Assessment of SARS-CoV-2 Screening Strategies to Permit the Safe Reopening of College Campuses in the United States
Assessment of SARS-CoV-2 Screening Strategies to Permit the Safe Reopening of College Campuses in the United States
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DOI：
10.1001/jamanetworkopen.2020.16818
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发表时间：
2020-07-31
影响因子：
13.8
通讯作者：
Walensky, Rochelle P.
中科院分区：
文献类型：
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作者：
Paltiel, A. David;Zheng, Amy;Walensky, Rochelle P.
这项分析建模研究定义了严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）测试的筛选性能标准，该标准将允许学生在2020年秋季学期安全返回美国住宿大学校园。什么样的严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）筛查和隔离计划能保证美国寄宿学院学生的安全，并允许校园重新开放？对4990名未感染SARS-CoV-2的大学生和10名未发现无症状SARS-CoV-2感染病例的大学生进行的假设队列分析建模研究表明，可能需要对所有学生进行低灵敏度、高特异性的筛查（每2天），以合理的成本控制疫情，管理隔离宿舍的使用。在这项建模研究中，仅基于症状的筛查不足以遏制疫情，2020年秋季校园的安全重新开放可能需要每2天筛查一次，保持毫不妥协的警惕，并持续关注良好的预防措施。2019冠状病毒病（COVID-19）大流行对许多美国寄宿学院构成了生存威胁；他们要么在9月份向学生敞开大门，要么冒着严重的经济后果。目的制定严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）筛查绩效标准，使学生能够在2020年秋季学期安全返回美国住宿大学校园。本分析建模研究包括一个假设的队列，包括4990名未感染SARS-CoV-2的学生和10名在学期开始时未被发现的无症状SARS-CoV-2感染的学生。决策和成本效益分析与一个区隔流行病模型相关联，以评估基于症状的筛查和不同频率（即每1、2、3和7天）、敏感性（即70%-99%）、特异性（即98%-99.7%）和成本（即10美元/次- 50美元/次）的检测。生殖数（R-t）分别为1.5、2.5和3.5，定义了3种流行情景，并通过外源性冲击输入了额外的感染。该模型假设有症状的病例死亡风险为0.05%，感染最终导致队列中可观察到的covid -19定义症状的概率为30%。模型预测的是为期80天的2020年秋季学期。本研究遵循美国政府对参数化数据的指导。累积检测、感染和成本；每日隔离宿舍普查；增量成本效益;以及预算影响。结果在学期开始时，假设队列中有5000名学生，其中4990名（99.8%）未感染SARS-CoV-2, 10名（0.2%）感染SARS-CoV-2。假设R(t)为2.5，每日筛查的灵敏度为70%，则特异性为98%的检测结果为162名累计学生感染，平均隔离宿舍每日普查为116名，其中21名学生（18%）为真阳性结果。每2天筛查一次，累计感染243例，平均每日隔离普查76例，其中28名学生（37%）为真阳性结果。每7天筛查一次，累计感染1840例，平均每日隔离普查121例，真阳性108例（90%）。在所有情况下，测试频率与累积感染的关系比测试敏感性更强。在我们考虑的任何情况下，该模型并未确定仅基于症状的筛查就足以控制疫情。成本效益分析选择每2天、1天或7天进行一次灵敏度为70%的筛查作为首选策略，R(t)分别为2.5、3.5或1.5，这意味着每个学生每学期的筛查成本分别为470美元、910美元或120美元。在这项分析建模研究中，每2天进行一次快速、廉价、甚至低灵敏度（>70%）的筛查，再加上严格的行为干预，使R(t)小于2.5，估计可以保持可控的COVID-19感染人数，并允许学生安全返回校园。
This analytic modeling study defines the screening performance standards for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests that would permit the safe return of students to US residential college campuses for the fall 2020 semester.Question What screening and isolation programs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will keep students at US residential colleges safe and permit the reopening of campuses? Findings This analytic modeling study of a hypothetical cohort of 4990 college-age students without SARS-CoV-2 infection and 10 students with undetected asymptomatic cases of SARS-CoV-2 infection suggested that frequent screening (every 2 days) of all students with a low-sensitivity, high-specificity test might be required to control outbreaks with manageable isolation dormitory utilization at a justifiable cost. Meaning In this modeling study, symptom-based screening alone was not sufficient to contain an outbreak, and the safe reopening of campuses in fall 2020 may require screening every 2 days, uncompromising vigilance, and continuous attention to good prevention practices.Importance The coronavirus disease 2019 (COVID-19) pandemic poses an existential threat to many US residential colleges; either they open their doors to students in September or they risk serious financial consequences. Objective To define severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening performance standards that would permit the safe return of students to US residential college campuses for the fall 2020 semester. Design, Setting, and Participants This analytic modeling study included a hypothetical cohort of 4990 students without SARS-CoV-2 infection and 10 with undetected, asymptomatic SARS-CoV-2 infection at the start of the semester. The decision and cost-effectiveness analyses were linked to a compartmental epidemic model to evaluate symptom-based screening and tests of varying frequency (ie, every 1, 2, 3, and 7 days), sensitivity (ie, 70%-99%), specificity (ie, 98%-99.7%), and cost (ie, $10/test-$50/test). Reproductive numbers (R-t) were 1.5, 2.5, and 3.5, defining 3 epidemic scenarios, with additional infections imported via exogenous shocks. The model assumed a symptomatic case fatality risk of 0.05% and a 30% probability that infection would eventually lead to observable COVID-19-defining symptoms in the cohort. Model projections were for an 80-day, abbreviated fall 2020 semester. This study adhered to US government guidance for parameterization data. Main Outcomes and Measures Cumulative tests, infections, and costs; daily isolation dormitory census; incremental cost-effectiveness; and budget impact. Results At the start of the semester, the hypothetical cohort of 5000 students included 4990 (99.8%) with no SARS-CoV-2 infection and 10 (0.2%) with SARS-CoV-2 infection. Assuming an R(t)of 2.5 and daily screening with 70% sensitivity, a test with 98% specificity yielded 162 cumulative student infections and a mean isolation dormitory daily census of 116, with 21 students (18%) with true-positive results. Screening every 2 days resulted in 243 cumulative infections and a mean daily isolation census of 76, with 28 students (37%) with true-positive results. Screening every 7 days resulted in 1840 cumulative infections and a mean daily isolation census of 121 students, with 108 students (90%) with true-positive results. Across all scenarios, test frequency was more strongly associated with cumulative infection than test sensitivity. This model did not identify symptom-based screening alone as sufficient to contain an outbreak under any of the scenarios we considered. Cost-effectiveness analysis selected screening with a test with 70% sensitivity every 2, 1, or 7 days as the preferred strategy for an R(t)of 2.5, 3.5, or 1.5, respectively, implying screening costs of $470, $910, or $120, respectively, per student per semester. Conclusions and Relevance In this analytic modeling study, screening every 2 days using a rapid, inexpensive, and even poorly sensitive (>70%) test, coupled with strict behavioral interventions to keep R(t)less than 2.5, is estimated to maintain a controllable number of COVID-19 infections and permit the safe return of students to campus.