• Ann. Intern. Med. · Aug 2021

    Optimizing SARS-CoV-2 Surveillance in the United States: Insights From the National Football League Occupational Health Program.

    • Christina DeFilippo Mack, Michael Osterholm, Erin B Wasserman, Natalia Petruski-Ivleva, Deverick J Anderson, Emily Myers, Navdeep Singh, Patti Walton, Gary Solomon, Christopher Hostler, Jimmie Mancell, and Allen Sills.
    • IQVIA, Durham, North Carolina (C.D.M., E.B.W., N.P.).
    • Ann. Intern. Med. 2021 Aug 1; 174 (8): 1081-1089.

    BackgroundEvidence to understand effective strategies for surveillance and early detection of SARS-CoV-2 is limited.ObjectiveTo describe the results of a rigorous, large-scale COVID-19 testing and monitoring program.DesignThe U.S. National Football League (NFL) and the NFL Players Association (NFLPA) instituted a large-scale COVID-19 monitoring program involving daily testing using 2 reverse transcription polymerase chain reaction (RT-PCR) platforms (Roche cobas and Thermo Fisher QuantStudio), a transcription-mediated amplification platform (Hologic Panther), and an antigen point-of-care (aPOC) test (Quidel Sofia).Setting32 NFL clubs in 24 states during the 2020 NFL season.ParticipantsNFL players and staff.MeasurementsSARS-CoV-2 test results were described in the context of medically adjudicated status. Cycle threshold (Ct) values are reported when available.ResultsA total of 632 370 tests administered across 11 668 persons identified 270 (2.4%) COVID-19 cases from 1 August to 14 November 2020. Positive predictive values ranged from 73.0% to 82.0% across the RT-PCR platforms. High Ct values (33 to 37) often indicated early infection. For the first positive result, the median Ct value was 32.77 (interquartile range, 30.02 to 34.72) and 22% of Ct values were above 35. Among adjudicated COVID-19 cases tested with aPOC, 42.3% had a negative result. Positive concordance between aPOC test result and adjudicated case status increased as viral load increased.LimitationsPlatforms varied by laboratory, and test variability may reflect procedural differences.ConclusionRoutine RT-PCR testing allowed early detection of infection. Cycle threshold values provided a useful guidepost for understanding results, with high values often indicating early infection. Antigen POC testing was unable to reliably rule out COVID-19 early in infection.Primary Funding SourceThe NFL and the NFLPA.

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