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Optimizing testing for COVID-19 in India.
PLoS Comput Biol. 2021 07; 17(7):e1009126.PC

Abstract

COVID-19 testing across India uses a mix of two types of tests. Rapid Antigen Tests (RATs) are relatively inexpensive point-of-care lateral-flow-assay tests, but they are also less sensitive. The reverse-transcriptase polymerase-chain-reaction (RT-PCR) test has close to 100% sensitivity and specificity in a laboratory setting, but delays in returning results, as well as increased costs relative to RATs, may vitiate this advantage. India-wide, about 49% of COVID-19 tests are RATs, but some Indian states, including the large states of Uttar Pradesh (pop. 227.9 million) and Bihar (pop. 121.3 million) use a much higher proportion of such tests. Here we show, using simulations based on epidemiological network models, that the judicious use of RATs can yield epidemiological outcomes comparable to those obtained through RT-PCR-based testing and isolation of positives, provided a few conditions are met. These are (a) that RAT test sensitivity is not too low, (b) that a reasonably large fraction of the population, of order 0.5% per day, can be tested, (c) that those testing positive are isolated for a sufficient duration, and that (d) testing is accompanied by other non-pharmaceutical interventions for increased effectiveness. We assess optimal testing regimes, taking into account test sensitivity and specificity, background seroprevalence and current test pricing. We find, surprisingly, that even 100% RAT test regimes should be acceptable, from both an epidemiological as well as a economic standpoint, provided the conditions outlined above are met.

Authors+Show Affiliations

Department of Physics, Ashoka University, Sonepat, Haryana, India.Simons Centre for the Study of Living Machines, National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore, Karnataka, India.Department of Physics, Ashoka University, Sonepat, Haryana, India. Department of Biology, Ashoka University, Sonepat, Haryana, India. Theoretical Physics and Computational Biology Groups, The Institute of Mathematical Sciences, Taramani, Chennai, India. Homi Bhabha National Institute, Mumbai, India.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34292931

Citation

Cherian, Philip, et al. "Optimizing Testing for COVID-19 in India." PLoS Computational Biology, vol. 17, no. 7, 2021, pp. e1009126.
Cherian P, Krishna S, Menon GI. Optimizing testing for COVID-19 in India. PLoS Comput Biol. 2021;17(7):e1009126.
Cherian, P., Krishna, S., & Menon, G. I. (2021). Optimizing testing for COVID-19 in India. PLoS Computational Biology, 17(7), e1009126. https://doi.org/10.1371/journal.pcbi.1009126
Cherian P, Krishna S, Menon GI. Optimizing Testing for COVID-19 in India. PLoS Comput Biol. 2021;17(7):e1009126. PubMed PMID: 34292931.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimizing testing for COVID-19 in India. AU - Cherian,Philip, AU - Krishna,Sandeep, AU - Menon,Gautam I, Y1 - 2021/07/22/ PY - 2021/01/21/received PY - 2021/05/28/accepted PY - 2021/7/22/entrez PY - 2021/7/23/pubmed PY - 2021/8/6/medline SP - e1009126 EP - e1009126 JF - PLoS computational biology JO - PLoS Comput Biol VL - 17 IS - 7 N2 - COVID-19 testing across India uses a mix of two types of tests. Rapid Antigen Tests (RATs) are relatively inexpensive point-of-care lateral-flow-assay tests, but they are also less sensitive. The reverse-transcriptase polymerase-chain-reaction (RT-PCR) test has close to 100% sensitivity and specificity in a laboratory setting, but delays in returning results, as well as increased costs relative to RATs, may vitiate this advantage. India-wide, about 49% of COVID-19 tests are RATs, but some Indian states, including the large states of Uttar Pradesh (pop. 227.9 million) and Bihar (pop. 121.3 million) use a much higher proportion of such tests. Here we show, using simulations based on epidemiological network models, that the judicious use of RATs can yield epidemiological outcomes comparable to those obtained through RT-PCR-based testing and isolation of positives, provided a few conditions are met. These are (a) that RAT test sensitivity is not too low, (b) that a reasonably large fraction of the population, of order 0.5% per day, can be tested, (c) that those testing positive are isolated for a sufficient duration, and that (d) testing is accompanied by other non-pharmaceutical interventions for increased effectiveness. We assess optimal testing regimes, taking into account test sensitivity and specificity, background seroprevalence and current test pricing. We find, surprisingly, that even 100% RAT test regimes should be acceptable, from both an epidemiological as well as a economic standpoint, provided the conditions outlined above are met. SN - 1553-7358 UR - https://www.unboundmedicine.com/medline/citation/34292931/Optimizing_testing_for_COVID-19_in_India. L2 - https://dx.plos.org/10.1371/journal.pcbi.1009126 DB - PRIME DP - Unbound Medicine ER -