Preventing COVID-19 spread in closed facilities by regular testing of employees—An efficient intervention in long-term care facilities and prisons?

Abstract

Background Different levels of control measures were introduced to contain the global COVID-19 pandemic, many of which have been controversial, particularly the comprehensive use of diagnostic tests. Regular testing of high-risk individuals (pre-existing conditions, older than 60 years of age) has been suggested by public health authorities. The WHO suggested the use of routine screening of residents, employees, and visitors of long-term care facilities (LTCF) to protect the resident risk group. Similar suggestions have been made by the WHO for other closed facilities including incarceration facilities (e.g., prisons or jails), wherein parts of the U.S., accelerated release of approved inmates is taken as a measure to mitigate COVID-19. Methods and findings Here, the simulation model underlying the pandemic preparedness tool CovidSim 1.1 (http://covidsim.eu/) is extended to investigate the effect of regularly testing of employees to protect immobile resident risk groups in closed facilities. The reduction in the number of infections and deaths within the risk group is investigated. Our simulations are adjusted to reflect the situation of LTCFs in Germany, and incarceration facilities in the U.S. COVID-19 spreads in closed facilities due to contact with infected employees even under strict confinement of visitors in a pandemic scenario without targeted protective measures. Testing is only effective in conjunction with targeted contact reduction between the closed facility and the outside world—and will be most inefficient under strategies aiming for herd immunity. The frequency of testing, the quality of tests, and the waiting time for obtaining test results have noticeable effects. The exact reduction in the number of cases depends on disease prevalence in the population and the levels of contact reductions. Testing every 5 days with a good quality test and a processing time of 24 hours can lead up to a 40% reduction in the number of infections. However, the effects of testing vary substantially among types of closed facilities and can even be counterproductive in U.S. IFs. Conclusions The introduction of COVID-19 in closed facilities is unavoidable without a thorough screening of persons that can introduce the disease into the facility. Regular testing of employees in closed facilities can contribute to reducing the number of infections there, but is only meaningful as an accompanying measure, whose economic benefit needs to be assessed carefully.

Rapid testing for coronavirus disease 2019 (COVID-19)

“…One recent study found that the frequency of employee testing, supplemented with other infection control measures, plays a key role in reducing the number of cases and deaths in long-term care facilities. [ 91 ] The findings suggested that frequent testing of employees (i.e., daily) using good quality antigen rapid tests is more effective than less frequent testing (i.e., once every 5 days) using good quality PCR tests. Similarly, a decision analytical modeling study based on simulated nursing home residents and staffs found that antigen tests performed better than PCR tests in reducing transmission at the same testing frequency due to rapid turn-around, and that daily antigen rapid testing was the most effective testing strategy in the reduction in infections.…”

Predicting the impact of COVID-19 vaccination campaigns – a flexible age-dependent, spatially-stratified predictive model, accounting for multiple viral variants and vaccines

“…As a consequence the waiting times to progress between compartments are Erlang-distributed (cf. [32][33][34][35]).…”

Evaluation and clinical implications of the time to a positive results of antigen testing for SARS-CoV-2

“…Antigen tests originally had low sensitivity compared to nucleic examinations [ 3 ]. Their diagnostic performance has improved over time [ 4 ], and previous research has found them beneficial for screening purposes [ 5 ] or in low-resource settings [ 6 ]. Advantages of antigen tests include the ability to analyze multiple samples simultaneously, the lack of a need for special equipment, and the fast turnaround time (TAT).…”