An intra-host SARS-CoV-2 dynamics model to assess testing and quarantine strategies for incoming travelers, contact management, and de-isolation.

ABSTRACT

Non-pharmaceutical interventions (NPIs) remain decisive tools to contain SARS-CoV-2. Strategies that combine NPIs with testing may improve efficacy and shorten quarantine durations. We developed a stochastic within-host model of SARS-CoV-2 that captures temporal changes in test sensitivities, incubation periods, and infectious periods. We used the model to simulate relative transmission risk for (1) isolation of symptomatic individuals, (2) contact person management, and (3) quarantine of incoming travelers. We estimated that testing travelers at entry reduces transmission risks to 21.3% ([20.7, 23.9], by PCR) and 27.9% ([27.1, 31.1], by rapid diagnostic test [RDT]), compared with unrestricted entry. We calculated that 4 (PCR) or 5 (RDT) days of pre-test quarantine are non-inferior to 10 days of quarantine for incoming travelers and that 8 (PCR) or 10 (RDT) days of pre-test quarantine are non-inferior to 14 days of post-exposure quarantine. De-isolation of infected individuals 13 days after symptom onset may reduce the transmission risk to <0.2% (<0.01, 6.0).