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Background Nursing homes and other long-term care facility (LTCF) settings have borne a disproportionately large burden from the ongoing COVID-19 pandemic, as the combination of age and increased comorbidities place LTCF residents at high risk of severe disease and death [1]. The difficulty of keeping SARS-CoV-2 out of facilities increases with the prevalence of infections in the surrounding community. Even in “locked down” facilities where residents do not leave or receive visitors, facility staff in an infectious but asymptomatic or presymptomatic state can unknowingly transmit infection to residents for whom they provide care [2]. Transmission among LTCF staff has been well documented [3], and transmission between residents can be difficult to avoid, particularly in wards where contact restrictions are difficult or impossible to successfully implement, such as in dementia units [4]. Testing to identify infected LTCF residents or staff is an important tool for outbreak mitigation, as identified cases and their prior facility contacts can be isolated or furloughed to prevent further spread. However, LTCFs relying on symptom-based testing have still experienced explosive outbreaks with many transmissions occurring before any positive test result [5]. Regular surveillance testing of asymptomatic individuals could be an effective strategy to identify and interrupt “silent” outbreaks earlier. However, because frequent testing can pose a substantial financial and logistical burden, it is critical that a surveillance strategy be efficient, to maximize the riskreduction benefit of each test.

Efficient SARS-CoV-2 surveillance strategies to prevent deadly outbreaks in vulnerable populations