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Optimizing Benefits of Testing Key Workers for Infection with SARS-CoV-2: A Mathematical Modeling Analysis.
Sandmann, Frank G; White, Peter J; Ramsay, Mary; Jit, Mark.
  • Sandmann FG; Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, United Kingdom.
  • White PJ; Department of Infectious Disease Epidemiology and NIHR Health Protection Research Unit in Modelling and Health Economics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Ramsay M; Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, United Kingdom.
  • Jit M; MRC Centre for Global Infectious Disease Analysis and NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London, United Kingdom.
Clin Infect Dis ; 71(12): 3196-3203, 2020 12 15.
Article in English | MEDLINE | ID: covidwho-1043985
ABSTRACT

BACKGROUND:

Internationally, key workers such as healthcare staff are advised to stay at home if they or household members experience coronavirus disease 2019 (COVID-19)-like symptoms. This potentially isolates/quarantines many staff without SARS-CoV-2, while not preventing transmission from staff with asymptomatic infection. We explored the impact of testing staff on absence durations from work and transmission risks to others.

METHODS:

We used a decision-analytic model for 1000 key workers to compare the baseline strategy of (S0) no RT-PCR testing of workers to testing workers (S1) with COVID-19-like symptoms in isolation, (S2) without COVID-19-like symptoms but in household quarantine, and (S3) all staff. We explored confirmatory re-testing scenarios of repeating all initial tests, initially positive tests, initially negative tests, or no re-testing. We varied all parameters, including the infection rate (0.1-20%), proportion asymptomatic (10-80%), sensitivity (60-95%), and specificity (90-100%).

RESULTS:

Testing all staff (S3) changes the risk of workplace transmission by -56.9 to +1.0 workers/1000 tests (with reductions throughout at RT-PCR sensitivity ≥65%), and absences by -0.5 to +3.6 days/test but at heightened testing needs of 989.6-1995.9 tests/1000 workers. Testing workers in household quarantine (S2) reduces absences the most by 3.0-6.9 days/test (at 47.0-210.4 tests/1000 workers), while increasing risk of workplace transmission by 0.02-49.5 infected workers/1000 tests (which can be minimized when re-testing initially negative tests).

CONCLUSIONS:

Based on optimizing absence durations or transmission risk, our modeling suggests testing staff in household quarantine or all staff, depending on infection levels and testing capacities.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Prognostic study Limits: Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2020 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Prognostic study Limits: Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2020 Document Type: Article Affiliation country: Cid