Effectivity and Efficiency of repeat testing of Health care workers (HCW) for SARS-CoV-2

Abstract

On the 9th of January 2021 roughly 240 new infection cases with SARS-CoV-2 per day were detected in China, about 24.000 in Germany and 240.000 in the United States. The Chinese government declared the province to be under martial law, Germany has a lockdown where people are asked not to travel- if they do so the should self-quarantine or maybe they risk a fine and in the United States there are various restrictions and recommendations. There is no doubt that draconic measures are most efficient in order to control the spreading of the virus, but martial law as an answer to pandemic infection is considered to be incompatible with western democratic rules and constitutions. We will have to find a way in order to reduce both the morbidity and mortality due to the pandemic and the political, socioeconomic and psychological consequences. It is known that asymptomatic SARS-CoV-2 carriers can spread the infection. Asymptomatic people may carry the virus and stay asymptomatic throughout the infection or they are presymptomatic, that means they develop clinical symptoms on the day of PCR-testing or later onwards. Within a hospital, there are 6 different ways for transmission of infection: - the symptomatic, SARS-CoV-2 positive patient to another patient (i) or to healthcare workers (HCW) (ii); - asymptomatic patients to another patient (iii) or to asymptomatic HCW (iv) and - finally asymptomatic HCW to other fellow HCW (v) or to asymptomatic patients (vi). Nowadays, with deep knowledge about COVID-19 among HCWs and a vast availability of personal protection equipment, the first two possibilities play an insignificant role. Every possible routine measure is taken in order to reduce the risk of bringing COVID-19 into the hospital (iii and iv), e.g. outpatient visits are restricted to those with negative medical history for any clinical symptoms, risk factors, travel history and no fever measured at point of care; elective patients undergo an operation only if delaying operative therapy for more than three months will lead to death or irreversible deterioration of the disease and if they present with a negative PCR not older tan 72 hours; visits from friends and relatives are banned. So spread of infection by asymptomatic HCWs, infection routes (v) and (vi), is of serious concern.