Optimising benefits of testing key workers for infection with SARS-CoV-2: A mathematical modelling analysis.
File(s)Sandmann CID 2020 suppl.docx (2.68 MB) ciaa901.pdf (10.66 MB)
Supporting information
Published version
Author(s)
Sandmann, Frank G
White, Peter J
Ramsay, Mary
Jit, Mark
Type
Journal Article
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, 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.
Date Issued
2020-12-15
Date Acceptance
2020-07-01
Citation
Clinical Infectious Diseases, 2020, 71 (12), pp.3196-3203
ISSN
1058-4838
Publisher
Oxford University Press (OUP)
Start Page
3196
End Page
3203
Journal / Book Title
Clinical Infectious Diseases
Volume
71
Issue
12
Copyright Statement
© 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/).
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/).
Sponsor
National Institute for Health Research
Medical Research Council (MRC)
National Institute for Health Research
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32634823
PII: 5868532
Grant Number
HPRU-2012-10080
MR/R015600/1
NIHR200908
Subjects
COVID-19
RT-PCR
SARS-CoV-2
isolation
modelling
testing
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2020-07-07