key: cord-1032413-b7qv4m3t authors: Denford, S.; Martin, A. F.; Towler, L.; Mowbray, F.; Essery, R.; Bloomer, R.; Ready, D. R.; Love, N. K.; Amlot, R.; Oliver, I.; Rubin, J.; Yardley, L. title: A qualitative process analysis of DCT as an alternative to self-isolation following close contact with a confirmed case of COVID-19 date: 2022-01-25 journal: nan DOI: 10.1101/2022.01.14.21267257 sha: c680e8152a3d8a30c63fd0dbdbc76961a9b44ace doc_id: 1032413 cord_uid: b7qv4m3t Background In July 2021, a randomised controlled trial was conducted to compare the effect on SARS-CoV-2 transmission of seven days of daily contact testing (DCT) using lateral flow devise (LFT) and 2 PCR tests as an alternative to 10 days of standard self-isolation with 1 PCR, following close contact with a confirmed case of COVID-19. DCT appeared equivalent to self-isolation in terms of transmission in the trial, however it was not clear how tests were viewed and used in practice. In this qualitative study, we used a nested process to aid interpretation of the trial and provide insight into factors influencing use of tests, understanding of test results, and how tests were used to inform behavioural decisions. Methods Interviews were conducted with 60 participants (42 randomised to DCT and 18 randomised to self-isolation) who had been in close contact with a confirmed positive case of COVID-19 and had consented to take part in the trial. Results Sub-themes emerging from the data were organised into three overarching themes: (1) assessing the risks and benefits of DCT; (2) use of testing during the study period and (3) future use of testing. Attitudes toward DCT as an alternative to self-isolation, and behaviour during the testing period appeared to be informed by an assessment of the associated risks and benefits. Participants reported how important it was for them to avoid isolation, how necessary self-isolation was considered to be, and the ability of LFTs to detect infection. Behaviour during the testing period was modified to reduce risks and harms as much as possible. Testing was considered a potential compromise, reducing both risk of transmission and the negative impact of self-isolation and was highly regarded as a way to 'return to new normal'. Conclusion Participants in this study viewed DCT as a sensible, feasible and welcome means of avoiding unnecessary self-isolation. Although negative LFTs provided reassurance, most people still restricted their activity as recommended. DCT was also highly valued by those in vulnerable households as a means of providing reassurance of the absence of infection, and as an important means of detecting infection and prompting self-isolation when necessary. Participants in this study viewed DCT as a sensible, feasible and welcome means of avoiding unnecessary self-isolation. Although negative LFTs provided reassurance, most people still restricted their activity as recommended. DCT was also highly valued by those in vulnerable households as a means of providing reassurance of the absence of infection, and as an important means of detecting infection and prompting self-isolation when necessary. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint 5 Background Use of lateral flow device (LFT) antigen tests to provide a rapid diagnosis of COVID-19 infection has been an integral part of the UK Government response to the pandemic. In the Autumn of 2020, mass testing pilot schemes were introduced so that members of the public could take a test even if they did not have symptoms of COVID-19 [1, 2] . By April 2021, members of the public were encouraged to get tested with a LFT twice weekly [3, 4] so that asymptomatic and pre-symptomatic infections could be identified. Those testing positive for COVID-19 were required to take a confirmatory PCR test and self-isolate for 10 days. Close contacts of the positive case were also required to self-isolate at home for 10 days. Although self-isolation is an effective strategy for reducing the spread of COVID-19, it can have a substantial and negative impact on the individual and society [5, 6] . Self-isolation following close contact remains a requirement for adult contacts who are not fully vaccinated. In an attempt to reduce the negative impact of self-isolation without increasing transmission of COVID-19, the government made available a scheme in which daily contact testing (DCT) with an LFT was offered as an alternative to self-isolation for some settings [7] [8] [9] . Previous research has suggested DCT may be a feasible alternative to self-isolation [10] [11] [12] [13] , and may be as effective as selfisolation for controlling transmission in certain situations [14] . However, earlier studies were either conducted while stringent society-wide restrictions were in force, and familiarity with testing was low [11, 12] , or within specific settings, such as schools [14] . Research is needed to understand how the general public view and use testing as an alternative to self-isolation in a context in which many government imposed restrictions have eased and familiarity with testing has increased. In July 2021, Public Health England (now UK Health Security Agency), supported by researchers at the University of Bristol and King's College London (KCL), conducted a randomised controlled trial of the impact of DCT for contacts of COVID-19 cases on transmission in the UK. The primary aim was to compare the effect on infection transmission of seven days of DCT as an alternative to 10 days of standard self-isolation following close contact with a confirmed case of COVID-19. Participants randomised to DCT (DCT group) had the option to take a lateral flow test for seven consecutive days and were granted freedom from self-isolation for a 24hour period on receipt of a negative test result. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint Participants in the DCT arm were also asked to take two PCR tests; one on performing their first LFD and one after testing positive/on last negative LFD. Those in the standard self-isolation (SI group) were asked to take a single PCR test and self-isolate for 10 days. A total of 49,623 close contacts took part in the trial (excluding ineligible and withdrawing participants), of which 4,006 participants submitted a positive PCR test result. The trial found that the proportion of secondary cases from contacts of those who were in the DCT group (6%) were comparable to those who self-isolated (7.5%) [15] . The trial also found similar results among people who had received at least one dose of the vaccination (6.9% in the DCT arm compared with 7.8% in the SI arm). While a policy of DCT appears equivalent to self-isolation in terms of the risk of onwards transmission, previous research has highlighted a range of concerns and uncertainties that members of the public have, from concerns about the accuracy of LFT to confusion about how to engage with the policy if a household member has COVID-19 [11] . These issues may affect how people use LFTs and limit their willingness to use the freedoms that the system allows. Therefore, a secondary aim of the trial was to use a mixed methods approach to examine the acceptability and feasibility of DCT as an alternative to self-isolation, and behaviour during the testing period. This aim was achieved by means of a survey of 20,004 (40% response rate) participants who completed the trial, and in-depth one to one interviews. The survey analysis (reported elsewhere [15] ) compared those who were DCT and only reported negative tests (DCT negative test) to those who reported at least one positive test (DCT positive test) and those who completed standard self-isolation (SI), and found that most participants, regardless of group allocation, reported modifying their behaviour during the study period. Among those who were supposed to be isolating (i.e., those in the In the SI and the DCT positive test group) approximately 4 out of 5 people reported much less contact with non-household contacts during the study period. Among those who were not required to isolate, 3 out of 5 people reported much less contact. Only a small number of participants reported that they had left the home whilst self-isolating; approximately 1 in 6 in each group. However, the most common reason for leaving the home whilst isolating was to take a COVID-19 test. The survey also indicated that participants were confident in All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; 7 the results of their tests, with 79% of SI participants reporting that they were very or completely confident in the accuracy of their PCR test results, 64% of participants in the DCT positive group (PCR and LFT) and 83% in the DCT negative group. In this qualitative study, we used a nested process to aid interpretation of the trial and survey findings by providing a detailed understanding of factors influencing the use of tests, understanding of test results, and how tests are used to inform behavioural decisions. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint 8 We conducted interviews with individuals who had been in close contact with a confirmed positive case of COVID-19 and had consented to take part in the trial of LFT as an alternative to self-isolation. At the time of recruitment to the trial, all participants were asked if they would be happy to be contacted by researchers from the University of Bristol and King's College London. Demographic and contact details of those consenting to contact were shared securely with the research team. We carried out a pilot study prior to the RCT, findings have been reported previously [10, 11] . Data collected as part of the pilot study suggested key factors that may influence acceptability of DCT, and purposive sampling was used to ensure diversity in those factors, including; trial group allocation, gender, ethnicity, date of initial contact, and whether the participant lived in the same household as the confirmed positive case. Selected participants were contacted by text, phone, or email, and provided with a study information sheet. All interviews were conducted once the participant had completed the period of testing or self-isolation, and participants were given a £40 shopping voucher as reimbursement for their time. Interviews were conducted remotely (online or by telephone) by a qualitative researcher (SD, AFM, FM, LT, GT, BA, RAE, and RB) between the 24 th June and the 8 th July 2021. Our initial topic guide was based on findings from a qualitative analysis of the related pilot study [11] and designed to include open questions to explore experiences of the testing process, beliefs about testing, perceptions of positive and negative test results, and the impact of testing on behaviour. In order to encourage participants to speak openly about their views and behaviour during the testing period, participants were informed that the interviews would remain anonymous even if they disclosed having not always adhered to the guidance. However, participants were reminded that the research team would be obliged to notify authorities if the participant revealed