Population-scale testing can suppress the spread of infectious disease
Population-scale testing can suppress the spread of infectious disease
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人群规模检测可以抑制传染病的传播
DOI：
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
S. Linnarsson
中科院分区：
文献类型：
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作者：
J. Taipale;Ioannis Kontoyiannis;S. Linnarsson
预防疾病带来了公共卫生方面的重大进步。然而，由于疫苗和药物开发的缓慢进程，通过接种疫苗或药物来预防一种新的传染病变得困难。我们在此建议采取额外的干预措施，以便能够迅速控制新出现的传染病，并可用于根除几乎完全依赖于人与人之间传播的疾病。干预的基础是：(1)对每个人进行疾病检测，(2)反复，(3)隔离受感染的人。我们在这里表明，在足够的测试和隔离速度下，繁殖次数R0减少到1.0以下，流行病将迅速崩溃。该方法不依赖于关于检测准确性、对隔离的遵从性、人口结构或流行病学参数的强烈或不切实际的假设，并且可以通过测量检测阳性率随时间的变化来实时监测其成功。除了符合率和假阴性率外，所需的测试率取决于测试制度的设计，同时测试的效果优于对个人进行随机抽样。如果迅速得到结果，抑制疫情所需的测试频率对于R0、感染期和易感个体的比例是单调和近线性的。重要的是，检测制度将对早期和已确定的流行病有效，并作为其他干预措施的补充，如接触者追踪和社会距离。我们表明，这种方法对失败也是健壮的--任何速度的检测都会减少人群中感染的人数，从而改善公共卫生和经济条件。这些结论是基于严格的分析和对适当的流行病学模型的模拟。可以在家中使用的大规模生产的一次性抗原或基因测试将是理想的，因为同时测试的最佳性能可以立即返回结果。
Major advances in public health have resulted from prevention of disease. However, prevention of a new infectious disease by vaccination or pharmaceuticals is made difficult by the slow process of vaccine and drug development. We propose here an additional intervention that would allow rapid control of emerging infectious diseases, and could also be used to eradicate diseases that rely almost exclusively on human-to-human transmission. The intervention is based on: (1) testing every individual for the disease, (2) repeatedly, and (3) isolation of infected individuals. We show here that at a sufficient rate of testing and isolation, the reproduction number R0 is reduced below 1.0, and the epidemic will rapidly collapse. The approach does not rely on strong or unrealistic assumptions about test accuracy, compliance to isolation, population structure or epidemiological parameters, and its success can be monitored in real time by measuring the change of the test positivity rate over time. In addition to the rate of compliance and false negatives, the required rate of testing is dependent on the design of the testing regime, with concurrent testing outperforming random sampling of individuals. Provided that results are obtained rapidly, the test frequency required to suppress an epidemic is monotonic and near-linear with respect to R0, to the infectious period, and to the fraction of susceptible individuals. Importantly, the testing regime would be effective against both early phase and established epidemics, and additive to other interventions such as contact tracing and social distancing. We show that the approach is also robust to failure – any rate of testing reduces the number of infected individuals in the population, improving both public health and economic conditions. These conclusions are based on rigorous analysis as well as simulations of appropriate epidemiological models. A mass-produced, disposable antigen or genetic test that could be used at home would be ideal, due to the optimal performance of concurrent tests that return immediate results.