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Universal Community Nucleic Acid Testing for COVID-19 in Hong Kong Reveals Insights into Transmission Dynamics

34 Pages Posted: 18 May 2021

See all articles by Bingyi Yang

Bingyi Yang

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Tim K. Tsang

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Huizhi Gao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Eric H.Y. Lau

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Yun Lin

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Faith Ho

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Jingyi Xiao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Jessica Y. Wong

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Dillon C. Adam

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Qiuyan Liao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Peng Wu

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Benjamin J. Cowling

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Gabriel Leung

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

More...

Abstract

Background: Testing of an entire community has been used as an approach to control COVID-19. In Hong Kong, a universal community testing programme (UCTP) was implemented at the fadeout phase of a community epidemic in July to September 2020, to determine the prevalence of unrecognised cases and limit any remaining transmission chains. We described the utility of the UCTP in finding unrecognised cases, and analysed data from the UCTP and other sources to characterise transmission dynamics.

Methods: We described the characteristics of people participating in the UCTP, and compared the clinical and epidemiological characteristics of COVID-19 cases detected by the UCTP versus those detected by clinical diagnosis and public health surveillance. We developed a Bayesian model to estimate the age-specific incidence of infection and the proportion of cases detected by clinical diagnosis and public health surveillance.

Findings: 1.77 million people, 24% of the Hong Kong population, participated in the UCTP from 1 to 14 September 2020. The UCTP identified 32 new infections (1.8 per 100,000 samples tested), consisting of 29% of all local cases reported during the two-week UCTP period. Compared with the existing clinical diagnosis and public health surveillance, the UCTP detected a higher proportion of sporadic cases (62% versus 27%, p <0.01) and identified 6 (out of 18) additional transmission chains during that period. We estimated that 27% (95% credible interval: 22%, 34%) of all infections were detected by the existing clinical diagnosis and public health surveillance in the third wave.

Interpretation: We reported empirical evidence of the utility of population-wide COVID-19 testing in detecting unrecognised infections and transmission chains. Around three quarters of infections have not been identified through existing surveillance approaches including contact tracing.

Funding Statement: This project was supported by the Health and Medical Research Fund, Food and Health Bureau, Government of the Hong Kong Special Administrative Region (grant no. COVID190118).

Declaration of Interests: BJC consults for Roche, Sanofi Pasteur, GSK and Moderna. The authors report no other potential conflicts of interest.

Ethics Approval Statement: Our project was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB).

Suggested Citation

Yang, Bingyi and Tsang, Tim K. and Gao, Huizhi and Lau, Eric H.Y. and Lin, Yun and Ho, Faith and Xiao, Jingyi and Wong, Jessica Y. and Adam, Dillon C. and Liao, Qiuyan and Wu, Peng and Cowling, Benjamin J. and Leung, Gabriel, Universal Community Nucleic Acid Testing for COVID-19 in Hong Kong Reveals Insights into Transmission Dynamics. Available at SSRN: https://ssrn.com/abstract=3844899 or http://dx.doi.org/10.2139/ssrn.3844899

Bingyi Yang

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Tim K. Tsang

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Huizhi Gao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Hong Kong
China

Eric H.Y. Lau

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Yun Lin

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Hong Kong
China

Faith Ho

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Hong Kong
China

Jingyi Xiao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Jessica Y. Wong

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Dillon C. Adam

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Qiuyan Liao

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Peng Wu (Contact Author)

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

Hong Kong
China

Benjamin J. Cowling

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

7 Sassoon Road
Hong Kong
China
+852 3917 6711 (Phone)

Gabriel Leung

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Hong Kong
China