The Case for Altruism in Institutional Diagnostic Testing

Abstract

Amid COVID-19, many institutions deployed vast resources to test their members regularly for safe reopening. This self-focused approach, however, not only overlooks surrounding communities but also remains blind to community transmission that could breach the institution. To test the relative merits of a more altruistic strategy, we built an epidemiological model that assesses the differential impact on case counts when institutions instead allocate a proportion of their tests to members' close contacts in the larger community. We found that testing outside the institution benefits the institution in all plausible circumstances, with the optimal proportion of tests to use externally landing at 45% under baseline model parameters. Our results were robust to local prevalence, secondary attack rate, testing capacity, and contact reporting level, yielding a range of optimal community testing proportions from 18% to 58%. The model performed best under the assumption that community contacts are known to the institution; however, it still demonstrated a significant benefit even without complete knowledge of the contact network.

Multimodal surveillance of SARS-CoV-2 at a university enables development of a robust outbreak response framework

“…This is consistent with reports that adequate university testing can foreshadow community outcomes 12 and highlights the ability of well-designed university testing programs to serve as bellwethers. As the pandemic’s impact on the surrounding community became clearer, the university sponsored testing for external community members, both as a public benefit and to limit spread of SARS-CoV-2 into the campus 31 .…”

Automated, Miniaturized, and Scalable Screening of Healthcare Workers, First Responders, and Students for SARS-Cov-2 in San Diego County

“…The EXCITE lab was designed for repeated screening of UCSD students and employees, but has also partnered with a number of private and public preschool-grade 12 schools and SDFD to provide repeated testing of their members. A recent study highlighted the potential positive implications of institutions expanding their COVID-19 testing efforts to include members of surrounding communities, which can benefit the institution itself as well as the community as a whole (27).…”

Disease-dependent interaction policies to support health and economic outcomes during the COVID-19 epidemic

“…Testing for infected status can, in theory, be used to initiate targeted isolation, identification and tracing of contacts, quarantining of contacts, and then selected testing of contacts (Ferretti et al, 2020). If done rapidly and at scale, this kind of targeted PCR-based testing can provide early detection of cases and help break new chains of transmission (He et al, 2020;Yong et al, 2020;Gibson et al, 2021;Denny, 2020;Specht et al, 2021). The effectiveness of contact-tracing based control strategies hinges on the accurate identification and isolation of exposed and infectious cases.…”