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Optimal use of COVID-19 Ag-RDT screening at border crossings to prevent community transmission: A modeling analysis

Author

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  • Joshua M Chevalier
  • Karla Therese L Sy
  • Sarah J Girdwood
  • Shaukat Khan
  • Heidi Albert
  • Amy Toporowski
  • Emma Hannay
  • Sergio Carmona
  • Brooke E Nichols

Abstract

Countries around the world have implemented restrictions on mobility, especially cross-border travel to reduce or prevent SARS-CoV-2 community transmission. Rapid antigen testing (Ag-RDT), with on-site administration and rapid turnaround time may provide a valuable screening measure to ease cross-border travel while minimizing risk of local transmission. To maximize impact, we developed an optimal Ag-RDT screening algorithm for cross-border entry. Using a previously developed mathematical model, we determined the daily number of imported COVID-19 cases that would generate no more than a relative 1% increase in cases over one month for different effective reproductive numbers (Rt) and COVID-19 prevalence within the recipient country. We then developed an algorithm—for differing levels of Rt, arrivals per day, mode of travel, and SARS-CoV-2 prevalence amongst travelers—to determine the minimum proportion of people that would need Ag-RDT testing at border crossings to ensure no greater than the relative 1% community spread increase. When daily international arrivals and/or COVID-19 prevalence amongst arrivals increases, the proportion of arrivals required to test using Ag-RDT increases. At very high numbers of international arrivals/COVID-19 prevalence, Ag-RDT testing is not sufficient to prevent increased community spread, especially when recipient country prevalence and Rt are low. In these cases, Ag-RDT screening would need to be supplemented with other measures to prevent an increase in community transmission. An efficient Ag-RDT algorithm for SARS-CoV-2 testing depends strongly on the epidemic status within the recipient country, volume of travel, proportion of land and air arrivals, test sensitivity, and COVID-19 prevalence among travelers.

Suggested Citation

  • Joshua M Chevalier & Karla Therese L Sy & Sarah J Girdwood & Shaukat Khan & Heidi Albert & Amy Toporowski & Emma Hannay & Sergio Carmona & Brooke E Nichols, 2022. "Optimal use of COVID-19 Ag-RDT screening at border crossings to prevent community transmission: A modeling analysis," PLOS Global Public Health, Public Library of Science, vol. 2(5), pages 1-13, May.
    • Handle: RePEc:plo:pgph00:0000086
    DOI: 10.1371/journal.pgph.0000086
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    References listed on IDEAS

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    1. Lukas E Brümmer & Stephan Katzenschlager & Mary Gaeddert & Christian Erdmann & Stephani Schmitz & Marc Bota & Maurizio Grilli & Jan Larmann & Markus A Weigand & Nira R Pollock & Aurélien Macé & Sergio, 2021. "Accuracy of novel antigen rapid diagnostics for SARS-CoV-2: A living systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 18(8), pages 1-41, August.
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