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Logistic advantage of two-step screening strategy for SARS-CoV-2 at airport quarantine. Travel Med Infect Dis 2021; 43:102127. [PMID: 34174408 PMCID: PMC8220861 DOI: 10.1016/j.tmaid.2021.102127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022]
Abstract
Background Airport quarantine is required to reduce the risk of entry of travelers infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, it is challenging for both high accuracy and rapid turn-around time to coexist in testing; polymerase chain reaction (PCR) is time-consuming with high accuracy, while antigen testing is rapid with less accuracy. However, there are few data on the concordance between PCR and antigen testing. Methods Arrivals at three international airports in Japan between July 29 and September 30, 2020 were tested for SARS-CoV-2 using self-collected saliva by a screening strategy with initial chemiluminescent enzyme immunoassay (CLEIA) followed by confirmatory nucleic acid amplification tests (NAAT) only for intermediate range antigen concentrations. Results Among the 95,457 persons entering Japan during the period, 88,924 (93.2%) were tested by CLEIA, and 0.29% (254/88,924) were found to be SARS-CoV-2 antigen positive (≥4.0 pg/mL). NAAT was required for confirmatory testing in 0.58% (513/88,924) with intermediate antigen concentrations (0.67–4.0 pg/mL) whereby the virus was detected in 6.6% (34/513). This two-step strategy reduced the utilization of NAAT to one out of every 173 test subjects. The estimated performance of this strategy did not show significant increase in false negatives as compared to performing NAAT in all subjects. Conclusions Point of care testing by quantitative CLEIA using self-collected saliva is less labor-intensive and yields results rapidly, thus suitable as an initial screening test. Reserving NAAT for CLEIA indeterminate cases may prevent compromising accuracy while significantly improving the logistics of administering mass-screening at large venues.
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Hanson KE, Altayar O, Caliendo AM, Arias CA, Englund JA, Hayden MK, Lee MJ, Loeb M, Patel R, El Alayli A, Sultan S, Falck-Ytter Y, Lavergne V, Mansour R, Morgan RL, Murad MH, Patel P, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Antigen Testing. Clin Infect Dis 2021:ciab557. [PMID: 34160592 DOI: 10.1093/cid/ciab557] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Immunoassays designed to detect SARS-CoV-2 protein antigens are now commercially available. The most widely used tests are rapid lateral flow assays that generate results in approximately 15 minutes for diagnosis at the point-of-care. Higher throughput, laboratory-based SARS-CoV-2 antigen (Ag) assays have also been developed. The overall accuracy of SARS-CoV-2 Ag tests, however, is not well defined. The Infectious Diseases Society of America (IDSA) convened an expert panel to perform a systematic review of the literature and develop best practice guidance related to SARS-CoV-2 Ag testing. This guideline is the third in a series of rapid, frequently updated COVID-19 diagnostic guidelines developed by IDSA. OBJECTIVE IDSA's goal was to develop evidence-based recommendations or suggestions that assist clinicians, clinical laboratories, patients, public health authorities, administrators and policymakers in decisions related to the optimal use of SARS-CoV-2 Ag tests in both medical and non-medical settings. METHODS A multidisciplinary panel of infectious diseases clinicians, clinical microbiologists and experts in systematic literature review identified and prioritized clinical questions related to the use of SARS-CoV-2 Ag tests. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. RESULTS The panel agreed on five diagnostic recommendations. These recommendations address antigen testing in symptomatic and asymptomatic individuals as well as assess single versus repeat testing strategies. CONCLUSIONS Data on the clinical performance of U.S. Food and Drug Administration SARS-CoV-2 Ag tests with Emergency Use Authorization is mostly limited to single, one-time testing versus standard nucleic acid amplification testing (NAAT) as the reference standard. Rapid Ag tests have high specificity and low to modest sensitivity compared to reference NAAT methods. Antigen test sensitivity is heavily dependent on viral load, with differences observed between symptomatic compared to asymptomatic individuals and the time of testing post onset of symptoms. Based on these observations, rapid RT-PCR or laboratory-based NAAT remain the diagnostic methods of choice for diagnosing SARS-CoV-2 infection. However, when molecular testing is not readily available or is logistically infeasible, Ag testing can help identify some individuals with SARS-CoV-2 infection. The overall quality of available evidence supporting use of Ag testing was graded as very low to moderate.
