Aims:
In 2022, with the rise in COVID-19 cases, St Vincent’s Hospital Melbourne implemented routine asymptomatic rapid antigen tests (RATs) in the chemotherapy day unit (CDU) to prevent outbreaks and enable early antiviral treatment for cancer patients, who were believed to be at higher risk of severe COVID-19. This study aimed to evaluate the effectiveness of this screening program.
Methods:
The patient alert system (PAS) was used to identify confirmed COVID-19 cases among those who had attended the CDU. The medical records were reviewed for each of these patients to identify if the case was screening detected and their resultant outcomes.
Results:
125 positive alerts were identified during 2022. Only 14 of these were screening detected from 4532 eligible episodes of care. Of these, 10 were haematology patients, 4 were oncology patients. Five patients were on curative intent treatment. Among the 14 cases, 5 had symptoms, 3 had significant epidemiological risk factors, and only 6 were asymptomatic with no risk factors. Severity was mostly mild: 3 patients needed admission, 4 had moderate disease, and 10 had mild disease. There were no severe cases or deaths. 12 patients received antiviral therapy, and 9 were referred to the COVID-19 HITH service. Testing cost approximately $12,916, with each test taking 15 minutes of CDU chair time. On average, there was a 26-day delay between a positive test and the next treatment session.
Conclusions:
The screening program helped avoid in-centre outbreaks and severe cases of COVID-19 during a high transmission period, with high antiviral uptake. However, it incurred significant time and financial costs, detecting only one case per 324 tests. A more targeted testing approach and a stricter questionnaire might have improved efficiency. Unfortunately this study did not capture false positives which would have caused unnecessary treatment delays.