Efficient SARS-CoV-2 surveillance strategies to prevent deadly outbreaks in vulnerable populations

Karim Khader,Damon J. A. Toth

doi:10.1186/s12916-020-01886-2

Karim Khader, Damon J. A. Toth

Open Access

https://doi.org/10.1186/s12916-020-01886-2

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Abstract

Efficient SARS-CoV-2 surveillance strategies to prevent deadly outbreaks in vulnerable populations

Highlights

In the absence of empirical data to compare different surveillance schemes, mathematical modeling can provide much needed insights on the implications of different options for targeted surveillance, testing frequency, and test types
Smith et al [6] sought to identify optimal testing strategies through the analysis of simulated long-term care facility (LTCF) outbreaks. Their stochastic model simulated LTCF resident and staff interactions based on contact data from prior work employing wearable sensors [7] and quantified transmission and disease progression from COVID19 literature. Their simulation results in the absence of surveillance were consistent with important features of observed outbreaks, including silent introductions of SARS-CoV-2 leading to large outbreaks and realistic resident-to-staff infection ratios
COVID-19 outbreaks even when symptom-based testing and contact restrictions are implemented. This vulnerability is likely to remain for some time, even with LTCF staff being highly prioritized for receiving the first COVID-19 vaccines, as successful vaccine administration will pose significant logistical challenges, in remote locations [9]

Summary

Background

Nursing homes and other long-term care facility (LTCF) settings have borne a disproportionately large burden from the ongoing COVID-19 pandemic, as the combination of age and increased comorbidities place LTCF residents at high risk of severe disease and death [1]. The difficulty of keeping SARS-CoV-2 out of facilities increases with the prevalence of infections in the surrounding community. Transmission among LTCF staff has been well documented [3], and transmission between residents can be difficult to avoid, in wards where contact restrictions are difficult or impossible to successfully implement, such as in dementia units [4]. Testing to identify infected LTCF residents or staff is an important tool for outbreak mitigation, as identified cases and their prior facility contacts can be isolated or furloughed to prevent further spread.

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