any serious intended or planned breaches of All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint COVID-19 regulations that could put others in danger. In practice, we did not need to make any notifications. All participants provided verbal consent prior to taking part in the interview. Ethical approval was granted by the Public Health England Research Ethics and Governance Group (Reference NR0235). In accordance with the stages of thematic analysis [16] anonymised transcripts were read by two authors (SD, LT) and detailed notes were made about interesting concepts and ideas. Using the software NVivo 12, all text was labelled with an initial set of codes. Through discussion, similar codes were combined, and a preliminary set of themes were agreed. Relevant data for each theme were collated and reviewed, and themes refined and defined [16] . A total of 60 participants took part in an interview, including 42 (70%) participants randomized to DCT (DCT group), and 18 (30%) who were randomized to 10 days self-isolation with a single PCR (SI group). Of those randomised to the DCT group, 18 (43%) lived in the same household as the positive contact (DCT household positive group). Of the total participants, 33 (55%) were women, and 30 (50%) were from an ethnic minority background. Assessing the risks and benefits of DCT Attitudes toward DCT as an alternative to isolation appeared to be informed by an assessment of the associated risks and benefits. Participants considered how important it was for them to avoid isolation, how necessary self-isolation was, and the ability of LFTs to accurately detect infection. Testing was considered a potential compromise, reducing both risk of transmission and the negative impact of selfisolation, and was highly regarded as a way to 'return to new normal'. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; 1 0 Participants varied in the extent to which they wanted or needed to avoid isolation. Participants discussed multiple negative implications of self-isolation on mental and physical health, as well as the impact on their ability to work and receive an income. Those who were positive about the use of DCT explained how testing had the potential to reduce the negative impact of isolation: "I think [testing] prevents isolation, I think for myself being stuck indoors is really bad for your mental health and your physical health, so I think for me the biggest thing was being able to kind of go out and get some fresh air" (DCT 013). Multiple lockdowns and isolation periods increased the extent to which people were motivated to avoid additional restrictions, and testing was often viewed as a potential lifeline: "There's a limit to how many times you can do [self-isolation] and still be employed" (DCT 015). "It gives you the potential that you can go out, and I think now we've spent so much time inside I think it's quite important that if we can get out then we should, so yeah, definitely" (DCT 001) Perceived benefits of testing were lower among those who were able to work remotely, had a supportive network, or were happy to spend time alone: "Things like food and stuff weren't an issue cos obviously my husband could still go out and get stuff. I'm not massively fussed about going out gallivanting or anything like that, so I'm more than happy in my own company for a few days" (SI 020). Attitudes toward testing were strongly influenced by how necessary the participant considered selfisolation to be. Many participants did not consider self-isolation to be necessary because they did not consider themselves likely to have caught the virus. This may have been because they considered the contact with the positive case to have been low risk; for example, contact had not been prolonged, inside, or they had not been in close proximity with the confirmed case: Likewise, those who had been vaccinated described how this positively influenced attitudes toward testing: "I think it's going to be a progression in conjunction with the vaccine, and what was proposed during the trial seemed to be very much the common sense solution when you know individuals have been All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; [testing] seemed like a prudent step to take" (DCT 003). Perceived likelihood of infection was higher among those who viewed themselves as having been in close contact, or were living with, a positive case. This group voiced greater concerns about the safety of DCT, and at times, considered isolation to be a better option: Use of DCT as an alternative to self-isolation appeared to be influenced by participants' understanding of the accuracy of LFTs. Participants seemed divided as to how well LFTs were able to detect the virus. Whilst some participants were confident that the test would be as accurate as it could be, others were less certain: Participants, particularly those who felt they needed to avoid self-isolation, often described attempts to increase accuracy of testing, for example, through using multiple tests, or using tests in combination with other infection control measures to maximise safety: "[I went] to the chemist, got some lateral flows and I did one, yeah it came back straight away as negative. I did a second one just to make sure…I wanted two to compare, so the chances of both of them being a false negative was kind of remote …" (DCT household positive 026). Regardless of perceived likelihood of having the virus, and beliefs about the accuracy of tests, the majority of participants did not feel confident having contact with