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Affiliation(s)
- Kimberly E Hanson
- Division of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City, Utah
| | - Osama Altayar
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Angela M Caliendo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cesar A Arias
- Division of Infectious Diseases, Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center at Houston, McGovern Medical School and Center for Infectious Diseases, School of Public Health, Houston, TX
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington
| | - Mary K Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois; Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina
| | - Mark Loeb
- Division of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario
| | - Robin Patel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota
| | - Abdallah El Alayli
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Razan Mansour
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, Georgia
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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103
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van der Toorn W, Oh DY, von Kleist M. COVIDStrategyCalculator: A software to assess testing and quarantine strategies for incoming travelers, contact management, and de-isolation. PATTERNS (NEW YORK, N.Y.) 2021; 2:100264. [PMID: 33899035 PMCID: PMC8057763 DOI: 10.1016/j.patter.2021.100264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 12/27/2022]
Abstract
While large-scale vaccination campaigns against SARS-CoV-2 are rolled out at the time of writing, non-pharmaceutical interventions (NPIs), including the isolation of infected individuals and quarantine of exposed individuals, remain central measures to contain the spread of SARS-CoV-2. Strategies that combine NPIs with innovative SARS-CoV-2 testing strategies may increase containment efficacy and help to shorten quarantine durations. We developed a user-friendly software tool that implements a recently published stochastic within-host viral dynamics model that captures temporal attributes of the viral infection, such as test sensitivity, infectiousness, and the occurrence of symptoms. Based on this model, the software allows to evaluate the efficacy of user-defined, arbitrary NPI and testing strategies in reducing the transmission potential in different contexts. The software thus enables decision makers to explore NPI strategies and perform hypothesis testing, e.g., with regard to the utilization of novel diagnostics or with regard to containing novel virus variants.
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Affiliation(s)
- Wiep van der Toorn
- Systems Medicine of Infectious Disease (P5), Robert Koch Institute, Berlin, Germany
- Bioinformatics (MF1), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Djin-Ye Oh
- FG17 Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Max von Kleist
- Systems Medicine of Infectious Disease (P5), Robert Koch Institute, Berlin, Germany
- Bioinformatics (MF1), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
- German COVID Omics Initiative (deCOI) Bonn, Germany
| | - the Working Group on SARS-CoV-2 Diagnostics at RKI
- Systems Medicine of Infectious Disease (P5), Robert Koch Institute, Berlin, Germany
- Bioinformatics (MF1), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
- FG17 Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- German COVID Omics Initiative (deCOI) Bonn, Germany
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104
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van der Toorn W, Oh DY, Bourquain D, Michel J, Krause E, Nitsche A, von Kleist M. An intra-host SARS-CoV-2 dynamics model to assess testing and quarantine strategies for incoming travelers, contact management, and de-isolation. PATTERNS (NEW YORK, N.Y.) 2021; 2:100262. [PMID: 33899034 PMCID: PMC8057735 DOI: 10.1016/j.patter.2021.100262] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/20/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022]
Abstract
Non-pharmaceutical interventions (NPIs) remain decisive tools to contain SARS-CoV-2. Strategies that combine NPIs with testing may improve efficacy and shorten quarantine durations. We developed a stochastic within-host model of SARS-CoV-2 that captures temporal changes in test sensitivities, incubation periods, and infectious periods. We used the model to simulate relative transmission risk for (1) isolation of symptomatic individuals, (2) contact person management, and (3) quarantine of incoming travelers. We estimated that testing travelers at entry reduces transmission risks to 21.3% ([20.7, 23.9], by PCR) and 27.9% ([27.1, 31.1], by rapid diagnostic test [RDT]), compared with unrestricted entry. We calculated that 4 (PCR) or 5 (RDT) days of pre-test quarantine are non-inferior to 10 days of quarantine for incoming travelers and that 8 (PCR) or 10 (RDT) days of pre-test quarantine are non-inferior to 14 days of post-exposure quarantine. De-isolation of infected individuals 13 days after symptom onset may reduce the transmission risk to <0.2% (<0.01, 6.0).
