Active testing of groups at increased risk of acquiring SARS-CoV-2 in Canada: costs and human resource needs.

BACKGROUND

Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is largely passive, which impedes epidemic control. We defined active testing strategies for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) for groups at increased risk of acquiring SARS-CoV-2 in all Canadian provinces.

METHODS

We identified 5 groups who should be prioritized for active RT-PCR testing: contacts of people who are positive for SARS-CoV-2, and 4 at-risk populations - hospital employees, community health care workers and people in long-term care facilities, essential business employees, and schoolchildren and staff. We estimated costs, human resources and laboratory capacity required to test people in each group or to perform surveillance testing in random samples.

RESULTS

During July 8-17, 2020, across all provinces in Canada, an average of 41 751 RT-PCR tests were performed daily; we estimated this required 5122 personnel and cost $2.4 million per day ($67.8 million per month). Systematic contact tracing and testing would increase personnel needs 1.2-fold and monthly costs to $78.9 million. Conducted over a month, testing all hospital employees would require 1823 additional personnel, costing $29.0 million; testing all community health care workers and persons in long-term care facilities would require 11 074 additional personnel and cost $124.8 million; and testing all essential employees would cost $321.7 million, requiring 25 965 added personnel. Testing the larger population within schools over 6 weeks would require 46 368 added personnel and cost $816.0 million. Interventions addressing inefficiencies, including saliva-based sampling and pooling samples, could reduce costs by 40% and personnel by 20%. Surveillance testing in population samples other than contacts would cost 5% of the cost of a universal approach to testing at-risk populations.

INTERPRETATION

Active testing of groups at increased risk of acquiring SARS-CoV-2 appears feasible and would support the safe reopening of the economy and schools more broadly. This strategy also appears affordable compared with the $169.2 billion committed by the federal government as a response to the pandemic as of June 2020.

Informations de copyright

© 2020 Joule Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing interests: Alton Russell has provided consulting services to Terumo BCT, a medical device company, unrelated to and outside the submitted work; Terumo BCT does not manufacture diagnostic tests. Stephanie Law is a part-time employee at Carebook Technologies Inc., a mobile app tech company; Carebook Technologies Inc. is currently pilot-testing an app for monitoring symptoms related to coronavirus disease 2019 (COVID-19); this is unrelated to and outside the submitted work. Jonathon Campbell reports that he has received consulting fees from the COVID-19 Immunity Task Force, outside and unrelated to the submitted work. The fees were received and the work performed after initial submission of the present manuscript. Olivia Oxlade reports being Associate Scientific Director (Management) for the COVID-19 Immunity Task Force. All of the work related to this manuscript was done while Dr. Oxlade was part of the McGill International TB Centre and before this position started. Timothy Evans is Executive Director of the COVID-19 Immunity Task Force. No other competing interests were declared.