While the most recent Omicron surge and a steady stream of variants make it hard to believe, the COVID-19 pandemic won’t last forever — but what comes next? As public health bodies at the global and local levels work to prevent disease spread through practical measures, a consistent approach to adapting policies as case counts decline over time will prove essential.
A recent article in Frontiers in Public Health maps a strategy to help address this need, including expert-driven tactics for managing COVID-19’s shift to an endemic state. The authors tackle how to determine when an endemic state is reached, and — since SARS-CoV-2 is unlikely to ever go away completely — outline detailed testing recommendations to consider moving forward.
The diverse role of COVID-19 testing in transitioning to an endemic state
Vaccination and immunity from past infection are certainly critical elements to controlling the spread of COVID-19. However, with new variants, vaccine hesitancy, and avoidance of recommended public health measures, such as masking and social distancing, new cases will continue to emerge, making testing an important tool well into the future. As we work to transition out of the pandemic, three different approaches to testing are needed simultaneously, each with unique use cases.
- Testing symptomatic individuals
Testing of those who are symptomatic has been and will remain an area of focus throughout the endemic transition. Even when case counts are low, diagnostic tests are key to identifying COVID-19 positive patients who should quarantine and possibly initiate time-sensitive antiviral therapy. In general, due to its improved accuracy over antigen tests, experts encourage a shift to PCR testing for diagnostics where resources allow for it and offer alternative options where they don’t.
- Screening groups of asymptomatic patients
In certain high-risk settings, testing groups of asymptomatic patients can help protect the vulnerable while also providing broader public health insights with declining case counts. While PCR tests offer higher sensitivity and specificity, the authors explain why rapid antigen tests can play an important role in screening and what population characteristics support the use of these tests.
- Surveillance of population samples
SARS-CoV-2 is changing over time, introducing the risk of different COVID-19 disease characteristics, compromised protection from previous infection and/or vaccination, as well as decreased efficacy of treatments. Any of these variant effects could compromise an endemic state, making tracking of SARS-CoV-2 changes essential both in the near-term transitional period and likely well into the future. The article highlights technologies that can be used for this purpose, including accessible, cost-effective solutions to support key surveillance efforts.
Even after an endemic state is reached, experts say testing should remain an area of focus, including multiplex panels for a range of respiratory viruses as well as the potential use of antibody testing to determine immunity. They emphasize the global community’s unique opportunity to leverage current momentum and recent advances in PCR testing to build capacity and further enhance technologies. These efforts will prove critical in ensuring the global community effectively navigates out of the current pandemic and is prepared to manage any future threat of infectious disease.
Read the Frontiers in Public Health article for more detailed information on how we should strategically adapt testing strategies once the pandemic phase of COVID-19 nears its end.