Soft drinks can be misused to give false false positive SARS-CoV-2 lateral flow device results

BackgroundThe COVID-19 pandemic created the need for very large scale, rapid testing to prevent and contain transmission of the SARS-CoV-2 virus. Lateral flow device (LFD) immunoassays meet this need by indicating the presence of SARS-CoV-2 antigen from nose/throat swab washings in 30 minutes without laboratory processing, and can be manufactured quickly at low cost. Since March 2021, UK schools have asked pupils without symptoms to test twice weekly. Pupils have posted on social media about using soft drinks to create positive results. The aim of this study was to systematically test a variety soft drinks to determine whether they can cause false "false positive" LFD results. MethodsThis study used 14 soft drinks and 4 artificial sweeteners to determine the outcome of misusing them as analyte for the Innova SARS-CoV-2 antigen rapid qualitative LFD. The pH value, sugar content and ingredients of each sample are described. The LFD results were double read and a subset was repeated using the same devices and fake analytes but differently sourced. FindingsOne sample (1/14; 7%), spring water, produced a negative result. Ten drinks (10/14; 71%) produced a positive or weakly positive result. Three samples (3/14; 21%) produced void results, mostly the fruit concentrate drinks. There was no apparent correlation between the pH value (pH 5.0 in 13/14, 93%; pH 6.5 in 1/14; 7%) or the sugar content (range 0-10.7 grams per 100mls) of the drinks and their LFD result. The 4 artificial sweeteners all produced negative results. A subset of the results was fully replicated with differently sourced materials. InterpretationSeveral soft drinks can be misused to give false positive SARS-CoV-2 LFD results. Daily LFD testing should be performed first thing in the morning, prior to the consumption of any food or drinks, and supervised where feasible. FundingThis work was self-funded by author LO and the LFD were gifted for use in this study. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSO_LILateral flow devices (LFD) for SARS-CoV-2 antigen testing have been used extensively in the UK and internationally in COVID-19 pandemic responses, providing rapid testing at low cost C_LIO_LIRecent reports from young people on social media suggested soft drinks might be misused as LFD analyte and produce a seemingly positive result C_LI Added value of this studyO_LIVarious common soft drinks used as fake analyte can produce false positive SARS-CoV-2 LFD results C_LIO_LIArtificial sweeteners alone in fake analyte solution did not produce false positive results C_LI Implications of all the available evidenceO_LISoft drinks misused as analyte can produce false "false positive" SARS-CoV-2 LFD results C_LIO_LIDaily testing is best done first thing in the morning, prior to any food or drink, and under supervision where possible C_LI