| Title: |
Optimising benefits of testing key workers for infection with SARS-CoV-2: A mathematical modelling analysis. |
| Authors: |
Sandmann, FG; White, PJ; Ramsay, M; Jit, M |
| Contributors: |
National Institute for Health Research; Medical Research Council (MRC) |
| Source: |
3203 ; 3196 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2020 |
| Collection: |
Imperial College London: Spiral |
| Subject Terms: |
COVID-19; RT-PCR; SARS-CoV-2; isolation; testing; Asymptomatic Infections; Humans; Models; Theoretical; modelling; Microbiology; 06 Biological Sciences; 11 Medical and Health Sciences |
| Subject Geographic: |
United States |
| Description: |
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, whilst 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 1,000 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 per 1,000 tests (with reductions throughout at RT-PCR sensitivity of ≥65%), and absences by 0.5 to +3.6 days per test but at heightened testing needs of 989.6-1995.9 tests per 1,000 workers. Testing workers in household-quarantine (S2) reduces absences the most by 3.0-6.9 days per test (at 47.0-210.4 tests per 1,000 workers), while increasing risk of workplace transmission by 0.02-49.5 infected workers per 1,000 tests (which can be minimised when re-testing initially-negative tests). DISCUSSION: Based on optimising absence durations or transmission risk our modelling suggests testing staff in household-quarantine or all staff, depending on infection levels and testing capacities. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
Clinical Infectious Diseases; http://hdl.handle.net/10044/1/80683; MR/R015600/1; NIHR200908 |
| DOI: |
10.1093/cid/ciaa901 |
| Availability: |
http://hdl.handle.net/10044/1/80683; https://doi.org/10.1093/cid/ciaa901 |
| Rights: |
© Crown copyright 2020. This article contains public sector information licensed under the Open Government Licence v3.0 (http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/). |
| Accession Number: |
edsbas.7CBDAAB7 |
| Database: |
BASE |