Bringing COVID-19 home for Christmas: a need for enhanced testing in healthcare institutions after the holidays

Festive gatherings this 2020 holiday season threaten to cause a surge in new cases of novel coronavirus disease 2019 (COVID-19). Hospitals and long-term care facilities are key hotspots for COVID-19 outbreaks, and may be at elevated risk as patients and staff return from holiday celebrations in the community. Some settings and institutions have proposed fortified post-holiday testing regimes to mitigate this risk. We use an existing model to assess whether implementing a single round of post-holiday screening is sufficient to detect and manage holiday-associated spikes in COVID-19 introductions to the long-term care setting. We show that while testing early helps to detect cases prior to potential onward transmission, it likely to miss a substantial share of introductions owing to false negative test results, which are more probable early in infection. We propose a two-stage post-holiday testing regime as a means to maximize case detection and mitigate the risk of nosocomial COVID-19 outbreaks into the start of the new year. Whether all patients and staff should be screened, or only community-exposed patients, depends on available testing capacity: the former will be more effective, but also more resource-intensive.