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. 2021 Mar 1;72(5):e128-e135.
doi: 10.1093/cid/ciaa1802.

Identification of Presymptomatic and Asymptomatic Cases Using Cohort-Based Testing Approaches at a Large Correctional Facility-Chicago, Illinois, USA, May 2020

Ashutosh Wadhwa  1   2 , Kiva A Fisher  1   3 , Rachel Silver  1   4 , Mitsuki Koh  1   4 , Melissa M Arons  1   3 , David A Miller  1 , Anne F McIntyre  1 , Jeni T Vuong  1 , Kaylee Kim  1 , Mayuko Takamiya  1 , Alison M Binder  1 , Jacqueline E Tate  1 , Paige A Armstrong  1 , Stephanie R Black  5 , Connie C Mennella  6   7 , Rebecca Levin  8 , Jane Gubser  8 , Bridgette Jones  6   7 , Sharon F Welbel  7 , Patrick K Moonan  1 , Kathryn Curran  1 , Isaac Ghinai  1   3   5 , Reena Doshi  1 , Chad J Zawitz  6   7
Affiliations

Identification of Presymptomatic and Asymptomatic Cases Using Cohort-Based Testing Approaches at a Large Correctional Facility-Chicago, Illinois, USA, May 2020

Ashutosh Wadhwa et al. Clin Infect Dis. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) continues to cause significant morbidity and mortality worldwide. Correctional and detention facilities are at high risk of experiencing outbreaks. We aimed to evaluate cohort-based testing among detained persons exposed to laboratory-confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in order to identify presymptomatic and asymptomatic cases.

Methods: During 1-19 May 2020, 2 testing strategies were implemented in 12 tiers or housing units of the Cook County Jail, Chicago, Illinois. Detained persons were approached to participate in serial testing (n = 137) and offered tests at 3 time points over 14 days (day 1, days 3-5, and days 13-14). The second group was offered a single test and interview at the end of a 14-day quarantine period (day 14 group) (n = 87).

Results: 224 detained persons were approached for participation and, of these, 194 (87%) participated in ≥1 interview and 172 (77%) had ≥1 test. Of the 172 tested, 19 were positive for SARS-CoV-2. In the serial testing group, 17 (89%) new cases were detected, 16 (84%) on day 1, 1 (5%) on days 3-5, and none on days 13-14; in the day 14 group, 2 (11%) cases were identified. More than half (12/19; 63%) of the newly identified cases were presymptomatic or asymptomatic.

Conclusions: Our findings highlight the utility of cohort-based testing promptly after initiating quarantine within a housing tier. Cohort-based testing efforts identified new SARS-CoV-2 asymptomatic and presymptomatic infections that may have been missed by symptom screening alone.

Keywords: COVID-19; SARS-CoV-2; correctional facilities; serial testing.

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Figures

Figure 1.
Figure 1.
Flow diagram of the number of detained persons tested, interviewed, and refused in the serial testing cohort: Cook County Jail, Chicago, Illinois—May 2020. Serial testing was conducted in 7 tiers (housing units) at 3 time points over 14 days (day 1, days 3–5, and days 13–14). Detained persons who were cohorted and placed under quarantine due to exposure to a recent laboratory-confirmed case were approached to participate in the investigation. Eligible detained persons either interviewed and tested, only interviewed, or refused both. Detained persons with a positive test result were isolated and followed for clinical observation: those with negative test result were contacted again on later time points.
Figure 2.
Figure 2.
Number and percentage of detained persons reporting symptoms in 2 weeks prior to testing, by SARS-CoV-2 test result: Cook County Jail, Chicago, Illinois—May 2020. *152 detained persons tested negative; 1 detainee refused interview at all visits and is excluded from Figure 2. Abbreviation: SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

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