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Optimizing the nucleic acid screening strategy to mitigate regional outbreaks of SARS-CoV-2 Omicron variant in China:
Yun Yin1,2, Yuanhua Liu1,2, Mengwei Duan3
1Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, No.130, Dong'An Road, Xuhui District, Shanghai, 200032, China.
Background:
The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads rapidly and insidiously. Coronavirus disease 2019 (COVID-19) screening is an important means of blocking community transmission in China, but the costs associated with testing are high. Quarantine capacity and medical resources are also threatened. Therefore, we aimed to evaluate different screening strategies to balance outbreak control and consumption of resources.
Methods:
A community network of 2000 people, considering the heterogeneities of household size and age structure, was generated to reflect real contact networks, and a stochastic individual-based dynamic model was used to simulate SARS-CoV-2 transmission and assess different whole-area nucleic acid screening strategies. We designed a total of 87 screening strategies with different sampling methods, frequencies of screening, and timings of screening. The performance of these strategies was comprehensively evaluated by comparing the cumulative infection rates, the number of tests, and the quarantine capacity and consumption of medical resource, which were expressed as medians (95% uncertainty intervals, 95% UIs).
Results:
To implement COVID-19 nucleic acid testing for all people (Full Screening), if the screening frequency was four times/week, the cumulative infection rate could be reduced to 13% (95% UI: 1%, 51%), the miss rate decreased to 2% (95% UI: 0%, 22%), and the quarantine and medical resource consumption was lower than higher-frequency Full Screening or sampling screening. When the frequency of Full Screening increased from five to seven times/week (which resulted in a 2581 increase in the number of tests per positive case), the cumulative infection rate was only reduced by 2%. Screening all people weekly by splitting them equally into seven batches could reduce infection rates by 73% compared to once per week, which was similar to Full Screening four times/week. Full Screening had the highest number of tests per positive case, while the miss rate, number of tests per positive case, and hotel quarantine resource consumption in Household-based Sampling Screening scenarios were lower than Random Sampling Screening. The cumulative infection rate of Household-based Sampling Screening or Random Sampling Screening seven times/week was similar to that of Full Screening four times/week.
Conclusions:
If hotel quarantine, hospital and shelter hospital capacity are seriously insufficient, to stop the spread of the virus as early as possible, high-frequency Full Screening would be necessary, but intermediate testing frequency may be more cost-effective in non-extreme situations. Screening in batches is recommended if the testing capacity is low. Household-based Sampling Screening is potentially a promising strategy to implement.
Insights
Optimizing COVID-19 screening strategies is crucial for controlling Omicron variant spread. Household-based sampling screening offers a promising, cost-effective approach to balance outbreak control and resource consumption.
Area of Science:
- Epidemiology
- Public Health
- Infectious Disease Modeling
Background:
- Omicron variant (SARS-CoV-2) exhibits rapid transmission, necessitating effective control measures.
- Current COVID-19 screening in China faces challenges with high testing costs and strained resources.
- Evaluating diverse screening strategies is vital to balance disease containment with resource management.
Purpose of the Study:
- To assess various COVID-19 screening strategies for their effectiveness and resource implications.
- To identify optimal screening approaches for controlling SARS-CoV-2 Omicron variant transmission.
- To inform public health policy regarding resource allocation for pandemic response.
Main Methods:
- A stochastic individual-based dynamic model simulated SARS-CoV-2 transmission within a 2000-person community network.
- 87 distinct screening strategies were designed, varying in sampling methods, frequency, and timing.
- Performance was evaluated by cumulative infection rates, test numbers, and resource consumption (quarantine, medical).
Main Results:
- Full Screening four times/week reduced cumulative infection rates to 13% with manageable resource use.
- Increasing Full Screening frequency yielded diminishing returns in infection reduction.
- Batch screening significantly lowered infection rates compared to weekly screening.
- Household-based Sampling Screening demonstrated lower miss rates and resource consumption than Random Sampling Screening.
Conclusions:
- High-frequency Full Screening is essential during severe resource shortages.
- Intermediate testing frequencies offer cost-effectiveness in non-extreme scenarios.
- Batch screening is recommended for low testing capacity situations.
- Household-based Sampling Screening emerges as a potentially effective and resource-efficient strategy.