vulnerable people: All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It was thought that greater clarity could be helpful, as some participants reported having to seek the information out themselves: All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint 1 5 Many participants in the DCT group described how testing had enabled them to engage in low-risk and essential activities such as exercise, shopping, and to collect prescriptions during the testing period: "So I was able to go to the shops and help with the pick-up and drop off of the kids, and just able to go out for exercise. I'd go to the park and also take the kids to the park" (DCT 004). Among those who considered themselves to be at high-risk of having caught the virus, daily tests provided an additional layer of reassurance that they were safe to engage in low-risk activities outside the home without transmitting the virus to others: However, this group also described efforts to minimise close contact as much as possible; either through choosing to go out at quieter times of the day, or using infection control measures to reduce risk of transmission to others: Those considering themselves to be unlikely to have caught the virus still described feeling reassured by test results, describing the role of testing in reducing any remaining element of doubt: All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; Even those who were concerned about the accuracy of tests were able to use tests as an additional layer of reassurance prior to leaving the home: Provide reassurance and peace of mind Participants in both the DCT and the self-isolation/PCR group who considered themselves likely to catch, or have caught, the virus described using testing to reassure themselves and their housemates that they were not infected: For those living with a positive case, and so in constant contact with the virus, the tests provided regular reassurance that they had not caught the virus: "The way I understand it is if you're living with a person who has it, that person's contagious for ten days. So there was a bigger concern that, theoretically, on day seven to whatever near the end of the All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. "It was good peace of mind to know that, even though someone in the house had COVID, I was still testing negative" (DCT household positive 044). Even those who had been fully vaccinated, and as a result considered themselves unlikely to have contracted COVID-19, reported feeling safer both at home and outside the home as a result of DCT: Participants in the self-isolation/PCR arm described using LFTs during the study period for reassurance purposes, particularly if they considered themselves or their household to be at risk from COVID-19: "I have a lot of lateral flow tests at home, so I did a test immediately and tested negative thankfully. Then I tested myself every day for five days and tested negative" (SI 025). "'Because she's also high-risk because she's got asthma, so we were just like, ' We just need to keep testing and if anything changes, tell each other immediately'" (SI 046). Testing was often considered to be a way out of the pandemic and a compromise between the need to avoid isolation and keep others safe: "I don't see that as a big price to pay, really, for being able to go out, but also making sure everyone else is safe, and I can't really think of another way to make it easier without perhaps increasing the risk factor for somebody else. It's safe to go out and it allows you to have your life back" (DCT household positive 043). All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; "We're not potentially locking down or isolating people who haven't got it and are never likely to develop it, but yet we're still protecting people" (DCT household positive 043). It was suggested that a policy of self-isolation for all contacts was unsustainable long-term, and testing was viewed as potential step toward normality: "Well, we can't live like this for ever -half the country would be in isolation at any one time -so I was aware that this was obviously a first step towards a middle way of, actually, people could not continue the country with people isolating unnecessarily" (DCT household positive 043). Those who had been double vaccinated felt that they could safely avoid self-isolation following close contact with a positive case if they also had a negative lateral flow test. However, even those who were double vaccinated appreciated having the option to take a test: "If you've had the vaccine there needs to be a bit of freedom now, because otherwise people are just going to do it anyway because they're fed-up. So we just need to get back to a bit of normality now" (DCT 018). "I was very pleasantly surprised that there was a possibility for me to go outside especially as I'm vaccinated and know that I'm less likely to be infectious and that I was regularly taking lateral flows" (SI 025). Indeed, participants frequently described a preference for testing should mandatory self-isolation for contacts be removed, often considering testing a small inconvenience for increasing safety and reducing transmission: "It does open up that flexibility that you can go places and do things if you need to or you want to. It was thought that this had the potential to facilitate adherence to self-isolation through providing confirmation of infection: All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; "I think if I tested positive, and I knew that I was a threat to other people -perhaps even if I'm not ill myself -then I can justify having to stay at home" (SI 004). Given that infection transmission and self-isolation both have a major impact on health and society, it is essential to explore ways in which to reduce both transmission and the negative impact of selfisolation. A large trial across England found DCT to be a safe alternative to self-isolation facilitating greater return to normality and enabling people to carry on with work and other essential activities while controlling transmission [15] . This nested qualitative study found that, for most participants, DCT was viewed as a sensible, feasible, and welcome means of avoiding unnecessary self-isolation. This view was more commonly expressed by those who viewed their situation as low risk (for example due to their household being fully vaccinated, or the level of contact with the positive case being limited). DCT was also highly valued as a means of providing reassurance of the absence of infection, and as an important means of detecting infection and prompting self-isolation when necessary. This view was more commonly expressed by people who believed they had a high-risk of being infected, or who were concerned about serious consequences of infecting vulnerable people (for example, at home or at work). While there was some evidence that negative LFTs were reassuring for people, most people still restricted their activity as recommended. Participants expressed some uncertainty and confusion about the rules regarding what was and was not permitted during the trial and requested some clarity around what constitutes "essential" activity. Despite concerns that DCT could increase contact and transmission, this was not found to be the case [15] . Survey data suggests that many participants in the trial modified their behaviour during the study period, and the current qualitative study may present some additional insight into this decisionmaking process. In accordance with survey findings, participants in the current study described how testing had facilitated engagement in low-risk activities. Behaviour during the testing period appeared to be the result of a carefully considered assessment of the risks and benefits of DCT; including the need to avoid isolation, the perceived likelihood of infection, and the accuracy of LFTs [11, 12] . In line with previous studies [11, 12] , those considering themselves at a higher risk of having caught All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint 2 0 COVID-19 reported considerable efforts to reduce risk, with many avoiding close contact with others even after receiving negative test results. Survey data collected alongside the main trial revealed that most participants were confident that tests were accurate, although those who used daily LFTs and reported a positive test had lower confidence compared to other participants. Data collected through the interviews reported here showed that participants were aware that LFTs did not always capture infection. Tests were often interpreted in combination with other indicators, such as presence or absence of symptoms, likelihood of contact with the positive case, or vaccination status. In some cases, participants attempted to increase accuracy through repeated use of LFT or PCR tests. However, whilst LFTs were often viewed as preferable to no tests, it was noted by participants that they should be used cautiously in combination with reduced contact and increased infection control behaviours as much as possible. As of 16 th August 2021, in the UK only unvaccinated populations are required to isolate following close contact with a positive case, the trial found that the proportion of secondary cases were similar among DCT participants and IS participants who were double vaccinated (7.5%) [15] . Importantly, the 7.5% comprised mainly household contacts and very few non-household contacts were reported. Data generated through interviews also suggests that many participants were making educated assessments about the presence or absence of infection based on vaccination status (or degree of contact with infected cases). Even among the participants who were confident that they were unlikely to have contracted COVID-19, tests were able to provide an additional level of reassurance that they were safe to leave the house to engage in low-risk activities. This suggests that the option to take a daily test following close contact with a positive case may be welcomed by some members of the population regardless of vaccination status. The current study also provides support for the role of DCT for providing reassurance to vulnerable populations as we move into the next phase of the pandemic. Indeed, participants in both the selfisolation and testing arm reported using LFTs throughout the study period to provide an early indication of the presence or absence of infection. Testing for reassurance appeared to be particularly important for those living in vulnerable households, who were able to use DCT alongside infection All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Previous studies have found DCT to be an acceptable alternative to self-isolation during lockdown [10, 11] and in school settings [12] . Interviews conducted as part of the current study occurred during the summer months with relatively few social distancing measures in place; opportunities for social interaction were relatively high, and the number of fully vaccinated people had increased. Whilst this rapidly changing context will inevitably shift the weight of