Testing for COVID-19 is Much More Effective When Performed Immediately Prior to Social Mixing

Abstract

Objective: To quantify the utility of RT-PCR and rapid antigen tests in preventing post-arrival transmission based on timing of the pre-departure test. Methods: We derived analytical expressions to compute post-arrival transmission when no test is performed, and when either an RT-PCR or any of 18 rapid antigen tests is performed at specified times before arrival. We determined the diagnostic sensitivity of the rapid antigen tests by propagating their RT-PCR percent positive agreement onto known RT-PCR diagnostic sensitivity. Results: Depending on the rapid antigen test used, conducting a rapid antigen test immediately before departure reduces post-arrival transmission between 37.4% (95% CrI: 28.2%-40.7%) and 46.7% (95% CrI:40.0%-49.3%), compared to a 31.1% (95% CrI: 26.3%-33.5%) reduction using an RT-PCR 12 h before arrival. Performance of each rapid antigen test differed by diagnostic sensitivity over the course of disease. However, these differences were smaller than those engendered by testing too early. Conclusion: Testing closer to arrival-ideally on the day of arrival-is more effective at reducing post-arrival transmission than testing earlier. Rapid antigen tests perform the best in this application due to their short turnaround time.

Keywords: COVID-19; RT-PCR; event safety; post-arrival transmission; rapid antigen test; travel medicine; travel safety.

FIGURE 1

The post-arrival transmission for pre-arrival testing. Specifying an incubation period of 3.1 days, an RT-PCR diagnostic sensitivity based on data from Hellewell et al [24], and 35.1% infections as asymptomatic throughout disease, we calculated (A) the reduction in the post-arrival transmission compared to no pre-departure testing and (B) the probability of post-arrival transmission for a basic reproduction number of 6.93 when there is no pre-departure testing (gray dotted line), or when there is pre-departure testing using an RT-PCR test (black solid line), the BD Veritor (purple dashed line), BinaxNOW (red dashed line), CareStart (blue dashed line), LumiraDx (yellow dashed line), and Sofia (green dashed line) rapid antigen test conducted at departure or any previous day, up to 7 days prior to departure (United States, 2021–2022).