Population-scale testing can suppress the spread of COVID-19

Abstract

We propose an additional intervention that would contribute to the control of the COVID-19 pandemic, offer more protection for people working in essential jobs, and help guide an eventual reopening of society. The intervention is based on: (1) testing every individual (2) repeatedly, and (3) isolation of infected individuals. We show here that at a sufficient rate of testing and isolation, the R0 of SARS-CoV-2 would be reduced well below 1.0, and the epidemic would collapse. The approach does not rely on strong and/or unrealistic assumptions about test accuracy, compliance to isolation, population structure or epidemiological parameters, and its success can be monitored in real time by measuring the change of the test positivity rate over time. In addition to the rate of compliance and false negatives, the required rate of testing is dependent on the design of the testing regime, with concurrent testing outperforming random sampling of individuals. Provided that results are reported rapidly, the test frequency required to suppress an epidemic is linear with respect to R0, to the infectious period, and to the fraction of susceptible individuals. Importantly, the testing regime would be effective at any level of prevalence, and additive to other interventions such as contact tracing and social distancing. It would also be robust to failure, as even in the case where the testing rate would be insufficient to collapse the epidemic, it would still reduce the number of infected individuals in the population, improving both public health and economic conditions. A mass-produced, disposable antigen or RNA test that could be used at home would be ideal, due to the optimal performance of concurrent tests that return immediate results.The ongoing pandemic spread of SARS-CoV-2 is the cause of widespread and accelerating outbreaks of the respiratory syndrome COVID-19. As of May 17, 2020, a total of 4 525 497 persons have been confirmed to be infected, and 307 395 have died 1 . Currently, the virus is present on all continents, spreading rapidly in Europe and the USA, and is a major threat to world order. It now seems likely that unemployment in most countries will exceed the levels reached during the depth of the Great Depression of the 1930s. Detailed models of the epidemic dynamics of SARS-CoV-2 are available that take into account population structure, and can provide estimates of the magnitude and duration of the peak of infection 2 . However, very broadly speaking, an outbreak of a novel virus in a naïve population can have only two outcomes. As long as the reproduction number R0 remains greater than 1, the virus spreads rapidly until most people have been infected (Fig. 1A), creating a temporary surge of infected individuals. If, using pharmaceutical or social interventions, R0 can be reduced below 1, then the epidemic collapses (Fig. 1B), and most people remain uninfected (but still susceptible). Because of the exponential nature of epidemics, the outcomes are nearly binary. Even when R0 exceeds one by only a small amo...

COVID‐19 diagnostic testing: Technology perspective

“…100 To do so, large population screening is necessary; thus the assay must be high throughput, rapid, and cheap. 6,10,51,101,102 For example, Bendavid et al used an LIFA to test the prevalence of SARS-CoV-2 antibodies in 3330 people from Santa Clara County, California. The results indicated that 2.49% (95% CI: 1.80-3.17%) to 4.16% (95% CI: 2.58-5.70%) people in Santa Clara might be SARS-CoV-2 infected.…”

“…The graph was obtained from an online interactive dashboard developed by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, Baltimore, MD, USA 5 symptomatic. [6][7][8] Thus, the identification and isolation of infected people is paramount in fighting COVID-19 since vaccines and effective antiviral drugs have not yet been developed. 6,9 Tremendous efforts have been employed to develop highly accurate diagnostic testing for COVID-19 since January 2020.…”

“…[6][7][8] Thus, the identification and isolation of infected people is paramount in fighting COVID-19 since vaccines and effective antiviral drugs have not yet been developed. 6,9 Tremendous efforts have been employed to develop highly accurate diagnostic testing for COVID-19 since January 2020. 10 Together, the World Health Organization (WHO) and Foundation for Innovative New Diagnostics (FIND) are collaborating to independently validating tests from different manufactures across the globe.…”

Massive and rapid COVID-19 testing is feasible by extraction-free SARS-CoV-2 RT-PCR

“…he emergence of the novel human coronavirus in late 2019 in the Wuhan region of China rapidly evolved into a global pandemic. The high transmission rate and high proportion of asymptomatic infections led to a massive, worldwide need for rapid, affordable, and efficient diagnostic tests, that can be performed in clinical and non-clinical settings 1,2 .…”

A Multiplexed, Next Generation Sequencing Platform for High-Throughput Detection of SARS-CoV-2

“…contact tracing and focused quarantining can significantly suppress disease spread [1][2][3] and has significantly impacted disease transmission rates, the number of infected people, and prevented saturation of the healthcare system [4][5][6][7] . However, reliable systems allowing for parallel testing of 10-100,000's of patients in larger urban environments have not yet been employed.…”