The current standard of care for diagnostic of SARS-CoV-2 infection involves samplecollection which is then prepared and measured via real time-polymerase chain reaction(RT-PCR). This process is time consuming and dependent on expensive instrumentation andtrained technicians to perform both the sample preparation and assay. In many cases,sample turn-around times can take hours to several days. There are no establishedmonitoring nationwide protocols for COVID-19 prevention of infection. Due to the lack ofsuch protocols, this study will provide the proper experience to design a safe monitoringschema of asymptomatic cases of COVID-19.Self-testing using currently available RDT has a high specificity and relatively highsensitivity to identify individuals with a high probability of contagiousness. Therefore,we intend to use these RDT (Rapid diagnostic tests) for other use.There are several studies that point to the importance of the use of RDTs to monitorCOVID-19 (3). The recent metadata indicate that the performance of the antigen test iscrucial for obtaining good results to detect positive cases. We have already validated inthe laboratory and using relevant clinical samples several different labels of antigentests and we have compared them with already approved USA FDA antigen tests to confirmtheir performance prior to using them in this study.This project aims to monitor once a week the presence of SARS CoV-2 antigens usinganterior nares (AN) swab self-process, executing the test and recording of the result,immediately after.The lack of affordable diagnostic tests which can detect the presence of SARS-CoV-2 inthe general population which can give near real-time results is one critical missingcontrol intervention in USA for the control of the pandemic and the spread of thisdisease. As public health restrictions begin to ease and people return to normalactivities, while the COVID-19 pandemic is still a threat, a rapid diagnostic assay thatdoes not require the sophisticated laboratory equipment and techniques could provide asignificant advantage to screen asymptomatic individuals. The routine use of such rapidtests is a key element to show efficacy of protocol. We adjusted to once a week testingbased on the medium to low risk of the elderly population of this study.The list of rapid nucleoprotein tests utilized in the current study are: NETO Coronatest, Novir INSTA-TM COVID-19 Rapid Antigen test, COVICHEK COVID-19 Ag Test,SpectraBiotech COVID-19 track antigen test, Blandford Biotech AS-15™ Rapid AntigenDetection Kit SARS-CoV-2 Test (Colloidal Gold Method), Abbott BinaxNow tests.BACKGROUNDThe SARS-CoV-2 Direct Antigen Rapid Test ("Lateral flow") is an immunoassay developed forthe qualitative detection of SARS-CoV-2 viral particles/secreted protein in anteriornasal swabs and/or saliva samples from both asymptomatic and suspected participants withCOVID-19 infection. Lateral flow strips are printed with a monoclonal antibody that bindsthe signature SARS-CoV-2 viral particles/protein (Test line) and a control antibody(Control line) for quality control. A second monoclonal antibody is attached to goldnanoparticles (conjugate) and quencher buffer, and mixed with the nasal sample. TheSARS-CoV-2 nucleocapsid protein attach to both antibodies resulting in a visual line onthe test strip within 15 minutes. Prior experience in the detection of virus and viralproteins via antibody binding using lateral flow have been done through IDx20, Inc. TheHousing Authority and the Public Health Department of the City of Chelsea will beoverseeing this study.
The protocol will be deployed at three sites in the same geographical location. The
design encompasses weekly monitoring of asymptomatic, non- disease populations, confirmed
by RT-PCR for presumed positive cases. Each positive case will be followed with daily
antigen testing and matched RT-PCR testing for 8 consecutive days in accordance with the
CDC's stay-at-home protocol, the positive case will quarantine according to public
policy. In addition to asymptomatic participants, participants presenting with a positive
The antigen tests that will be utilized are all commercial final products with a CE mark.
All antigen tests utilized are close to identical procedure. Appendix 1 shows the
instructions for use of each of the tests. All tests determined nucleoprotein of SARS
CoV-2 in a qualitative manner.
Participants are not expected to participate beyond sample collection and processing of
rapid antigen test as part of the study. The collection of one anterior nares sample is
done once a week. A second nasal swab will be done once a sample indicates presumptive
positive for COVID-19. At the end of 4 months of the study we will provide a rate of
positive cases over time, and a positive agreement value over 8 days of testing of a
positive case. The data will include a Positive Percent Value (PPV) and potentially
expand to provide a NPV when negative samples are sent to the CLIA lab to determine the
specificity of the tests.
In order to be eligible to participate in this study, an individual must meet all of the
following criteria:
1. Individuals 12 year of age or older
2. Provision of paper-consent form and acceptance of participating on a volunteer
basis.
Eligible affiliates are individuals who are associated to the member communities of each
site and who are identified and consented into the study. These may be individuals who
are in close contact with the member community and thus seen as peripheral community
members.
- Subjects will be approached by research staff to determine if they would be
interested in participating in this study. If willing, a qualified study team member
will consent the subject. The electronic system will keep the information about
approval of the informed consent by participant. We will also keep a record of the
paper and a digital photo of the same document.
- Study staff will provide instructions to participants in the sample collection
procedures on site to ensure proper self-sample collection and to minimize the risk
of sample contamination. At the time of initial training. The participant will be
using a self-swabbing process to obtain the NA sample. If we encounter an impediment
for self-swabbing, the process will be done by assisting the participant.
- There will be 3 sites in the same geographical location. The design encompasses
weekly monitoring of asymptomatic, non- disease populations by antigen test.The
positive case will be followed with daily PCR / antigen test testing for 8
consecutive days in accordance with the CDC's stay-at-home protocol, each quarantine
period will be completed. This screening will be used for assessing positive cases
and confirming using a CLIA lab authorized molecular test.
