As a consequence, the use of surveillance testing to identify infectious individuals presents one possible means to break enough transmission chains to suppress the ongoing pandemic and reopen societies, with or without a vaccine. Critically, the ability of SARS-CoV-2 to spread from individuals who are pre-symptomatic, symptomatic, or essentially asymptomatic means that diagnosis and isolation based on symptoms alone will be unable to prevent ongoing spread.
Successful surveillance testing of SARS-CoV-2 depends on understanding both the dynamics of spread between individuals and the dynamics of the virus within the human body.
We therefore conclude that surveillance should prioritize accessibility, frequency, and sample-to-answer time analytical limits of detection should be secondary. These results demonstrate that effective surveillance depends largely on frequency of testing and the speed of reporting, and is only marginally improved by high test sensitivity. Given the pattern of viral load kinetics, we model surveillance effectiveness considering test sensitivities, frequency, and sample-to-answer reporting time. After infection, individuals undergo a period of incubation during which viral titers are usually too low to detect, followed by an exponential viral growth, leading to a peak viral load and infectiousness, and ending with declining viral levels and clearance. Because SARS-CoV-2 can spread from individuals with pre-symptomatic, symptomatic, and asymptomatic infections, the re-opening of societies and the control of virus spread will be facilitated by robust surveillance, for which virus testing will often be central. The COVID-19 pandemic has created a public health crisis.
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