Volta

Fundamental limits to the effectiveness of traveler screening with molecular tests

Abstract Despite the appeal of screening travelers during emerging infectious disease outbreaks, evidence shows that syndromic and questionnaire-based programs are largely ineffective in preventing or delaying the geographic spread of infection. Molecular tests offer high sensitivity and specificity, and can detect infections earlier than symptom screening, suggesting potential for improved outcomes, yet molecular tests were used to screen travelers for COVID-19 with mixed success. To investigate why screening for COVID-19 was not more successful, and to quantify the limits of screening for other pathogens of concern, we developed a probabilistic model that incorporates within-host viral kinetics. We then evaluated the potential effectiveness of screening travelers with molecular tests for influenza A, SARS-CoV-1, SARS-CoV-2, and Ebola virus. Even under highly optimistic …

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