Routine asymptomatic testing strategies for airline travel during the COVID-19 pandemic: a simulation study

Autor: Kirsten Bibbins-Domingo, Diane V. Havlir, Mathew V. Kiang, Nathan Lo, Sanjay Basu, Isabel Rodriguez-Barraquer, Elizabeth T Chin, George W. Rutherford, Lloyd A. C. Chapman, Benjamin Q. Huynh, Bryan Greenhouse
Jazyk: angličtina
Rok vydání: 2021
Předmět:
0301 basic medicine
medicine.medical_specialty
Aircraft
Clinical Sciences
Microbiology
Asymptomatic
law.invention
Vaccine Related
03 medical and health sciences
COVID-19 Testing
0302 clinical medicine
Diagnostic Tests
law
Biodefense
Correspondence
Pandemic
Quarantine
medicine
Humans
Routine
Computer Simulation
030212 general & internal medicine
Asymptomatic Infections
Pandemics
Travel
Diagnostic Tests
Routine
SARS-CoV-2
Transmission (medicine)
business.industry
Prevention
Incidence (epidemiology)
Risk of infection
COVID-19
Articles
Emerging Infectious Diseases
Good Health and Well Being
030104 developmental biology
Infectious Diseases
Medical Microbiology
Rapid antigen test
Carrier State
Emergency medicine
Cohort
Public Health and Health Services
medicine.symptom
Infection
business
human activities
Zdroj: The Lancet. Infectious Diseases
The Lancet. Infectious diseases, vol 21, iss 7
ISSN: 1474-4457
1473-3099
Popis: Summary Background Routine viral testing strategies for SARS-CoV-2 infection might facilitate safe airline travel during the COVID-19 pandemic and mitigate global spread of the virus. However, the effectiveness of these test-and-travel strategies to reduce passenger risk of SARS-CoV-2 infection and population-level transmission remains unknown. Methods In this simulation study, we developed a microsimulation of SARS-CoV-2 transmission in a cohort of 100 000 US domestic airline travellers using publicly available data on COVID-19 clinical cases and published natural history parameters to assign individuals one of five health states of susceptible to infection, latent period, early infection, late infection, or recovered. We estimated a per-day risk of infection with SARS-CoV-2 corresponding to a daily incidence of 150 infections per 100 000 people. We assessed five testing strategies: (1) anterior nasal PCR test within 3 days of departure, (2) PCR within 3 days of departure and 5 days after arrival, (3) rapid antigen test on the day of travel (assuming 90% of the sensitivity of PCR during active infection), (4) rapid antigen test on the day of travel and PCR test 5 days after arrival, and (5) PCR test 5 days after arrival. Strategies 2 and 4 included a 5-day quarantine after arrival. The travel period was defined as 3 days before travel to 2 weeks after travel. Under each scenario, individuals who tested positive before travel were not permitted to travel. The primary study outcome was cumulative number of infectious days in the cohort over the travel period without isolation or quarantine (population-level transmission risk), and the key secondary outcome was the number of infectious people detected on the day of travel (passenger risk of infection). Findings We estimated that in a cohort of 100 000 airline travellers, in a scenario with no testing or screening, there would be 8357 (95% uncertainty interval 6144–12831) infectious days with 649 (505–950) actively infectious passengers on the day of travel. The pre-travel PCR test reduced the number of infectious days from 8357 to 5401 (3917–8677), a reduction of 36% (29–41) compared with the base case, and identified 569 (88% [76–92]) of 649 actively infectious travellers on the day of flight; the addition of post-travel quarantine and PCR reduced the number of infectious days to 1474 (1087–2342), a reduction of 82% (80–84) compared with the base case. The rapid antigen test on the day of travel reduced the number of infectious days to 5674 (4126–9081), a reduction of 32% (26–38) compared with the base case, and identified 560 (86% [83–89]) actively infectious travellers; the addition of post-travel quarantine and PCR reduced the number of infectious days to 2518 (1935–3821), a reduction of 70% (67–72) compared with the base case. The post-travel PCR alone reduced the number of infectious days to 4851 (3714–7679), a reduction of 42% (35–49) compared with the base case. Interpretation Routine asymptomatic testing for SARS-CoV-2 before travel can be an effective strategy to reduce passenger risk of infection during travel, although abbreviated quarantine with post-travel testing is probably needed to reduce population-level transmission due to importation of infection when travelling from a high to low incidence setting. Funding University of California, San Francisco.
Databáze: OpenAIRE
Externí odkaz: