An Innovative Non-Pharmaceutical Intervention to Mitigate SARS-CoV02 Spread: Probability Sampling to Identify and Isolate Asymptomatic Cases

  1. Nathalie E. Williams
  2. Xiaozheng Yao
  3. Ankita Pal
  4. Xiaolu Qian
  5. Mansi Rathod
  6. Chang Xu
  7. Adrian Dobra

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Abstract

Studies estimate that a substantial proportion of SARS-CoV-2 transmission occurs through individuals who do not exhibit symptoms. Mitigation strategies test only those who are moderately to severely symptomatic, excluding the substantial portion of cases that are asymptomatic yet still infectious and likely responsible for a large proportion of the virus’ spread ( 1-8 ). While isolating asymptomatic cases will be necessary to effectively control viral spread, these cases are functionally invisible and there is no current method to identify them for isolation. To address this major omission in COVID-19 control, we develop a strategy, Sampling-Testing-Quarantine ( STQ ), for identifying and isolating individuals with asymptomatic SARS-CoV-2 in order to mitigate the epidemic. STQ uses probability sampling in the general population, regardless of symptoms, then isolates the individuals who test positive along with their household members who are high probability for asymptomatic infections. To test the potential efficacy of STQ , we use an agent-based model, designed to computationally simulate the epidemic in the Seattle with infection parameters, like R 0 and asymptomatic fraction, derived from population data. Our results suggest that STQ can substantially slow and decrease the spread of COVID-19, even in the absence of school and work shutdowns. Results also recommend which sampling techniques, frequency of implementation, and population subject to isolation are most efficient in reducing spread with limited numbers of tests.

Significance Statement

A substantial portion of SARS-CoV-2 infections are spread through asymptomatic carriers. Until a vaccine is developed, research indicates an urgent need to identify these asymptomatic infections to control COVID-19, but there is currently no effective strategy to do so. In this study, we develop such a strategy, a procedure called S ampling-Testing-Quarantine ( STQ ), that combines techniques from survey methods for sampling from the general population and testing and isolation techniques from epidemiology. With computational simulations, we demonstrate that STQ procedures can dramatically decrease and slow COVID-19 spread, even in the absence of widespread work, school, and community lockdowns. We also find particular implementation strategies (including sampling techniques, frequencies of implementation, and people who are subject to isolation) are most efficient in mitigating spread.

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    SciScore for 10.1101/2020.10.07.20208686: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.1101/2020.10.07.20208686 on medRxiv