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Children aged 4 to 14 years can accurately self-collect nasal swabs for COVID-19 testing after viewing simple instructions, suggests a study late last week in JAMA.

Emory University researchers led the study of 197 symptomatic children aged 4 to 14 years who self-collected nasal swabs for COVID-19 polymerase chain reaction (PCR) testing after being shown a 90-second video and given a handout with written and pictorial instructions. The swabs were tested along with those collected by a healthcare worker (HCW) to determine result agreement.

The children were recruited from the Children's Healthcare of Atlanta from July to August 2021. Median patient age was 9 years, 55.7% were boys, and 44% tested positive for COVID-19 by both methods of specimen collection.

Self-collected swabs with positive COVID-19 test results agreed with those from an HCW 97.8% of the time (95% confidence interval [CI], 94.7% to 100.0%), while negative results had 98.1% (95% CI, 95.6% to 100.0%) agreement. SARS-CoV-2 viral loads didn't differ significantly.

Children aged 8 and younger more often required help, such as further instruction, to accurately swab their nose (21.8% vs 6.1% for older children), but viral detection didn't differ between the two groups.

The researchers said the results could inform school testing policies. "Pediatric self-swabbing will support expanded testing access and should make it even easier to test school age populations with fewer resources," coauthor Tim Stenzel, MD, PhD, of the US Food and Drug Administration (FDA), said in a National Institute of Biomedical Imaging & Bioengineering (NIBIB) news release.

In a related editorial, Ilan Youngster, MD, of Shamir Medical Center in Israel, cautioned that further research in broader populations (eg, asymptomatic children, those infected with the newer SARS-CoV-2 variants) is required. "If the preliminary results of this study are replicated in other studies, this simple intervention could be applied in a variety of settings in the community for different respiratory pathogens, without specialized personnel," he wrote. Aug 26 JAMA study and editorial Aug 26 NIBIB news release

Almost half of children infected with the original Omicron COVID-19 strain still tested positive 7 days after they first had symptoms, calling into question guidance from the US Centers for Disease Control and Prevention (CDC) on how long to isolate, according to a small study late last week in Clinical Infectious Diseases.

University of Florida researchers screened 65 sequential nasal swab samples from 31 children who no longer had symptoms and were 0 to 16 years old. Swabs were collected starting at day 5 after symptoms first appeared, the point at which they would be clear to leave isolation, according to CDC guidelines updated in January. The children tested positive for SARS-CoV-2 Omicron BA.1, and the swabs were collected from Dec 20, 2020, through Feb 21, 2022.

Of the 31 children, 15 (48%) still tested positive by day 7 by rapid antigen test. The investigators also performed virus culture on the first 15 samples collected and found 100% agreement with the rapid antigen results, indicating the children were likely still infectious after their positive antigen tests.

The study authors conclude, "In this study, close to half of infected children remained positive for SARS-CoV-2 (and likely were infectious) for at least two days after they would have returned to school under the January 14, 2022, CDC guidelines."

They add, "Consideration should be given to lengthening the recommendation for five days of isolation before return to school, potentially in combination with requirements for a negative rapid test result." Aug 27 Clin Infect Dis abstract

In the lead-up to the Labor Day holiday weekend, most US COVID-19 markers continued to decline last week, with cases falling 6% compared with the previous week and hospitalizations down 3%, according to the Washington Post tracker. However, deaths—often a lagging indicator—were up 3%. Currently, the 7-day average for new daily cases is 87,533, with the daily average of deaths at 490.

In other US developments, the FDA last week provided clinicians with more guidance on evaluating potential drug interactions for prescribing Paxlovid.

Also, the federal government said it is winding down its free mail-order distribution of rapid COVID-19 tests on Sep 2, due to a lack of funding by Congress to replenish the national stockpile. For a few more days, a third round of tests is available by mail to those who haven't already received their quota.

In international developments, the European Centre for Disease Prevention and Control (ECDC) posted five plausible scenarios on how the COVID-19 pandemic might play out over the next decade, a tool to help with pandemic planning. It added that the scenarios are not mutually exclusive and that the situation could transition from one to the next. The scenarios range from a diminished threat to long, barely manageable winters to a new pandemic. Washington Post COVID-19 tracker FDA updated Paxlovid prescribing guidance Federal government free rapid test site Aug 29 ECDC long-term COVID scenarios

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