Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening

• Published in: Science advances Vol. 7; no. 1
• Main Authors: Larremore, Daniel B., Wilder, Bryan, Lester, Evan, Shehata, Soraya, Burke, James M., Hay, James A., Tambe, Milind, Mina, Michael J., Parker, Roy
• Format: Journal Article
• Language: English
• Published: United States American Association for the Advancement of Science 01.01.2021
• Subjects: Asymptomatic Infections; Calibration; Computer Simulation; Coronavirus; COVID-19 - diagnosis; COVID-19 Nucleic Acid Testing; Diseases and Disorders; Epidemics; Epidemiology; Humans; Kinetics; Limit of Detection; Mass Screening - methods; Models, Theoretical; Polymerase Chain Reaction; Reproducibility of Results; SciAdv r-articles; Sensitivity and Specificity; Time Factors; Viral Load
• ISSN: 2375-2548; 2375-2548
• DOI: 10.1126/sciadv.abd5393

Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening. The COVID-19 pandemic has created a public health crisis. Because SARS-CoV-2 can spread from individuals with presymptomatic, symptomatic, and asymptomatic infections, the reopening of societies and the control of virus spread will be facilitated by robust population screening, for which virus testing will often be central. After infection, individuals undergo a period of incubation during which viral titers are too low to detect, followed by exponential viral growth, leading to peak viral load and infectiousness and ending with declining titers and clearance. Given the pattern of viral load kinetics, we model the effectiveness of repeated population screening considering test sensitivities, frequency, and sample-to-answer reporting time. These results demonstrate that effective screening depends largely on frequency of testing and speed of reporting and is only marginally improved by high test sensitivity. We therefore conclude that screening should prioritize accessibility, frequency, and sample-to-answer time; analytical limits of detection should be secondary.