Reactive vs. Early Detection

Testing and quarantining individuals with a high risk of recent infection stands as one of the foundational pillars of the nonpharmaceutical interventions to control the ongoing COVID-19 (SARS-CoV-2) pandemic.  Continued isolation of symptomatic cases and test-positive cases, combined with contact tracing, the process of identifying potentially infected persons who may have come into contact with an infected person (“contacts”) and subsequent testing of these persons, to reduce infections in the population has been the standard protocol for most governments.  Tracing of contacts has been used as an early COVID-19 containment measure in many countries, with additional physical distancing measures introduced as outbreaks have grown. Effective contact tracing remains essential.  Most governments are taking various steps to maintain control of infections while attempting to minimize disruption to populations. There is still a need for best practices to understand what combination of measures, including contact, digital tracing, and other methodologies will be required as attempts to restart the economy are now in the 3rd, 4th, or 5th wave of the COVID-19 pandemic, depending upon where you live.

This is important, especially given that the actual number of people infected with coronavirus—and able to spread it to others—may be five to 10 times greater than the number of confirmed cases, the New York Times reported this week, summarizing new research published in the journal Science. The study, “Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2),” emphasized how the lack of testing creates pathways for other people to become infected. Most infected carriers have very mild symptoms and can unknowingly transmit the disease to people who can experience life-threatening complications from COVID-19.

However, it is nearly impossible to estimate a reduction in transmission under different control measures, including contact tracing, if many of your infected targets exhibit asymptomatic case incidence(s). Contact tracing is essential, if continued and frequent testing of vulnerable demographics and industries are not facilitated, a super-spreader event can result. (See “Vulnerable Demographics & Vulnerable Industries”). Interviews conducted from March to April 2021, with 30+ health-care systems, including hospitals, urgent care, and state testing facilities, showed that less than 10% of tests were conducted upon high-risk or potentially exposed individuals without symptoms. Less than 1% of tests to high-risk or highly social individuals (e.g., medical workers, teachers, food service, retail, etc.) are repeated to isolate a carrier in quarantine potentially. 

The lack of adoption of weekly COVID test screenings in the U.S. is due to (1) limited FDA approved tests; 2) tests that provide immediate results; (3) cost of the test needs to be lower, with most tests running from $8-$21; (4) many tests require a Clinical Laboratory Improvement Amendments (“CLIA”)  certified lab to validate the test; (5) a CLIA lab processing the test will take from 24-96 hours; (6) an additional $50-75 in lab fees will be accrued and (7) medical staff may be needed to administer the tests.

Key Takeaways:
  • Testing protocols and contact tracing are foundational tools for symptomatic patients.
  • Testing protocols and contract tracing have not been readily established for asymptomatic case incidence(s).
  • If continued and frequent testing of vulnerable demographics and industries is not facilitated, a super-spreader event can result.
  • Testing has traditionally had limited adoption based upon the time, effort, cost, and regulatory approvals of COVID-19, Antigen-based tests.