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Affiliation(s)
- Wiep van der Toorn
- Systems Medicine of Infectious Disease (P5), Robert Koch Institute, Berlin, Germany
- Bioinformatics (MF1), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
| | - Djin-Ye Oh
- FG17 Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Daniel Bourquain
- ZBS1 Highly Pathogenic Viruses, Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Janine Michel
- ZBS1 Highly Pathogenic Viruses, Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Eva Krause
- ZBS1 Highly Pathogenic Viruses, Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Andreas Nitsche
- ZBS1 Highly Pathogenic Viruses, Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Max von Kleist
- Systems Medicine of Infectious Disease (P5), Robert Koch Institute, Berlin, Germany
- Bioinformatics (MF1), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
- German COVID Omics Initiative (deCOI), Bonn, Germany
| | - the Working Group on SARS-CoV-2 Diagnostics at RKI
- Systems Medicine of Infectious Disease (P5), Robert Koch Institute, Berlin, Germany
- Bioinformatics (MF1), Methodology and Research Infrastructure, Robert Koch Institute, Berlin, Germany
- FG17 Influenza and Other Respiratory Viruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- ZBS1 Highly Pathogenic Viruses, Center for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
- German COVID Omics Initiative (deCOI), Bonn, Germany
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105
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Deguma MC, Deguma JJ. The possible threat of faking Covid-19 diagnostic tests and vaccination certifications: a call to an immediate action. J Public Health (Oxf) 2021; 43:e340-e341. [PMID: 33675353 PMCID: PMC7989401 DOI: 10.1093/pubmed/fdab054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/22/2022] Open
Abstract
The pandemic's recessive effect on the global economy created a 'de-globalized' process that detrimentally causes financial turmoil to countries whose economy depends on tourism, urban passenger transport services and civil aviation, among others. The need to help the most vulnerable industries non-resilient to the pandemic reopen to aid economic recovery amid the pandemic's threat is a very urgent concern. With the move to start the vaccination program against the threat of Covid-19, faking Covid-19 diagnostic testing certification pose a severe problem to matters of ethics and economics. If not taken seriously, falsifying documents that certify a person who has undergone Covid-19 vaccination could also happen. This paper argues that everyone's collective effort could be the real embodiment of hope toward a new normal world immune from the virus and malpractices.
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Affiliation(s)
- Melona C Deguma
- College of Education, Cebu Technological University, M.J. Cuenco Ave., Cebu City, Cebu, 6000, Philippines
| | - Jabin J Deguma
- College of Education, Cebu Technological University, M.J. Cuenco Ave., Cebu City, Cebu, 6000, Philippines
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106
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Falzone L, Gattuso G, Tsatsakis A, Spandidos DA, Libra M. Current and innovative methods for the diagnosis of COVID‑19 infection (Review). Int J Mol Med 2021; 47:100. [PMID: 33846767 PMCID: PMC8043662 DOI: 10.3892/ijmm.2021.4933] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID‑19) pandemic has forced the scientific community to rapidly develop highly reliable diagnostic methods in order to effectively and accurately diagnose this pathology, thus limiting the spread of infection. Although the structural and molecular characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) were initially unknown, various diagnostic strategies useful for making a correct diagnosis of COVID‑19 have been rapidly developed by private research laboratories and biomedical companies. At present, rapid antigen or antibody tests, immunoenzymatic serological tests and molecular tests based on RT‑PCR are the most widely used and validated techniques worldwide. Apart from these conventional methods, other techniques, including isothermal nucleic acid amplification techniques, clusters of regularly interspaced short palindromic repeats/Cas (CRISPR/Cas)‑based approaches or digital PCR methods are currently used in research contexts or are awaiting approval for diagnostic use by competent authorities. In order to provide guidance for the correct use of COVID‑19 diagnostic tests, the present review describes the diagnostic strategies available which may be used for the diagnosis of COVID‑19 infection in both clinical and research settings. In particular, the technical and instrumental characteristics of the diagnostic methods used are described herein. In addition, updated and detailed information about the type of sample, the modality and the timing of use of specific tests are also discussed.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute-IRCCS 'Fondazione G. Pascale', I-80131 Naples, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
- Research Center for the Prevention, Diagnosis and Treatment of Tumors, University of Catania, I-95123 Catania, Italy
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107
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Falzone L, Gattuso G, Tsatsakis A, Spandidos DA, Libra M. Current and innovative methods for the diagnosis of COVID‑19 infection (Review). Int J Mol Med 2021. [PMID: 33846767 DOI: 10.3892/ijmm.2021.4933/html] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID‑19) pandemic has forced the scientific community to rapidly develop highly reliable diagnostic methods in order to effectively and accurately diagnose this pathology, thus limiting the spread of infection. Although the structural and molecular characteristics of the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) were initially unknown, various diagnostic strategies useful for making a correct diagnosis of COVID‑19 have been rapidly developed by private research laboratories and biomedical companies. At present, rapid antigen or antibody tests, immunoenzymatic serological tests and molecular tests based on RT‑PCR are the most widely used and validated techniques worldwide. Apart from these conventional methods, other techniques, including isothermal nucleic acid amplification techniques, clusters of regularly interspaced short palindromic repeats/Cas (CRISPR/Cas)‑based approaches or digital PCR methods are currently used in research contexts or are awaiting approval for diagnostic use by competent authorities. In order to provide guidance for the correct use of COVID‑19 diagnostic tests, the present review describes the diagnostic strategies available which may be used for the diagnosis of COVID‑19 infection in both clinical and research settings. In particular, the technical and instrumental characteristics of the diagnostic methods used are described herein. In addition, updated and detailed information about the type of sample, the modality and the timing of use of specific tests are also discussed.
