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The Ministry of Health has issued a favorable opinion on the use of rapid antigen tests in the school environment, to detect any coronavirus infection among staff and students. Adoption of this system should allow an infection to be detected more quickly in the presence of a suspected case, organizing isolation activities and reducing the risk that other people may become infected. The coronavirus emergency commissioner, Domenico Arcuri, has launched a competition for the supply of 5 million test kits, which will close on October 8. There are not many details yet on how they will be distributed and allocated among the Regions.
Schools have reopened in most of the Regions for a couple of weeks, amid great precautions and fears of an increase in infections due to the permanence in closed environments of students and teachers for several hours a day. Cases of positive individuals have been reported in some classes, resulting in class suspension, but overall there has not been a significant increase in cases so far. According to experts from the Ministry of Health, the possibility of using rapid tests in schools should allow better control of the situation, reducing the risk of outbreaks.
Proof
To date, there are three main types of coronavirus tests:
• in molecular test (PCR), the most widespread and which we colloquially call “the hyssop”, which searches for the genetic material of the coronavirus from a sample of mucus and saliva extracted from deep within the nasal septum;
• in serological test, which is used to identify antibodies in the blood developed during a coronavirus infection;
• in antigenic test, which looks for some viral proteins (antigens) from a sample taken using a swab.
While the molecular test takes several hours to perform, requiring the swab to be processed in a laboratory, the antigen test can be performed quickly, resulting in a result only 15 minutes after collection. For this reason, the test is often referred to as a “quick swab” and is used in particular settings where many people need to be tested, such as in ports and airports.
Alitalia, for example, has launched a test last week on some flights between Milan Linate and Rome Fiumicino, which can only be boarded after having certified their negativity in the previous 72 hours. Passengers can undergo a free, rapid antigen test at the airport: If they test positive, they cannot board, must remain isolated, and must undergo the classic swab for further confirmation.
Accuracy and reliability
In fact, antigen tests are less accurate than the traditional swab. In the event that an individual has a low viral load, for example, there is an increased risk of having a false negative and this could result in some cases being missed if they are in the initial incubation stage. These tests must also always be confirmed with a molecular test, to exclude the risk of a false positive, although quite remote according to the experiments carried out so far to assess their reliability. Furthermore, no test is perfect to the point of always offering certain results.
According to the Ministry of Health, in the contexts in which they have already been used, rapid antigen tests have made it possible to detect “a significant number of infected people, probably with high viral loads, who would not have been identified otherwise.” For this reason, its use is also recommended in contexts other than those of ports and airports where they have been tested so far.
School
In a recently published ministerial circular, it is said that rapid tests used in schools could “speed up the diagnosis of suspected COVID-19 cases.” The idea is that its use can help to make diagnoses more quickly, especially in the autumn and winter period, where there are often students with fever and flu syndromes, whose symptoms could be confused with those of illness caused by the coronavirus.
Until now, for suspected cases, schools had to request a swab verification, with all the difficulties of the case due to the less accessibility to this type of tests and the longer times to obtain a result. Case identification, isolation, and contact tracing should be easier with rapid tests.
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