Effectiveness of Frequent Point-of-Care Molecular COVID-19 Surveillance in a Rural Workplace: A Non-Randomized Controlled Clinical Trial Among Miners (Preprint)

BACKGROUND Numerous studies have assessed the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and infection among healthcare workers during the pandemic. However, far fewer studies have investigated the impact of SARS-CoV-2 on essential workers in other sectors. Moreover, guidance for maintaining a safely operating workplace in sectors outside of healthcare remains limited. Workplace surveillance has been recommended by the Centers for Disease Control and Prevention, but few studies have examined the feasibility or effectiveness of this approach. OBJECTIVE The objective of this study was to investigate the feasibility and effectiveness of using frequent point-of-care molecular workplace surveillance as an intervention strategy to prevent the spread of SARS-CoV-2 at essential rural workplaces (mining sites) where physical distancing, remote work, and flexible schedules are not possible. METHODS In this non-randomized controlled clinical trial conducted from February 2021–March 2022, 169 miners in New Mexico (intervention cohort) and 61 miners in Wyoming (control cohort) were enrolled. Investigators performed point-of-care rapid antigen testing on midnasal swabs (NS) self-collected by intervention miners. Rates of seropositivity to SARS-CoV-2 nucleocapsid protein were analyzed in the intervention cohort compared to the control cohort at baseline and 3, 6, and 12 months. The diagnostic accuracy of detecting SARS-CoV-2 using rapid antigen testing on NS was compared to laboratory-based RT-PCR on nasopharyngeal swabs (NPS) in a subset of 68 samples. RESULTS Our intervention had a mean acceptance rate of 96.7% and intervention miners exibited lower cumulative seropositivity (p=0.025) demonstrating frequent point-of-care testing is a feasible, effective way to lower the rate of infection. Analysis of SARS-CoV-2 antigen detection in self-administered NS revealed 100% sensitivity and specificity compared to laboratory-based RT-PCR testing on NPS. CONCLUSIONS Our findings establish frequent point-of-care molecular workplace COVID-19 surveillance as a feasible option for keeping essential rural workplaces open and preventing SARS-CoV-2 spread. These findings extend beyond this study, providing valuable insights for designing interventions to maintain employees’ safety at other essential workplaces during an infectious disease outbreak. CLINICALTRIAL ClinicalTrials.gov NCT04977050