Screening for safe opening of universities under Omicron and Delta variants of COVID-19: When less is more (preprint)

ABSTRACT As new COVID-19 variants emerge, and disease and population characteristics change, screening strategies may also need to change. We develop screening guidelines for the safe opening of college campuses, considering COVID-19 infections/hospitalizations/deaths; peak daily hospitalizations; and the tests required. Our compartmental model simulates disease spread on a college campus under co-circulating variants with different disease dynamics, considering: (i) the heterogeneity in disease transmission and outcomes for faculty/staff and students based on vaccination status and level of natural immunity; and (ii) variant- and dose-dependent vaccine efficacy. Using the Spring 2022 academic semester as a case study, we study various routine screening strategies, and find that screening the faculty/staff less frequently than the students, and/or the boosted and vaccinated less frequently than the unvaccinated, may avert a higher number of infections per test, compared to universal screening of the entire population at a common frequency. We also discuss key policy issues, including the need to revisit the mitigation objective over time, effective strategies that are informed by booster coverage, and if and when screening alone can compensate for low booster coverage.

Benefits of integrated screening and vaccination for infection control (preprint)

Importance Screening and vaccination are essential in the fight against infectious diseases, but need to be integrated and customized based on community and disease characteristics. Objective To develop effective screening and vaccination strategies, customized for a college campus, to reduce COVID-19 infections, hospitalizations, deaths, and peak hospitalizations. Design, Setting, and Participants We construct a compartmental model of disease spread for vaccination and routine screening, and study the efficacy of four mitigation strategies (routine screening only, vaccination only, vaccination with partial routine screening, vaccination with full routine screening), and a no-intervention strategy. The study setting is a hypothetical college campus of 5,000 students and 455 faculty members, with 11 undetected, asymptotic SARS-CoV-2 infections at the start of an 80-day semester. For sensitivity analysis, we vary the screening frequency, daily vaccination rate, initial vaccination coverage, and screening and vaccination compliance; and consider three scenarios that represent low/medium/high transmission rates and test efficacy. Model parameters come from publicly available or published sources. Results With low initial vaccination coverage, even aggressive vaccination and screening result in a high number of infections: 1,024/2,040 (1,532/1,773) with routine daily (every other day) screening of the unvaccinated; 275/895 with daily screening extended to the newly vaccinated in base- and worst-case scenarios, with reproduction numbers 4.75 and 6.75, respectively, representative of COVID-19 Delta variant. With the emergence of the Omicron variant, the reproduction number may increase and/or effective vaccine coverage may decrease if a booster shot is needed to maximize vaccine efficacy. Conclusion Integrated vaccination and routine screening can allow for a safe opening of a college when initial vaccination coverage is sufficiently high. The interventions need to be customized considering the initial vaccination coverage, estimated compliance, screening and vaccination capacity, disease transmission and adverse outcome rates, and the number of infections/peak hospitalizations the college is willing to tolerate.