Negative SARS-CoV-2 PCR or rapid antigen test result and the subsequent risk of being infectious: a mathematical simulation study

Abstract

Background. A considerable proportion of SARS-CoV-2 transmission occurs from asymptomatic and pre-symptomatic cases. Therefore, different polymerase chain reaction (PCR)- or rapid antigen test (RAT)-based approaches are being discussed and applied to identify infectious cases that would have gone undetected (e.g., in nursing homes). In this article, we provide a framework to estimate the time-dependent risk of being infectious after a negative SARS-CoV-2 test and we simulate the number of expected cases over time in populations of individuals who initially tested negative. Methods. A Monte Carlo approach is used to simulate infections that occurred over a one-week period in populations with 1,000 individuals following a negative SARS-Cov-2 test. Parameters representing the application of PCR tests or RATs are utilized, and SARS-CoV-2 7-day incidences between 25 and 200 per 100,000 people are considered. Simulation results are compared to case numbers predicted via a mathematical equation. Results. The simulations showed a linear increase in cases over time in populations of individuals who initially tested SARS-CoV-2 negative. The different false negative rates of PCR tests and RATs have a strong impact on the number of simulated cases. The simulated and the mathematically predicted case numbers were comparable. However, Monte Carlo simulations highlight that, due to random effects, infectious cases can exceed predicted case numbers even shortly after a test was conducted. Conclusions. The analysis demonstrates that the number of infectious cases in a population can be effectively reduced by the screening of asymptomatic individuals. However, the time since the negative test and the underlying SARS-CoV-2 incidence are critical parameters in determining the observed subsequent number of cases in tested populations.

An overview of COVID-19 in solid organ transplantation

“…NAT is preferred to rapid antigen testing given the greater sensitivity for detecting SARS-CoV-2 RNA. However, NAT turnaround times can vary greatly between laboratories and regions and the resulting time-lag between testing and organ procurement could potentially result in a misclassified donor converting to NAT positive by the time of organ procurement [20].…”