Optimizing COVID-19 surveillance in long-term care facilities: a modelling study
Bibliographic record
Abstract
ABSTRACT Background Long-term care facilities (LTCFs) are vulnerable to COVID-19 outbreaks. Timely epidemiological surveillance is essential for outbreak response, but is complicated by a high proportion of silent (non-symptomatic) infections and limited testing resources. Methods We used a stochastic, individual-based model to simulate SARS-CoV-2 transmission along detailed inter-individual contact networks describing patient-staff interactions in real LTCF settings. We distributed nasopharyngeal swabs and RT-PCR tests using clinical and demographic indications, and evaluated the efficacy and resource-efficiency of a range of surveillance strategies, including group testing (sample pooling) and testing cascades, which couple (i) testing for multiple indications (symptoms, admission) with (ii) random daily testing. Results In the baseline scenario, randomly introducing SARS-CoV-2 into a 170-bed LTCF led to large outbreaks, with a cumulative 86 (6-224) infections after three weeks of unmitigated transmission. Efficacy of symptom-based screening was limited by (i) lags between infection and symptom onset, and (ii) silent transmission from asymptomatic and pre-symptomatic infections. Testing upon admission detected up to 66% of patients silently infected upon LTCF entry, but missed potential introductions from staff. Random daily testing was more effective when targeting patients than staff, but was overall an inefficient use of limited resources. At high testing capacity (>1 test/10 beds/day), cascades were most effective, with a 22-52% probability of detecting outbreaks prior to any nosocomial transmission, and 38-63% prior to first onset of COVID-19 symptoms. Conversely, at low capacity (<1 test/85 beds/day), pooling randomly selected patients in a daily group test was most effective (9-15% probability of detecting outbreaks prior to transmission; 30-44% prior to symptoms). The most efficient strategy compared to the reference was to pool individuals with any COVID-like symptoms, requiring only 5-7 additional tests and 17-24 additional swabs to detect outbreaks 5-6 days earlier, prior to an additional 14-18 infections. Conclusions Group testing is an effective and efficient COVID-19 surveillance strategy for resource-limited LTCFs. Cascades are even more effective given ample testing resources. Increasing testing capacity and updating surveillance protocols accordingly could facilitate earlier detection of emerging outbreaks, informing a need for urgent intervention in settings with ongoing nosocomial transmission.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".