the effectiveness of population wide rapid antigen test based screening in reducing CORD-Papers-2022-06-02 (Version 1)

Title: The effectiveness of population-wide rapid antigen test based screening in reducing SARS-CoV-2 infection prevalence in Slovakia
Abstract: Non-pharmaceutical interventions have been extensively used worldwide to limit the transmission of SARS-CoV-2 but they also place an enormous social and economic burden on populations . We report the results of recent mass testing for SARS-CoV-2 in Slovakia where rapid antigen tests were used to screen the whole population and to isolate infectious cases together with their household members. Prevalence of detected infections decreased by 58% (95% CI: 57-58%) within one week in the 45 counties that were subject to two rounds of mass testing. Adjusting for geographical clustering and differences in attendance rates and the epidemiological situation at the time of the first round this changed to 61% (95% CI: 50-70%). Adjusting for an estimated growth rate in infections of 4.4% (1.1-6.9%) per day in the week preceding the mass testing campaign and the corresponding expected growth in infection prevalence the estimated decrease in prevalence compared to a scenario of unmitigated growth was 70% (67-73%). Using a microsimulation model we find that this decrease can not be explained solely by infection control measures that were introduced in the weeks preceding the intervention but requires the additional impact of isolation as well as quarantine of household members of those testing positive during the mass testing campaign.
Published: 2020-12-04
DOI: 10.1101/2020.12.02.20240648
DOI_URL: http://doi.org/10.1101/2020.12.02.20240648
Author Name: Pavelka M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/pavelka_m
Author Name: van Zandvoort K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/van_zandvoort_k
Author Name: Abbott S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/abbott_s
Author Name: Sherratt K
Author link: https://covid19-data.nist.gov/pid/rest/local/author/sherratt_k
Author Name: Majdan M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/majdan_m
Author Name: CMMID COVID working group
Author link: https://covid19-data.nist.gov/pid/rest/local/author/cmmid_covid_working_group
Author Name: Institut Zdravotnych Analyz
Author link: https://covid19-data.nist.gov/pid/rest/local/author/institut_zdravotnych_analyz
Author Name: Jarcuska P
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jarcuska_p
Author Name: Krajci M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/krajci_m
Author Name: Flasche S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/flasche_s
Author Name: Funk S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/funk_s
sha: e4e725d145eb927ce6613df1e2ef1c37bdd2778d
license: medrxiv
source_x: MedRxiv; WHO
source_x_url: https://www.who.int/
url: http://medrxiv.org/cgi/content/short/2020.12.02.20240648v1?rss=1 https://doi.org/10.1101/2020.12.02.20240648
has_full_text: TRUE
Keywords Extracted from Text Content: SARS-CoV-2 medRxiv Slovakia 50,466 individuals non-household I C I S Slovakia. i j β eigenvalue Covid-19 Bardejov bank volunteers UNWPP lines Prem calcium alginate swabs Považská Bystrica test-positives lockdown p i m Slovakia in SARS-CoV CDF Nasal swabs contacts R e =1.4 matrix ′ Tvrdošín at-school contacts lockdown β Oct medRxiv preprint seed solid lines saPR https://github.com/kevinvzandvoort/covid_svk Figure S2 left nasopharyngeal samples Slovakia • pre-infectious t I S stratum Slovakija W ij * SARS-CoV-2 contact matrix aluminum-shaft z t z t = N attend,t N eligible 1 Wald-Normal W W ij t S Figure S6 NUTS 3 regions dark-green I P I S I C Slovakia t I C Red E I P blue dots Figure 2 samples Námestovo R e =1 extra-household SARS-CoV-2 ( 1 -4 ) COVID-19 B nasal swabs j. aquaparks 2-6 Figure S5 β Figure 3 R E * R e C p medRxiv participants nasopharyngeal swabs Figure 1 people https://doi.org/10.1101/2020.12.02.20240648 doi COVID-19 patients non-pilot ○ children lockdowns UNWPP, 2019 volunteers participants