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Affiliation(s)
- Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute‑IRCCS 'Fondazione G. Pascale', I‑80131 Naples, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
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108
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Hart WS, Maini PK, Thompson RN. High infectiousness immediately before COVID-19 symptom onset highlights the importance of continued contact tracing. eLife 2021; 10:e65534. [PMID: 33899740 PMCID: PMC8195606 DOI: 10.7554/elife.65534] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/25/2021] [Indexed: 01/03/2023] Open
Abstract
Background Understanding changes in infectiousness during SARS-COV-2 infections is critical to assess the effectiveness of public health measures such as contact tracing. Methods Here, we develop a novel mechanistic approach to infer the infectiousness profile of SARS-COV-2-infected individuals using data from known infector-infectee pairs. We compare estimates of key epidemiological quantities generated using our mechanistic method with analogous estimates generated using previous approaches. Results The mechanistic method provides an improved fit to data from SARS-CoV-2 infector-infectee pairs compared to commonly used approaches. Our best-fitting model indicates a high proportion of presymptomatic transmissions, with many transmissions occurring shortly before the infector develops symptoms. Conclusions High infectiousness immediately prior to symptom onset highlights the importance of continued contact tracing until effective vaccines have been distributed widely, even if contacts from a short time window before symptom onset alone are traced. Funding Engineering and Physical Sciences Research Council (EPSRC).
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Affiliation(s)
- William S Hart
- Mathematical Institute, University of OxfordOxfordUnited Kingdom
| | - Philip K Maini
- Mathematical Institute, University of OxfordOxfordUnited Kingdom
| | - Robin N Thompson
- Mathematics Institute, University of WarwickCoventryUnited Kingdom
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of WarwickCoventryUnited Kingdom
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109
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Reid MJA, Prado P, Brosnan H, Ernst A, Spindler H, Celentano J, Wall-Shui M, Sachdev D. Assessing Testing Strategies and Duration of Quarantine in Contact Tracing for SARS-CoV-2: A Retrospective Study of San Francisco's COVID-19 Contact Tracing Program, June-August 2020. Open Forum Infect Dis 2021; 8:ofab171. [PMID: 34316499 PMCID: PMC8083597 DOI: 10.1093/ofid/ofab171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/31/2021] [Indexed: 02/01/2023] Open
Abstract
We sought to assess the proportion of elicited close contacts diagnosed with coronavirus disease 2019 at the start of and before exiting quarantine in San Francisco. From June 8 to August 31, 6946 contacts were identified: 3008 (46.3%) were tested, 940 (13.5%) tested positive, and 90% tested positive in the first 9 days of quarantine.
