Synergistic interventions to control COVID-19: Mass testing and isolation mitigates reliance on distancing

Abstract

Stay-at-home orders and shutdowns of non-essential businesses are powerful, but socially costly, tools to control the pandemic spread of SARS-CoV-2. Mass testing strategies, which rely on widely administered frequent and rapid diagnostics to identify and isolate infected individuals, could be a potentially less disruptive management strategy, particularly where vaccine access is limited. In this paper, we assess the extent to which mass testing and isolation strategies can reduce reliance on socially costly non-pharmaceutical interventions, such as distancing and shutdowns. We develop a multi-compartmental model of SARS-CoV-2 transmission incorporating both preventative non-pharmaceutical interventions (NPIs) and testing and isolation to evaluate their combined effect on public health outcomes. Our model is designed to be a policy-guiding tool that captures important realities of the testing system, including constraints on test administration and non-random testing allocation. We show how strategic changes in the characteristics of the testing system, including test administration, test delays, and test sensitivity, can reduce reliance on preventative NPIs without compromising public health outcomes in the future. The lowest NPI levels are possible only when many tests are administered and test delays are short, given limited immunity in the population. Reducing reliance on NPIs is highly dependent on the ability of a testing program to identify and isolate unreported, asymptomatic infections. Changes in NPIs, including the intensity of lockdowns and stay at home orders, should be coordinated with increases in testing to ensure epidemic control; otherwise small additional lifting of these NPIs can lead to dramatic increases in infections, hospitalizations and deaths. Importantly, our results can be used to guide ramp-up of testing capacity in outbreak settings, allow for the flexible design of combined interventions based on social context, and inform future cost-benefit analyses to identify efficient pandemic management strategies.

The impact of community asymptomatic rapid antigen testing on COVID-19 hospital admissions: a synthetic control study

“…[14] Similar to previous studies we find that effects seem to have been greatest early on in the programme when large numbers of tests were administered to a large number of people within a relatively short time period. [6,31] Others have also highlighted the importance of combining rapidly testing in a large proportion of the population along with minimising test delays to control transmission, with modelling indicating that this can compensate for lower test sensitivity. [31] Clearly the use of asymptomatic testing to control transmission will be undermined if the positive cases identified are unable to or disinclined to isolate, for example if there are financial penalties to isolation.…”

“…[6,31] Others have also highlighted the importance of combining rapidly testing in a large proportion of the population along with minimising test delays to control transmission, with modelling indicating that this can compensate for lower test sensitivity. [31] Clearly the use of asymptomatic testing to control transmission will be undermined if the positive cases identified are unable to or disinclined to isolate, for example if there are financial penalties to isolation. Effectiveness will also be reduced when, as we found in Liverpool, uptake of testing tends to be lower in populations where transmission tends to be higher (for example amongst more deprived groups).…”

Perception of COVID-19 Testing in the Entire Population

“…The prognosis shows negative events which will decrease slowly (45). One possible strategy is mass testing, which has been highlighted in other studies whose authors have recommended involving the population in frequent testing along with appropriate isolation (46)(47)(48)(49). On the other hand, these studies did not take into account society as such, but also the attitudes, perceptions, behaviors and willingness of individuals.…”

COVID-19 testing: A qualitative study exploring enablers and barriers in the Greater Accra Region, Ghana

“…According to the World Health Organization (WHO), there have been 396 million con rmed cases of COVID-19, including 5.7 million deaths, and 10 billion vaccine doses have been administered as of 8 February 2022 [1]. Although vaccines are rolled out in many countries to help reduce the risk of contracting the virus and infecting others, extensive testing remains essential to slow the transmission [2]. Besides, COVID-19 testing could be a potentially less disruptive management strategy, particularly where vaccine access is limited [2].…”

“…Although vaccines are rolled out in many countries to help reduce the risk of contracting the virus and infecting others, extensive testing remains essential to slow the transmission [2]. Besides, COVID-19 testing could be a potentially less disruptive management strategy, particularly where vaccine access is limited [2]. Increasing testing capacity enables resource-poor countries experiencing slow rollout of vaccines due to poor supply chains to break disease transmission and reform the architecture for future pandemic preparedness e ciently and reform the architecture for future pandemic preparedness e ciently [3].…”