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Optimising benefits of testing key workers for infection with SARS-CoV-2: A mathematical modelling analysis.

ABSTRACT: BACKGROUND:Internationally, key workers such as healthcare staff are advised to stay at home if they or household members experience coronavirus disease 2019 (COVID-19)-like symptoms. This potentially isolates / quarantines many staff without SARS-CoV-2, whilst not preventing transmission from staff with asymptomatic infection. We explored the impact of testing staff on absence durations from work and transmission risks to others. METHODS:We used a decision-analytic model for 1,000 key workers to compare the baseline strategy of (S0) no RT-PCR testing of workers to testing workers (S1) with COVID-19-like symptoms in isolation, (S2) without COVID-19-like symptoms but in household-quarantine, and (S3) all staff. We explored confirmatory re-testing scenarios of repeating all initial tests, initially-positive tests, initially-negative tests; or no re-testing. We varied all parameters, including the infection rate (0.1%-20%), proportion asymptomatic (10%-80%), sensitivity (60%-95%), and specificity (90%-100%). RESULTS:Testing all staff (S3) changes the risk of workplace transmission by -56.9 to +1.0 workers per 1,000 tests (with reductions throughout at RT-PCR sensitivity of ?65%), and absences by 0.5 to +3.6 days per test but at heightened testing needs of 989.6-1995.9 tests per 1,000 workers. Testing workers in household-quarantine (S2) reduces absences the most by 3.0-6.9 days per test (at 47.0-210.4 tests per 1,000 workers), while increasing risk of workplace transmission by 0.02-49.5 infected workers per 1,000 tests (which can be minimised when re-testing initially-negative tests). DISCUSSION:Based on optimising absence durations or transmission risk our modelling suggests testing staff in household-quarantine or all staff, depending on infection levels and testing capacities.

SUBMITTER: Sandmann FG

PROVIDER: S-EPMC7454477 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Optimizing Benefits of Testing Key Workers for Infection with SARS-CoV-2: A Mathematical Modeling Analysis.

Sandmann Frank G FG White Peter J PJ Ramsay Mary M Jit Mark M

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20201201 12

<h4>Background</h4>Internationally, key workers such as healthcare staff are advised to stay at home if they or household members experience coronavirus disease 2019 (COVID-19)-like symptoms. This potentially isolates/quarantines many staff without SARS-CoV-2, while not preventing transmission from staff with asymptomatic infection. We explored the impact of testing staff on absence durations from work and transmission risks to others.<h4>Methods</h4>We used a decision-analytic model for 1000 ke ...[more]

PMID: 32634823

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Project description:BackgroundIn order to protect health workers from SARS-CoV-2, there is need to characterise the different types of patient facing health workers. Our first aim was to determine both the infection status and seroprevalence of SARS-CoV-2 in health workers. Our second aim was to evaluate the occupational and demographic predictors of seropositivity to inform the country's infection prevention and control (IPC) strategy.Methods and principal findingsWe invited 713 staff members at 24 out of 35 health facilities in the City of Bulawayo in Zimbabwe. Compliance to testing was defined as the willingness to uptake COVID-19 testing by answering a questionnaire and providing samples for both antibody testing and PCR testing. SARS-COV-2 antibodies were detected using a rapid diagnostic test kit and SAR-COV-2 infection was determined by real-time (RT)-PCR. Of the 713 participants, 635(89%) consented to answering the questionnaire and providing blood sample for antibody testing while 560 (78.5%) agreed to provide nasopharyngeal swabs for the PCR SARS-CoV-2 testing. Of the 635 people (aged 18-73) providing a blood sample 39.1% reported a history of past COVID-19 symptoms while 14.2% reported having current symptoms of COVID-19. The most-prevalent co-morbidity among this group was hypertension (22.0%) followed by asthma (7.0%) and diabetes (6.0%). The SARS-CoV-2 sero-prevalence was 8.9%. Of the 560 participants tested for SARS-CoV-2 infection, 2 participants (0.36%) were positive for SAR-CoV-2 infection by PCR testing. None of the SARS-CoV-2 antibody positive people were positive for SAR-CoV-2 infection by PCR testing.Conclusion and interpretationIn addition to clinical staff, several patient-facing health workers were characterised within Zimbabwe's health system and the seroprevalence data indicated that previous exposure to SAR-CoV-2 had occurred across the full spectrum of patient-facing staff with nurses and nurse aides having the highest seroprevalence. Our results highlight the need for including the various health workers in IPC strategies in health centres to ensure effective biosecurity and biosafety.

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Optimising benefits of testing key workers for infection with SARS-CoV-2: A mathematical modelling analysis.

Publications

Optimizing Benefits of Testing Key Workers for Infection with SARS-CoV-2: A Mathematical Modeling Analysis.

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