PCR) nasopharyngeal swab test looking for SARS-CoV-2 viral RNA. The program run April to December 2020, during the peak of the pandemic and covered the period of the 1st lockdown, the summer period of viral remission and the second wave in autumn/winter 2020. Here we present our results between April and October 2020.

Methods: Cancer patients were checked at specific intervals based on their treatment plan, and asymptomatic personnel working across 14 centres were tested weekly. Staff and patient adherence to infection prevention control (IPC) procedures, social distancing, clinic spacing, virtual clinics, intensive cleaning routines, and appropriate Personal Protective Equipment (PPE) use complimented the COVID-ATP testing programme.

Results: Each week, an average of 204 healthcare workers and 21 patients were tested. The prevalence of asymptomatic staff infection was 0.8% shortly after the first lockdown in April/May 2020, reduced to 0% between June/July 2020, increased to 1% in August/September and was 0.8% in September/ October 2020. Two asymptomatic patients tested positive on routine testing, towards the end of the 1st lockdown, but they carried on with treatment and they did well. Staff who tested positive on routine testing entered a period of self-isolation according to Public Health England guidelines.

Conclusions: This is the first longitudinal study in which a systematic testing programme was used to determine the prevalence of asymptomatic COVID-19 in healthcare staff and patients in a UK private healthcare group.

The asymptomatic COVID-19 prevalence in staff was comparable to the community prevalence in England at the time of testing, and the temporal prevalence reflected community prevalence trends. The protective measures taken within centres and the self-isolation of staff testing positive, resulted in lack of viral spread. The program continued until December 2020 with no increase in the prevalence of asymptomatic infections, as we entered the second wave. The introduction of mass vaccinations in England from December 2020 offered an extra protection from the virus to those vulnerable cancer patients.