Abstract
BackgroundA considerable proportion of SARS-CoV-2 transmission occurs from asymptomatic and pre-symptomatic cases. Therefore, different polymerase chain reaction (PCR)- or rapid antigen test (RAT)-based approaches are being discussed and applied to identify infectious individuals that would have otherwise gone undetected. In this article, we provide a framework to estimate the time-dependent risk of being infectious after a negative SARS-CoV-2 test, and we simulate the number of expected infectious individuals over time in populations who initially tested negative.MethodsA Monte Carlo approach is used to simulate asymptomatic infections over a 10-days period in populations of 1000 individuals following a negative SARS-CoV-2 test. Parameters representing the application of PCR tests or RATs are utilized, and SARS-CoV-2 cumulative 7-day incidences between 25 and 200 per 100,000 people are considered. Simulation results are compared to case numbers predicted via a mathematical equation.ResultsThe simulations showed a continuous increase in infectious individuals over time in populations of individuals who initially tested SARS-CoV-2 negative. The interplay between false negative rates of PCR tests or RATs, and the time that has passed since testing determines the number of infectious individuals. The simulated and the mathematically predicted number of infectious individuals were comparable. However, Monte Carlo simulations highlight that, due to random variation, theoretically observed infectious individuals can considerably exceed predicted case numbers even shortly after a test was conducted.ConclusionsThis study demonstrates that the number of infectious individuals in a screened group of asymptomatic people can be effectively reduced, and this effect can be described mathematically. However, the false negative rate of a test, the time since the negative test and the underlying SARS-CoV-2 incidence are critical parameters in determining the observed subsequent number of cases in tested population groups.
Highlights
A considerable proportion of SARS-CoV-2 transmission occurs from asymptomatic and presymptomatic cases
Where polymerase chain reaction (PCR) test scenarios are calculated, the 12-h offset to infectiousness must be considered; if 0 < t ≤ 12 h, t = 0, else t = t-12
More than 4 infectious individuals were observed after 115 h, 84 h, 49 h, and 21 h in simulations based on cumulative 7-day incidences of 25, 50, 100 and 200 cases per 100,000 people, respectively
Summary
A considerable proportion of SARS-CoV-2 transmission occurs from asymptomatic and presymptomatic cases. Krumkamp et al BMC Medical Research Methodology (2021) 21:165 risk settings like nursing homes, to reduce unnecessary quarantine of non-infectious people, or to lift social contacts restrictions e.g., to permit care home visiting, travelling, restaurant visits or leisure time activities) [3]. For such measures to be effective, laboratory tests would ideally be done in real-time, as the test result reflects the current state of infectiousness of an individual. As time since testing increases, individuals with a previous negative test result will have the same risk of being infectious as the underlying population
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