perceived risks and benefits, participants still appeared to view DCT as an acceptable alternative to self-isolation, often considering DCT to be a potential compromise that could reduce the risk of transmission and reduce the impact of unnecessary isolation. Despite our best efforts to recruit a diverse sample of participants, the main potential limitation of this work is that relevant voices may have been missed. It is possible that more vulnerable populations, or those with greater concerns about the role of DCT as an alternative to self-isolation did not consent to take part in the trial and were therefore not invited to take part in an interview. It should also be noted that this work was conducted during a period when cases of COVID-19 were declining and restrictions were easing. This may have influenced perceptions of testing and isolation, and our results should be interpreted with this in mind. This work has a number of implications regarding the use of testing in the future. As we negotiate a return to a 'new normal' it is essential that strategies and policies are introduced that maximise safety whilst reducing the negative impact of unnecessary isolation. DCT as an alternative to self-isolation has the potential to reduce the negative impact of self-isolation among those who are still required to do so. However, it may also provide additional reassurance, both inside and outside the home, for those who are not. At the time of writing, LFTs were freely available to members of the public in the UK, but this is not guaranteed to continue [17] . Our results suggest that there may be value in All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint 2 2 continuing to make tests freely available to people who have been in contact with a COVID-19 case, both to prompt early self-isolation when necessary and also to provide people with the reassurance needed to continue with their day to day activities. Participants in this study viewed DCT as a sensible, feasible, and welcome means of avoiding unnecessary self-isolation. Although negative LFTs provided reassurance, most people still restricted their activity as recommended. DCT was also highly valued by those in vulnerable households as a means of providing reassurance of the absence of infection, and as an important means of detecting infection and prompting timely self-isolation when indicated. Greater clarity around what constitutes essential activities would be welcomed. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint 2 3 Declarations Ethics approval and consent to participate Ethical approval for this study was granted by Public Health England's Research Ethics and Governance Group (ref R&D 434). All participants provided informed consent/assent to participate. Informed consent was also obtained from parents of all participants under the age of 16 years. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication NA The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Authors' contributions Conceived the study: All authors Study design: All authors All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint Low uptake of covid-19 lateral flow testing among university students: a mixed methods evaluation COVID-19 Response -Spring 2021 The psychological impact of quarantine and how to reduce it: rapid evidence review Understanding the impact of COVID-19 on BAME groups Office for National Statistics. Coronavirus and Self-Isolation After Being in Contact with a Office for National Statistics Daily contact testing expands to 2000 sites across critical sectors Workplace daily contact testing pilot Engagement with daily testing instead of self-isolating in contacts of confirmed cases of SARS-CoV-2 Engagement with daily testing instead of self-isolating in contacts of confirmed cases of SARS-CoV-2: A qualitative analysis. Frontiers in Public Health Feasibility and acceptability of DCT at school as an alternative to self-isolation following close contact with a confirmed case of COVID-19: A qualitative analysis The acceptability of testing contacts of confirmed COVID-19 cases using serial, self-administered lateral flow devices as an alternative to self-isolation. medRxiv Daily testing for contacts of individuals with SARS-CoV-2 infection and attendance and SARS-CoV-2 transmission in English secondary schools and colleges: an open-label, clusterrandomised trial A noninferiority randomised controlled trial to determine the risk of onward infection transmission from contacts of confirmed COVID-19 cases using serial, self-administered Lateral Flow Tests with a 'test to enable' approach compared to PCR with isolation Using thematic analysis in psychology No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint 2 5All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint 2 8 Testing as a way of encouraging people to isolate when they have a positive test result Avoiding unnecessary isolation Including any comments about unnecessary isolation Low-risk/essential activities Includes quotes about low-risk (e.g., zero contact) or essential (but possibly with contact) activities.Also includes comments about attempts to reduce All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint this version posted January 25, 2022. Comments about use of lateral flow testing among participants in the PCR group -including risk of non-adherence following negative test results All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint this version posted January 25, 2022. ; https://doi.org/10.1101/2022.01.14.21267257 doi: medRxiv preprint