Evaluating the Need for Routine COVID-19 Testing of Emergency Department Staff: Quantitative Analysis

  1. Yuemei Zhang
  2. Sheng-Ru Cheng

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Abstract

As the number of COVID-19 cases in the US continues to increase and hospitals experience shortage of personal protective equipment (PPE), health care workers have been disproportionately affected. However, since COVID-19 testing is now easily available, there is a need to evaluate whether routine testing should be performed for asymptomatic health care workers.

Objective

This study aimed to provide a quantitative analysis of the predicted impact that regular testing of health care workers for COVID-19 may have on the prevention of the disease among emergency department patients and staff.

Methods

Using publicly available data on COVID-19 cases and emergency department visits, as well as internal hospital staffing information, we developed a mathematical model to predict the impact of periodic COVID-19 testing of asymptomatic staff members of the emergency department in COVID-19–affected regions. We calculated various transmission constants based on the Diamond Princess cruise ship data, used a logistic model to calculate new infections, and developed a Markov model based on the average incubation period for COVID-19.

Results

Our model predicts that after 180 days, with a transmission constant of 1.219e-4 new infections/person2, weekly COVID-19 testing of health care workers would reduce new health care worker and patient infections by approximately 3%-5.9%, and biweekly testing would reduce infections in both by 1%-2.1%. At a transmission constant of 3.660e-4 new infections/person2, weekly testing would reduce infections by 11%-23% and biweekly testing would reduce infections by 5.5%-13%. At a lower transmission constant of 4.067e-5 new infections/person2, weekly and biweekly COVID-19 testing for health care workers would result in an approximately 1% and 0.5%-0.8% reduction in infections, respectively.

Conclusions

Periodic COVID-19 testing for emergency department staff in regions that are heavily affected by COVID-19 or are facing resource constraints may significantly reduce COVID-19 transmission among health care workers and previously uninfected patients.

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    SciScore for 10.1101/2020.04.28.20084053: (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: We detected the following sentences addressing limitations in the study:
    A limitation of our model is that we do not know the actual transmission rate in various hospital emergency departments, and transmission rates may vary widely between hospitals based on PPE supply, type of interactions with patients and severity of illness (which also impacts the types of procedures and therapies involved), and other factors. Additionally, the transmission rate may be different for different types of healthcare workers: for instance, those who perform aerosolizing procedures like intubation may experience a higher rate of transmission. By changing the initial parameters, this model can be adapted for different ED visit rates, different ED staffing numbers, different levels of infection prevalence, different transmission constants, and different levels of testing sensitivity. Lower levels of testing sensitivity will lead to decreased utility in periodic HCW testing. In addition, our analysis was performed with the population characteristics of a county that is moderately affected by COVID-19. Currently, there are many regions of the country with a much higher COVID-19 prevalence, which would lead to a greater potential benefit from periodic HCW testing to prevent HCW infections. Due to the current state of COVID-19 testing, US statistics on confirmed COVID-19 cases may not be the most reliable, either. Per CDC guidelines that were last updated March 24,2020, laboratory testing for COVID-19 is only indicated for individuals who are not healthcare workers nor f...

    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 10.2196/20260
  3. Version published to 10.2196/preprints.20260
  4. Version published to 10.1101/2020.04.28.20084053v1 on medRxiv