Large-scale implementation of rapid antigen testing system for COVID-19 in workplaces

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Abstract

The transmission of coronavirus disease 2019 (COVID-19) in workplaces has been a persistent issue throughout the pandemic. In response, a not-for-profit initiative emerged to mitigate COVID-19 workplace transmission in Canada. We report the process for establishing a workplace frequent rapid antigen test (RAT) program. The screening program identified 473 asymptomatic individuals who tested positive on the RAT and confirmed positive by a nasopharyngeal polymerase chain reaction (PCR) diagnostic test. One in 4300 RATs was presumptive positive but later tested PCR negative, and thus, false positives did not meaningfully disrupt workplace operations. Most employers rated the program highly and felt strongly that the program contributed to workplace and community safety. The findings describe a sustained and scalable implementation plan for establishing a frequent workplace testing program. High-frequency testing programs offer the potential to break chains of transmission and act as an extra layer of protection in a comprehensive public health response.

Abstract

We present a guide to developing a large-scale workplace screening program for COVID-19.

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Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts

Joel Hellewell, Sam Abbott, Amy Gimma … (2020)

Summary Background Isolation of cases and contact tracing is used to control outbreaks of infectious diseases, and has been used for coronavirus disease 2019 (COVID-19). Whether this strategy will achieve control depends on characteristics of both the pathogen and the response. Here we use a mathematical model to assess if isolation and contact tracing are able to control onwards transmission from imported cases of COVID-19. Methods We developed a stochastic transmission model, parameterised to the COVID-19 outbreak. We used the model to quantify the potential effectiveness of contact tracing and isolation of cases at controlling a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-like pathogen. We considered scenarios that varied in the number of initial cases, the basic reproduction number (R 0), the delay from symptom onset to isolation, the probability that contacts were traced, the proportion of transmission that occurred before symptom onset, and the proportion of subclinical infections. We assumed isolation prevented all further transmission in the model. Outbreaks were deemed controlled if transmission ended within 12 weeks or before 5000 cases in total. We measured the success of controlling outbreaks using isolation and contact tracing, and quantified the weekly maximum number of cases traced to measure feasibility of public health effort. Findings Simulated outbreaks starting with five initial cases, an R 0 of 1·5, and 0% transmission before symptom onset could be controlled even with low contact tracing probability; however, the probability of controlling an outbreak decreased with the number of initial cases, when R 0 was 2·5 or 3·5 and with more transmission before symptom onset. Across different initial numbers of cases, the majority of scenarios with an R 0 of 1·5 were controllable with less than 50% of contacts successfully traced. To control the majority of outbreaks, for R 0 of 2·5 more than 70% of contacts had to be traced, and for an R 0 of 3·5 more than 90% of contacts had to be traced. The delay between symptom onset and isolation had the largest role in determining whether an outbreak was controllable when R 0 was 1·5. For R 0 values of 2·5 or 3·5, if there were 40 initial cases, contact tracing and isolation were only potentially feasible when less than 1% of transmission occurred before symptom onset. Interpretation In most scenarios, highly effective contact tracing and case isolation is enough to control a new outbreak of COVID-19 within 3 months. The probability of control decreases with long delays from symptom onset to isolation, fewer cases ascertained by contact tracing, and increasing transmission before symptoms. This model can be modified to reflect updated transmission characteristics and more specific definitions of outbreak control to assess the potential success of local response efforts. Funding Wellcome Trust, Global Challenges Research Fund, and Health Data Research UK.

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SARS-CoV-2 Transmission From People Without COVID-19 Symptoms

Michael Johansson, Talia Quandelacy, Sarah Kada … (2021)

Key Points Question What proportion of coronavirus disease 2019 (COVID-19) spread is associated with transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from persons with no symptoms? Findings In this decision analytical model assessing multiple scenarios for the infectious period and the proportion of transmission from individuals who never have COVID-19 symptoms, transmission from asymptomatic individuals was estimated to account for more than half of all transmission. Meaning The findings of this study suggest that the identification and isolation of persons with symptomatic COVID-19 alone will not control the ongoing spread of SARS-CoV-2.

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Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening

Daniel Larremore, Bryan Wilder, Evan Lester … (2021)

Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening.

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Contributors

Laura C. Rosella:

ORCID: https://orcid.org/0000-0003-4867-869X

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing - original draftRole: Writing - review & editing

Ajay Agrawal:

ORCID: https://orcid.org/0000-0002-0911-2194

Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing - review & editing

Joshua Gans:

ORCID: https://orcid.org/0000-0001-6567-5859

Role: ConceptualizationRole: MethodologyRole: Writing - original draft

Avi Goldfarb:

ORCID: https://orcid.org/0000-0002-8919-5814

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing - original draftRole: Writing - review & editing

Sonia Sennik: Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing - original draftRole: Writing - review & editing

Janice Stein:

ORCID: https://orcid.org/0000-0002-3218-8808

Role: ConceptualizationRole: Funding acquisition

Journal

Journal ID (nlm-ta): Sci Adv

Journal ID (iso-abbrev): Sci Adv

Journal ID (publisher-id): sciadv

Journal ID (hwp): advances

Title: Science Advances

Publisher: American Association for the Advancement of Science

ISSN (Electronic): 2375-2548

Publication date Collection: February 2022

Publication date (Electronic, pub): 25 February 2022

Volume: 8

Issue: 8

Electronic Location Identifier: eabm3608

Affiliations

[1 ]Dalla Lana School of Public Health and Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

[2 ]Rotman School of Management, University of Toronto, Toronto, ON, Canada.

[3 ]Creative Destruction Lab, Rotman School of Management, University of Toronto, Toronto, ON, Canada.

[4 ]Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, ON, Canada.

Author notes

[* ]Corresponding author. Email: laura.rosella@ 123456utoronto.ca

Author information

Laura C. Rosella https://orcid.org/0000-0003-4867-869X

Ajay Agrawal https://orcid.org/0000-0002-0911-2194

Joshua Gans https://orcid.org/0000-0001-6567-5859

Avi Goldfarb https://orcid.org/0000-0002-8919-5814

Janice Stein https://orcid.org/0000-0002-3218-8808

Article

Publisher ID: abm3608

DOI: 10.1126/sciadv.abm3608

PMC ID: 8880770

PubMed ID: 35213224

SO-VID: 23db8edf-6d82-44fb-befe-9e57f8282976

Copyright © Copyright © 2022 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial license, which permits use, distribution, and reproduction in any medium, so long as the resultant use is not for commercial advantage and provided the original work is properly cited.

History

Date received : 12 September 2021

Date accepted : 10 January 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000008, Health Canada;

Award ID: Safe Restart Agreement

Funded by: FundRef http://dx.doi.org/10.13039/501100016155, Sharjah Research Academy;

Award ID: 2021 CDL RSC

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Large-scale implementation of rapid antigen testing system for COVID-19 in workplaces

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Novel Coronavirus Disease COVID-19

Most cited references 26

Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts

SARS-CoV-2 Transmission From People Without COVID-19 Symptoms

Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening

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