Extracted Text Content in Record: First 5000 Characters:Non-pharmaceutical interventions have been extensively used worldwide to limit the transmission of SARS-CoV-2, but they also place an enormous social and economic burden on populations . We report the results of recent mass testing for SARS-CoV-2 in Slovakia where rapid antigen tests were used to screen the whole population and to isolate infectious cases together with their household members. Prevalence of detected infections decreased by 58% (95% CI: 57-58%) within one week in the 45 counties that were subject to two rounds of mass testing. Adjusting for geographical clustering and differences in attendance rates and the epidemiological situation at the time of the first round, this changed to 61% (95% CI: 50-70%). Adjusting for an estimated growth rate in infections of 4.4% (1.1-6.9%) per day in the week preceding the mass testing campaign and the corresponding expected growth in infection prevalence, the estimated decrease in prevalence compared to a scenario of unmitigated growth was 70% (67-73%). Using a microsimulation model we find that this decrease can not be explained solely by infection control measures that were introduced in the weeks preceding the intervention, but requires the additional impact of isolation as well as quarantine of household members of those testing positive during the mass testing campaign. In total, 5,276,832 rapid antigen tests were used in the mass testing campaigns, with 65% of the respective populations tested in the pilot, 66% in mass testing round 1 and 62% round 2. This corresponded to 87%, 83% and 84% of the age-eligible population in each round, respectively, and does not include another 534,300 tests that were conducted through additional testing sites for medical, military and governmental personnel and not included in geographical county data. A total of 50,466 tests indicated the presence of a currently infectious SARS-CoV-2 infection. The proportion of positive tests was 3.91% (range across counties: 3.12 to 4.84%) in the pilot, 1.01% (range: 0.13-3.22%) in round 1 and 0.62% (range: 0.28-1.65%) in . CC-BY 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) Non-pharmaceutical interventions have been extensively used worldwide to limit the transmission of SARS-CoV-2 ( 1 -4 ) . These have included travel restrictions, mandating face masks, closure of schools and non-essential businesses, and nationwide stay-at-home orders. While all the measures were aimed at mitigating ill-health due to 5 ) they also place an unprecedented economic and social burden on people ( 6 -9 ) , the majority uninfected. Testing of reported symptomatic cases and tracing their contacts aims to provide a more targeted measure but in many settings has proven insufficient for containing transmission ( 10 , 11 ) . Mass testing campaigns are an alternative way to identify infectious individuals and allow targeting of interventions without much added burden to those uninfectious ( 12 ) . However, they have been limited until recently by the dependence on Polymerase Chain Reaction (PCR) for the diagnosis of a SARS-CoV-2 infection. While laboratory capacities have been upscaled in record time, PCR testing remains expensive and can seldom achieve a turnaround time of less than one day ( 13 , 14 ) . In comparison, recently developed rapid antigen tests are cheap and can be quickly produced in large quantities offering results on site in 15-30 mins without the need for a laboratory. They are less sensitive in detecting infections with low viral load but have been found to detect the vast majority of infectious infections, and hence may make mass testing a viable part of the portfolio of non-pharmaceutical interventions ( 15 -17 ) . In October 2020, Slovakia became the first country in the world to use rapid antigen tests in a campaign targeting the whole population in order to identify infections at scale, rapidly reduce transmission and allow quicker easing of lockdown measures ( 18 ) . A pilot took place between 23 and 25 October in the four most affected counties, followed by a round of national mass testing on 31 October and 1 November (henceforth: round 1). High prevalence counties were again targeted with a subsequent round on 7 and 8 November (round 2). We evaluated the impact of mass testing in Slovakia, in combination with other measures put in place around the time, by comparing infection prevalence in each round of testing. round 2 ( Figure 2C and D). We estimate that with 95% certainty the specificity of the SD Biosensor Standard Q antigen test was exceeding 99.85%. In the four counties where the pilot was conducted, prevalence decreased by 56% (95% Confidence Interval, CI: 54-58%) between the pilot and round 1 of the mass testing campaign and a further 60% (95% CI: 56-63%) between rounds 1 and 2, totalling a decrease of 82% (95% CI: 81-83%) over two
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