- All materials part of the COVID-19 antigen test kit will be provided by the sponsor
(Manufacturers provide the test to the sponsors). The test cassettes will be kept at
Room Temperature.
SCIENTIFIC RATIONALE FOR STUDY DESIGN
The testing of asymptomatic cases to mitigate COVID-19 Pandemic requires frequent use in
the population. Lateral flow bioassays are relatively inexpensive to manufacture, easy to
store, and easy for front line use in public setting.
END OF STUDY DEFINITION
Participants are not expected to participate beyond frequent sample collection and
processing of rapid antigen test as part of the study. The collection of anterior nares
sample will be done once a week, as well as daily testing for up to 8 days in case of
positive PCR result.
STUDY POPULATION
INCLUSION CRITERIA
1. Individuals age 12 or older
2. Provision paper-consent and acceptance of participating on a volunteer basis.
Up to 450 residents at:
Margolis Apartments (Federal Elderly/Disabled) - A 152- unit thirteen-story brick
structure for elderly and/or disabled residents
Buckley Apartments (State Elderly/Disabled) - Located at 14 Bloomingdale Street has 210
one-bedroom apartments
Housing at 242 Walnut Street (State Elderly/Disable 40 Units
Affiliates are individuals who are associated to the member communities of The Chelsea
Project sites and who are identified and consented into the study. These may be
individuals who are in close contact with the member community and thus seen as
peripheral community members.
EXCLUSION CRITERIA
If the participant requires medical urgent attention at the site of collection.
PARTICIPANT DISCONTINUATION/WITHDRAWAL
DISCONTINUATION OF STUDY SAMPLE EVALUATION
Subjects may withdraw at any time and request that their samples not be processed.
STUDY ASSESSMENTS AND PROCEDURES
STUDY PROCEDURES
All materials will be provided by the sponsor (IDx20-CCI) along with the co-sponsors
owners of the test cassettes. The test cassettes should be kept at Room Temperature until
use and in an indoor environment.
1. Subjects will be approached by research staff to determine if they would be
interested in participating in this study. If willing, a qualified study team member
will conduct a paper or e-informed consent process with the subject. The detailed
procedure to conduct the test will be provided (insert) for each type of test each
week. In two lenguages. The electronic system will populate the information about
approval of the verbal informed consent by participant and it will provide a digital
step by step instructions.
2. Study staff will provide support to participants to obtain the instructions and
materials for sample collection procedures on site at each of the Chelsea Project
sites to ensure proper sample collection and to minimize the risk of sample
contamination.
3. The building administrator will have information of a presumptive positive case.
Each site will follow their approved procedures for quarantine once the participant
has been confirmed by RT-PCR. The participant will be tested at home each day after
contracting COVID-19 for the following 8 days. The samples for PCR confirmation will
be collected at home and sent to a CLIA lab.
Participant confidentiality and privacy is strictly held in trust by the participating
investigators, their staff, and the sponsor(s) and their interventions. This
confidentiality is extended to cover testing of biological samples in addition to any
clinical information relating to participants. Therefore, the study protocol,
documentation, data, and all other information generated will be held in strict
confidence. No information concerning the study, or the data will be released to any
unauthorized third party without prior written approval of the sponsor.
The study monitor, other authorized representatives of the sponsor, representatives of
the Institutional Review Board (IRB), regulatory agencies or pharmaceutical company
supplying study product may inspect all documents and records required to be maintained
by the investigator, including but not limited to, medical records (office, laboratory
facility).
The study participant's contact information will be securely stored at each site for
internal use during the study. At the end of the study, all records will continue to be
kept in a secure location for as long a period as dictated by the reviewing IRB,
Institutional policies, or sponsor requirements.
Study participant research data, which is for purposes of statistical analysis and
scientific reporting, will be transmitted to and stored at the The Chelsea Project
server. A designed application will be used for the collection of cassette result images.
This will not include the participant's contact or identifying information and includes
participant ID numbers only. Rather, individual participants and their research data will
be identified by a unique study identification number. The study data entry and study
management systems used by study sites and by sponsor research staff will be secured and
password protected. At the end of the study, all study databases will be de-identified
and archived at the sponsor facilities.
FUTURE USE OF STORED SPECIMENS AND DATA
The nasal swab collected in saline will be required for RT-PCR confirmation, these
samples will be stored at the CLIA lab (EcoLaboratory. Acton Ma). After the study is
completed, the de-identified, archived data will be for use by other researchers as
determined by sponsor only.
The data of the study could be used for research purposes.
During the conduct of the study, an individual participant can choose to withdraw consent
to have biological specimens stored for future research. However, withdrawal of consent
with regard to bio sample storage may not be possible after the study is completed.
Diagnostic Test: SARS CoV-2 antigen tests
The intervention is to compare antigen tests
Inclusion Criteria:
- older than 12 years of age
Exclusion Criteria:
- critical ill
Chelsea Housing Authority
Chelsea, Massachusetts, United States
Investigator: Paul Nowicki, BsC
Contact: 617-409-5321
pnowicki@chelseaha.com
Investigator: Sina Hoche, PhD
Irene Bosch, PhD
6176861249
ibosch@idx20.us
Laura Holberger, PhD
5086124126
lholberger@idx20.us
Irene Bosch, PhD, Principal Investigator
IDX20 Inc