Diagnostic tool or screening programme? Asymptomatic testing for SARS-CoV-2 needs clear goals and protocols

Skittrall, Jordan P.; Fortune, Mary D; Jalal, Hamid; Zhang, Hongyi; Enoch, David; Brown, Nicholas M.; Swift, Anne

doi:10.1016/j.lanepe.2020.100002

Cited by 26 publications

(31 citation statements)

References 40 publications

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“…Our realistic model parameters are used where not otherwise stated. [11,12]. Testing strategies that employ confirmatory testing to reduce false-positive rates need clear protocols for communicating with those awaiting confirmatory testing, to retain the benefit of earlier isolation.…”

Section: Discussionmentioning

confidence: 99%

“…Engagement with screening substantially impacts success and must not be taken for granted [ 10 ]. A holistic approach considering the social, economic and political impacts, acknowledging the incidence of false-positive results and balancing their impact, and combined with good communication, is therefore a key part of a successful programme [ 11 , 12 ]. Testing strategies that employ confirmatory testing to reduce false-positive rates need clear protocols for communicating with those awaiting confirmatory testing, to retain the benefit of earlier isolation.…”

Section: Discussionmentioning

confidence: 99%

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SARS-CoV-2 screening: effectiveness and risk of increasing transmission

Skittrall

2021

J. R. Soc. Interface.

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Testing asymptomatic people for SARS-CoV-2 aims to reduce COVID-19 transmission. Screening programmes’ effectiveness depends upon testing strategy, sample handling logistics, test sensitivity and individual behaviour, in addition to dynamics of viral transmission. The interaction between these factors is not fully characterized. We investigated the interaction between these factors to determine how to optimize reduction of transmission. We estimate that under idealistic assumptions 70% of transmission may be averted, but under realistic assumptions only 7% may be averted. We show that programmes that overwhelm laboratory capacity or reduce isolation of those with minor symptoms have increased transmission compared with those that do not: programmes need to be designed to avoid these issues, or they will be ineffective or even counter-productive. Our model allows optimal selection of whom to test, quantifies the balance between accuracy and timeliness, and quantifies potential impacts of behavioural interventions. We anticipate our model can be used to understand optimal screening strategies for other infectious diseases with substantially different dynamics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 screening: effectiveness and risk of increasing transmission

Skittrall

2021

J. R. Soc. Interface.

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“…To account for imperfect tests, decisions can be based on not just the test result (infected or not), but also on conditional probabilities of the result being true or false. Conditional probabilities of test result accuracy (positive or negative predictive values of a test) depend not only on test sensitivity (true positive rate) and specificity (true negative rate), but also on the population-level parameter, prevalence [ 16 , 17 ] (Fig 1 in [ 18 ]; “Conditional probabilities of infection” in S1 Text ), estimates of which depend on sampling strategy and inference method. If readily measured individual covariates such as symptoms are associated with the probability that an individual is infected, then we model that infection probability as a function of the covariates (see next section) and use it in place of an overall prevalence parameter in the expressions of “Conditional probabilities of infection” in S1 Text .…”

Section: Introductionmentioning

confidence: 99%

Strategic testing approaches for targeted disease monitoring can be used to inform pandemic decision-making

et al. 2021

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More than 1.6 million Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) tests were administered daily in the United States at the peak of the epidemic, with a significant focus on individual treatment. Here, we show that objective-driven, strategic sampling designs and analyses can maximize information gain at the population level, which is necessary to increase situational awareness and predict, prepare for, and respond to a pandemic, while also continuing to inform individual treatment. By focusing on specific objectives such as individual treatment or disease prediction and control (e.g., via the collection of population-level statistics to inform lockdown measures or vaccine rollout) and drawing from the literature on capture–recapture methods to deal with nonrandom sampling and testing errors, we illustrate how public health objectives can be achieved even with limited test availability when testing programs are designed a priori to meet those objectives.

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“…Asymptomatic testing for COVID-19 for staff in workplaces has become an increasingly common response to the pandemic (1)(2)(3), based on the principle that early detection of positive cases can, through isolation of individuals and their close contacts, disrupt transmission and reduce risk (4)(5)(6)(7). COVID-19 asymptomatic testing programmes have, however, attracted considerable controversy, for example regarding their e cacy, possible unintended negative consequences, and issues around equity and privacy (4,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Guiding Organisational Decision-Making About COVID-19 Asymptomatic Testing in Workplaces: Mixed-Method Study to Inform an Ethical Framework

Scheer

Ansari

McLaughlin

et al. 2021

Preprint

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Background: Workplace programmes to test staff for asymptomatic COVID-19 infection have become common, but raise a number of ethical challenges. In this article, we report the findings of a consultation that informed the development of an ethical framework for organisational decision-making about such programmes.Methods: We conducted a mixed-method consultation – a survey and semi-structured interviews – in a case study organisation that had introduced asymptomatic testing for all staff working on-site in its buildings. Analysis of closed-end survey data was conducted descriptively. An analysis approach based on the Framework Method was used for the open-end survey responses and interview data. The analyses were then integrated to facilitate systematic analysis across themes. Inferences were based on the integrated findings and other inputs (literature review, ethical analysis, legal and public health guidance, expert discussions) to develop an ethical framework. Results: The consultation involved 61 staff members from the case study organisation (50 survey respondents and 11 interview participants). There was strong support for the asymptomatic testing programme: 90% of the survey respondents viewed it as helpful or very helpful. Open-ended survey responses and interviews gave insight into participants’ concerns, including those relating to goal drift, risk of false negatives, and potential negative impacts for household members and people whose roles lacked contractual and financial stability. Integration of the consultation findings and the other inputs identified the importance of a whole-system approach with appropriate support for the key control measure of isolation following positive tests. The need to build trust in the testing programme, for example through effective communication from leaders, was also emphasised.Conclusions: This consultation, together with other inputs, informed an ethical framework intended to support employers. The framework may support organisational decision-making in areas ranging from design and operation of the programme through to choices about participation. The framework is likely to benefit from further consultation and refinement in new settings.

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Diagnostic tool or screening programme? Asymptomatic testing for SARS-CoV-2 needs clear goals and protocols

Cited by 26 publications

References 40 publications

SARS-CoV-2 screening: effectiveness and risk of increasing transmission

SARS-CoV-2 screening: effectiveness and risk of increasing transmission

Strategic testing approaches for targeted disease monitoring can be used to inform pandemic decision-making

Guiding Organisational Decision-Making About COVID-19 Asymptomatic Testing in Workplaces: Mixed-Method Study to Inform an Ethical Framework

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