Smart Investment of Virus RNA Testing Resources to Enhance Covid-19 Mitigation

Covid-19 mitigation commonly involves contact tracing (CT) and social distancing. Due to its high economic toll and its impact on personal freedom, we need to ease social distancing and deploy alternative measures, while preventing further waves of infections. While reliable mass testing (for virus RNA) would require too many resources to be effective, CT, which focuses on isolating symptomatic cases and their contacts, has been implemented in many countries. However, the latter approach has reduced efficiency when high numbers of positive patients are burdening the tracing centers. Moreover, CT misses transmissions by asymptomatic cases. Therefore, its effect in reducing the reproduction number has a theoretical limit. To improve effectiveness of contact tracing, we propose to complement it with a strategy relying on identifying and testing symptom free subgroups with a significantly higher than average virus prevalence. We call this smart testing (ST). By testing everybody in these subgroups, in addition to symptomatic cases, also large fractions of pre- and asymptomatic persons can be identified, which enhances the effectiveness of contact tracing. High prevalence subgroups can be found in different ways, which are discussed in this paper. A particularly efficient way is via preselection using cheap and fast virus antigen tests, as proposed recently. Mathematical modeling quantifies the potential reduction of the reproduction number by such a two-stage ST strategy. In addition to global scenarios, also more realistic local applications of two-stage ST have been investigated, that is, within counties, institutions, schools, companies, etc., where members have internal as well as external contacts. All involved model parameters have been varied within realistic ranges and results are presented with probabilities. Even with the most pessimistic parameter set, these results suggest that the effect of two-stage ST on the reproduction number would clearly outweigh its economic cost. Two-stage ST is technically and logistically feasible. Further, it is locally effective also when only applied within small local subpopulations. Thereby, two-stage ST efficiently complements the portfolio of mitigation strategies, which allow easing social distancing without compromising public health. Single Sentence Summary Identification of high prevalence groups within subpopulations to enhance detection rate of Covid-19 infections by virus RNA tests combined with subsequent isolation.