Role of Covid-19 Rapid Antigen Test in Dental Patients at Tertiary Health Care Center: A Hospital-based Study

INTRODUCTION

In the beginning of December, the corona virus was first identified in Wuhan, China. This virus caused severe acute respiratory syndrome (SARS) and common cold.^[1] On Feb 2020, WHO officially named this as COVID-19.^[2] By the direct contact with respiratory droplets of a person suffering from this virus, other person can get infected.^[3] Clinical symptoms of COVID-19 may resemble to flu-like symptoms and seasonal allergies.^[4] According to the Centre for Disease Control and Prevention, some of the symptoms may include hyperthermia, cough, breathlessness, myalgia, headache, sore throat, altered taste and smell, nasal stuffiness, vomiting, and diarrhea. In patients with underlying medical conditions, the risk of developing serious complications is higher and can be fatal.^[5] It has a potential to transmit such infections in enclosed dental environments.^[6] Exposure to these viruses can put the operator at higher risk as these infectious viruses could stay on hands, objects or surfaces for a long time.^[7] These viral infections can be diagnosed by culture and various serological techniques. Indian Council of Medical Research (ICMR) has considered Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard diagnostic test for COVID-19 detection, but has its own limitations, such as higher cost, longer turnaround time, issues of sample collection and transportation, and need for specialized laboratory set up. Rapid antigen test (RAT) could be used as an alternative to polymerase chain reaction (PCR) as it is cost-effective, used as point-of-care (POC) test, and could improve the turnaround time for results.^[8] Rapid POC tests are an appropriate screening test for dental patients as it provides results within a few minutes, and take rapid decision whether intervention is needed. These methods of investigating COVID-19 virus will be helpful in identifying the viral pathogens in our highly infectious zone.^[9] Hence, the aim of our study was to evaluate the efficacy of RAT.

MATERIAL AND METHODS

Collection of clinical data

Information was gathered from the subjects who visited dental OPD at IGIMS during the rise in peak of SARS-CoV-2 VOCs, over a period of 4 weeks (May to June 2022). All patients who reported to the OMR department were sent for RAT before entering the OPD area. The test was carried out in the Department of Microbiology at our hospital premises using the SD BIOSENSOR antigen kit that is ICMR approved [Figure 1]. The specimen type collected was throat and nasopharyngeal swabs for all subjects. Single examiner with all required precautionary measures recorded the demographic data and symptoms such as cold, cough, fever and breathlessness, independent of whether they reported positive or negative.

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Figure 1:

Rapid antigen test kit.

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RESULTS

A total of 103 subjects participated in our study, and RAT was done for all subjects keeping in mind the risk of high infectivity in dental operatory. In Novel Coronavirus (NCov), cross-tabulation age was divided as less than 20, 21–40, 41–60 and above 60. Among the less than 20 age group, 22.3% patients had undergone RAT, and all were tested negative. A total of 49.5% among the age group of 21–40 underwent RAT, out of which 46.6% were negative and 2.9% were positive; 21.4% subjects belonged to the 41–60 age group, in which 19.4% were negative and 1.9% were positive; 6.8% subjects belonged to above 60-years group, and all showed negative results [Table 1].

In 50.5% of males, 2.9% tested positive and 47.6% tested negative. In 49.5% females, 1.9% tested positive whereas 47.6% were negative [Table 2].

The most common symptoms observed were cold, cough, fever and breathlessness. It was observed that though among the total patients, 3.9% suffered from cold and cough, and 1.9% tested positive and 1.9% tested negative [Tables 3a and 3b].

Another symptom that an oral physician came across was fever; 6.8% subjects reported to OPD were suffering from fever. Among them, 3.9% had a positive and 2.9% had a negative RAT report [Table 3c].

The symptom which was of most concern was breathlessness; 1.9% subjects had breathlessness, and all were RAT positive [Table 3d].

DISCUSSION

Unique environment of dental setup possesses an increased risk of cross infection with SARS-CoV-2 for both the staff and the patient; the risk is inherent to close contact between these two groups, as well as to the exposure to saliva, aerosol, and other secretions.^[10,11] Dental emergency cannot be neglected for longer duration due to considerable impact of oral health on general health. Keeping in mind the emerging variants of virus classified by WHO as variants of interest (VOI) or VOC, only screening and emergency procedures were performed with implementation of strict preventive measures.^[12]

ICMR has considered RT-PCR as the gold standard treatment, but RAT has also been useful for screening patients and performing elective dental procedures. In our study, we have used SD BIOSENSOR antigen kits, which are reliable for the diagnosis of SARS‐CoV‐2 infection, as they fulfilled the general recommendations for the use of these tests that are recommended by the WHO (≥ 80% sensitivity and ≥97% specificity compared with PCR). Though RAT has lower sensitivity compared with PCR, they improve the turnaround time for results that is key to interrupt transmission chains to control the spread of this pandemic.^[13,14]

In our study, the predominant age group affected by COVID-19 was 21–40 years, followed by 41–60 years age group. Males of this age group were at higher risk of getting affected when compared to females that was concurrent to the study by Munayco et al. in 2020.^[15,16]

Study subjects presented with various symptoms such as cold, cough, fever, and breathlessness. All the patients reporting with these symptoms in our department were sent for RAT for COVID-19 before entering the OPD as a precautionary measure to control the spread of virus in the dental operatory. It was observed that subjects with these symptoms were not necessarily suffering from COVID-19. But the patient who reported breathlessness along with all the above-mentioned symptoms was found to be COVID-positive. Only emergency procedures were performed, keeping a check on infection control by using aseptic techniques, fumigation of working area, aerosol control management, and using personal protective barriers.

CONCLUSION

Rapid screening and testing were boon for dental practitioners as it distinguished patients with COVID-19 from those who were healthy or infected with other viruses. It was an emergency and essential need to take required actions, optimize patient care, and maintain the safety of dental patients, practitioners, and healthcare workers too. POC tests delivers rapid, accurate and actionable results to dental clinicians and lower the risks of disease transmission, and contribute to safe patient flow in dental hospitals.