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Affiliation(s)
- M J A Reid
- Division of HIV, ID and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.,Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - P Prado
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - H Brosnan
- Population Health Division, San Francisco Department of Public Health, San Francisco, California, USA
| | - A Ernst
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - H Spindler
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - J Celentano
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - M Wall-Shui
- Population Health Division, San Francisco Department of Public Health, San Francisco, California, USA
| | - D Sachdev
- Population Health Division, San Francisco Department of Public Health, San Francisco, California, USA
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110
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Kiang MV, Chin ET, Huynh BQ, Chapman LAC, Rodríguez-Barraquer I, Greenhouse B, Rutherford GW, Bibbins-Domingo K, Havlir D, Basu S, Lo NC. Routine asymptomatic testing strategies for airline travel during the COVID-19 pandemic: a simulation study. THE LANCET. INFECTIOUS DISEASES 2021; 21:929-938. [PMID: 33765417 PMCID: PMC7984872 DOI: 10.1016/s1473-3099(21)00134-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Routine viral testing strategies for SARS-CoV-2 infection might facilitate safe airline travel during the COVID-19 pandemic and mitigate global spread of the virus. However, the effectiveness of these test-and-travel strategies to reduce passenger risk of SARS-CoV-2 infection and population-level transmission remains unknown. METHODS In this simulation study, we developed a microsimulation of SARS-CoV-2 transmission in a cohort of 100 000 US domestic airline travellers using publicly available data on COVID-19 clinical cases and published natural history parameters to assign individuals one of five health states of susceptible to infection, latent period, early infection, late infection, or recovered. We estimated a per-day risk of infection with SARS-CoV-2 corresponding to a daily incidence of 150 infections per 100 000 people. We assessed five testing strategies: (1) anterior nasal PCR test within 3 days of departure, (2) PCR within 3 days of departure and 5 days after arrival, (3) rapid antigen test on the day of travel (assuming 90% of the sensitivity of PCR during active infection), (4) rapid antigen test on the day of travel and PCR test 5 days after arrival, and (5) PCR test 5 days after arrival. Strategies 2 and 4 included a 5-day quarantine after arrival. The travel period was defined as 3 days before travel to 2 weeks after travel. Under each scenario, individuals who tested positive before travel were not permitted to travel. The primary study outcome was cumulative number of infectious days in the cohort over the travel period without isolation or quarantine (population-level transmission risk), and the key secondary outcome was the number of infectious people detected on the day of travel (passenger risk of infection). FINDINGS We estimated that in a cohort of 100 000 airline travellers, in a scenario with no testing or screening, there would be 8357 (95% uncertainty interval 6144-12831) infectious days with 649 (505-950) actively infectious passengers on the day of travel. The pre-travel PCR test reduced the number of infectious days from 8357 to 5401 (3917-8677), a reduction of 36% (29-41) compared with the base case, and identified 569 (88% [76-92]) of 649 actively infectious travellers on the day of flight; the addition of post-travel quarantine and PCR reduced the number of infectious days to 2520 days (1849-4158), a reduction of 70% (64-75) compared with the base case. The rapid antigen test on the day of travel reduced the number of infectious days to 5674 (4126-9081), a reduction of 32% (26-38) compared with the base case, and identified 560 (86% [83-89]) actively infectious travellers; the addition of post-travel quarantine and PCR reduced the number of infectious days to 3124 (2356-495), a reduction of 63% (58-66) compared with the base case. The post-travel PCR alone reduced the number of infectious days to 4851 (3714-7679), a reduction of 42% (35-49) compared with the base case. INTERPRETATION Routine asymptomatic testing for SARS-CoV-2 before travel can be an effective strategy to reduce passenger risk of infection during travel, although abbreviated quarantine with post-travel testing is probably needed to reduce population-level transmission due to importation of infection when travelling from a high to low incidence setting. FUNDING University of California, San Francisco.
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Affiliation(s)
- Mathew V Kiang
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Elizabeth T Chin
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Benjamin Q Huynh
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Lloyd A C Chapman
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Isabel Rodríguez-Barraquer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - George W Rutherford
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Diane Havlir
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sanjay Basu
- Center for Primary Care, Harvard Medical School, Boston, MA, USA; Research and Population Health, Collective Health, San Francisco, CA, USA; School of Public Health, Imperial College, London, UK
| | - Nathan C Lo
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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111
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Abstract
Analysing the characteristics of the SARS-CoV-2 virus makes it possible to estimate the length of quarantine that reduces the impact on society and the economy, while minimising infections.
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Affiliation(s)
- Mirjam Kretzschmar
- University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johannes Müller
- Department of Mathematics, Technical University of Munich, Garching, Germany.,Institute for Computational Biology, Helmholtz Center Munich, Neuherberg, Germany
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Chen YC, Lai HW, Hou IL, Hsieh PY, Wang PY, Ni TY, Chou CC, Lin YR. Rapid respiratory panel test for non-COVID-19 pathogen examinations among frontline medical personnel in Taiwan. Environ Health Prev Med 2021; 26:22. [PMID: 33583394 PMCID: PMC7882038 DOI: 10.1186/s12199-021-00945-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yu-Chih Chen
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Huei-Wen Lai
- Center of Infection Prevention and Control, Changhua Christian Hospital, Changhua City, Taiwan
| | - I-Lun Hou
- Center of Infection Prevention and Control, Changhua Christian Hospital, Changhua City, Taiwan
| | - Pei-You Hsieh
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Po-Yu Wang
- Department of Pediatric Emergency, Changhua Christian Children's Hospital, Changhua City, Taiwan
| | - Ting-Yuan Ni
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Chu-Chung Chou
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua City, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yan-Ren Lin
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua City, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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