Linking Statistics with Testing Policy to Manage COVID-19 in the Community

Published in: American Journal of Clinical Pathology, Volume 154, Issue 2, pages 142–148 (August 2020). doi: 10.1093/ajcp/aqaa099

Posted on RAND.org on August 04, 2020

by Lee H. Hilborne, Zachary Wagner, Irineo Cabreros, Robert H. Brook

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Objectives

To determine the public health surveillance severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing volume needed, both for acute infection and seroprevalence.

Methods

Required testing volumes were developed using standard statistical methods based on test analytical performance, disease prevalence, desired precision, and population size.

Results

Widespread testing for individual health management cannot address surveillance needs. The number of people who must be sampled for public health surveillance and decision making, although not trivial, is potentially in the thousands for any given population or subpopulation, not millions.

Conclusions

While the contributions of diagnostic testing for SARS-CoV-2 have received considerable attention, concerns abound regarding the availability of sufficient testing capacity to meet demand. Different testing goals require different numbers of tests and different testing strategies; testing strategies for national or local disease surveillance, including monitoring of prevalence, receive less attention. Our clinical laboratory and diagnostic infrastructure are capable of incorporating required volumes for many local, regional, and national public health surveillance studies into their current and projected testing capacity. However, testing for surveillance requires careful design and randomization to provide meaningful insights.

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