Abstract
Healthcare facilities are vulnerable to SARS-CoV-2 introductions and subsequent nosocomial outbreaks. Antigen rapid diagnostic testing (Ag-RDT) is widely used for population screening, but its health and economic benefits as a reactive response to local surges in outbreak risk are unclear. We simulate SARS-CoV-2 transmission in a long-term care hospital with varying COVID-19 containment measures in place (social distancing, face masks, vaccination). Across scenarios, nosocomial incidence is reduced by up to 40-47% (range of means) with routine symptomatic RT-PCR testing, 59-63% with the addition of a timely round of Ag-RDT screening, and 69-75% with well-timed two-round screening. For the latter, a delay of 4-5 days between the two screening rounds is optimal for transmission prevention. Screening efficacy varies depending on test sensitivity, test type, subpopulations targeted, and community incidence. Efficiency, however, varies primarily depending on underlying outbreak risk, with health-economic benefits scaling by orders of magnitude depending on the COVID-19 containment measures in place.
Highlights
Healthcare facilities are vulnerable to SARS-CoV-2 introductions and subsequent nosocomial outbreaks
Following a simulated surge in SARS-CoV-2 outbreak risk, nosocomial incidence varied across longterm care facilities (LTCFs) depending on the COVID-19 containment measures in place (Fig. 1)
Low-control LTCF 1 experienced exponential epidemic growth driven by patient-dominated clusters, by two weeks reaching a mean cumulative number of incident nosocomial SARS-CoV-2 infections I= 28.9
Summary
Healthcare facilities are vulnerable to SARS-CoV-2 introductions and subsequent nosocomial outbreaks. Into 2022, widespread postholiday, inter-generational population movement in the context of variants like Delta and B.1.1.529 (Omicron) may pose similar concerns[16] In such a context where local knowledge or epidemiological data indicate a suspected spike in epidemic risk, or where identification of a new case or exposed contact within a healthcare facility indicates potential for a nosocomial outbreak, reactive use of antigen rapid diagnostic testing (Ag-RDT) may be an efficient public health response. We aim to help determine the best surveillance strategies for control of SARS-CoV-2 transmission in healthcare facilities in the context of a surge in nosocomial outbreak risk To this end, we adapt a simulation model and assess the epidemiological efficacy and health-economic efficiency of single or repeated AgRDT screening coupled with routine symptomatic reverse transcriptase polymerase chain reaction (RT-PCR) testing. Simulated Ag-RDT screening interventions are conceptualized as reactive public health responses, conducted in a long-term care hospital with varying COVID-19 containment measures in place
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