Background

The importance of mass testing and surveillance as basis to end lockdown and normalise social life has recently been highlighted (amongst others):

• McClellan M, Gottlieb S, Mostashari F, Rivers C, Silvis L. A National COVID19 Surveillance System: Achieving Containment. Duke-Margolis Center for Health Policy; Durham, NC, USA; 2020. [Accessed: 04 May 2020].
• Shah P. Testing Is Our Way Out; 2020. [Accessed: 04 May 2020].
• Peto J, Alwan NA, Godfrey KM, et al. Universal weekly testing as the UK COVID19 lockdown exit strategy. The Lancet. 2020; [Accessed: 04 May 2020].
• Prakash S, Jain A, Rade K. Advisory on feasibility of using pooled samples for molecular testing of COVID-19. Indian Council of Medical Research; 2020. [Accessed: 04 May 2020].
• Peto J. Covid-19 mass testing facilities could end the epidemic rapidly. BMJ. 2020;368:m1163. [Accessed: 04 May 2020].
• Edmond J Safra Center for Ethics at Harvard University. Roadmap to Pandemic Resilience. Harvard University; Boston, MA, USA; 2020. [Accessed: 04 May 2020].
• Rubin EJ, Baden LR, Morrissey S. Audio Interview: Loosening Covid-19 Restrictions. New England Journal of Medicine. 2020;382(18):e67. [Accessed: 04 May 2020].

This online tool is based on the following preprint:

Evaluation of Pool-based Testing Approaches to Enable Population-wide Screening for COVID-19

Timo de Wolff^{* 1,2}, Dirk Pflüger^{* 1,3}, Michael Rehme³, Janin Heuer², Martin-Immanuel Bittner^1,4

^* Contributed equally
¹ = Die Junge Akademie (German National Young Academy), Berlin, Germany
² = Technical University of Braunschweig, Germany
³ = University of Stuttgart, Germany
⁴ = Arctoris, Oxford, UK

Available as a preprint at https://arxiv.org/abs/2004.11851.

Abstract

Background: Rapid testing for an infection is paramount during a pandemic to prevent continued viral spread and excess morbidity and mortality. This study aimed to determine whether alternative testing strategies based on sample pooling can increase the speed and throughput of screening for SARS-CoV-2.

Methods: A mathematical modelling approach was chosen to simulate six different testing strategies based on key input parameters (infection rate, test characteristics, population size, testing capacity etc.). The situations in five countries (US, Germany, UK, Italy and Singapore) currently experiencing COVID-19 outbreaks were simulated to reflect a broad variety of population sizes and testing capacities. The primary study outcome measurements that were finalised prior to any data collection were time and number of tests required; number of cases identified; and number of false positives.

Findings: The performance of all tested methods depends on the input parameters, i.e. the specific circumstances of a screening campaign. To screen one tenth of each country's population at an infection rate of 1% - e.g. when prioritising frontline medical staff and public workers -, realistic optimised testing strategies enable such a campaign to be completed in ca. 29 days in the US, 71 in the UK, 25 in Singapore, 17 in Italy and 10 in Germany (ca. eight times faster compared to individual testing). When infection rates are considerably lower, or when employing an optimal, yet logistically more complex pooling method, the gains are more pronounced. Pool-based approaches also reduces the number of false positive diagnoses by 50%.

Interpretation The results of this study provide a clear rationale for adoption of pool-based testing strategies to increase speed and throughput of testing for SARS-CoV-2. The current individual testing approach unnecessarily wastes valuable time and resources.

Funding: Die Junge Akademie (German National Young Academy); German Research Foundation.