Abstract
The COVID-19 epidemic can probably be ended and normal life restored, perhaps quite quickly, by weekly SARS-CoV-2 RNA testing together with household quarantine and systematic contact tracing. Isolated outbreaks could then be contained by contact tracing, supplemented if necessary by temporary local reintroduction of population testing or lockdown. Leading public health experts have recommended that this should be tried in a demonstration project in which a medium-sized city introduces weekly testing and lifts lockdown completely. The idea was not considered by the groups whose predictions have guided UK policy, so we have examined the statistical case for such a study. The combination of regular testing with strict household quarantine, which was not analysed in their models, has remarkable power to reduce transmission to the community from other household members as well as providing earlier diagnosis and facilitating rapid contact tracing.
Highlights
Julian Peto1, James Carpenter1, George Davey Smith2, Stephen Duffy3, Richard Houlston4, David J
The combination of regular testing with strict household quarantine, which was not analysed in their models, has remarkable power to reduce transmission to the community from other household members as well as providing earlier diagnosis and facilitating rapid contact tracing
Box 1. 10 million tests per day are needed for weekly testing of the UK population. This is feasible with single-step RT-LAMP on saliva samples, which requires minimal equipment and training
Summary
Viral RNA testing of the whole population with strict quarantine for households when an infection is detected has been proposed as a practical way to end lockdown while controlling the epidemic [1,2]. Isothermal singlestep RT-LAMP [6] (reverse transcriptase loop amplification) is an economical high-throughput alternative that is at least three times faster than conventional RT-PCR (reverse transcriptase polymerase chain reaction) for detecting SARS-CoV-2 RNA and does not require expensive equipment or expert staff This could be implemented worldwide with saliva samples as soon as an adequate supply of reagents can be manufactured (box 1). Implementation details for weekly sample collection and quarantine arrangements in a demonstration study and in subsequent national roll-out were outlined in an open letter to the UK Government on 10 April [2], with an estimated cost over a few months at about £1 billion per month for weekly testing of the whole UK population This is a small fraction of the long-term economic costs of a continuing epidemic. Subsequent evidence that RT-LAMP testing on saliva self-samples is a viable (and cheaper) alternative to RT-PCR on nasal/throat swabs meets the two main logistical objections to that original proposal
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