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Evaluating COVID-19 screening strategies based on serological tests

Background. Facing the SARS-CoV-2 epidemic requires intensive testing on the population to early identify and isolate infected subjects. Although RT-PCR is the most reliable technique to detect ongoing infections, serological tests are frequently proposed as tools in heterogeneous screening strategies. We analyze the performance of a screening strategy proposed in Tuscany (Italy), which first uses qualitative rapid tests for antibody detection, and then RT-PCR tests on the positive subjects. Methods. We simulate the number of RT-PCR tests required by the screening strategy and the undetected ongoing infections in a pseudo-population of 500000 subjects, under different prevalence scenarios and assuming a sensitivity of the serological test ranging from 0.50 to 0.80 (specificity=0.98). A compartmental model is used to predict the number of new infections generated by the false negatives two months after the screening, under different values of the infection reproduction number. Results. Assuming a sensitivity equal to 0.80 and a prevalence of 0.3%, the screening procedure would require on average 11167.6 RT-PCR tests and would produce 300 false negatives, responsible after two months of a number of contagions ranging from 526 to 1132, under the optimistic scenario of a reproduction number between 0.5 to 1. Costs and false negatives increase with the prevalence. Conclusions. The analyzed screening procedure should be avoided unless the prevalence and the rate of contagion are very low. The cost and effectiveness of the screening strategies should be evaluated in the actual context of the epidemic, accounting for the fact that it may change over time.