Background: Contact tracing is commonly recommended to control outbreaks of COVID-19, but its effectiveness is unclear. This systematic review aimed to examine contact tracing effectiveness in the context of COVID-19. Methods: Following PRISMA guidelines, MEDLINE, Embase, Global Health, and All EBM Reviews were searched using a range of terms related to contact tracing for COVID-19. Articles were included if they reported on the ability of contact tracing to slow or stop the spread of COVID-19 or on characteristics of effective tracing efforts. Two investigators screened all studies. Results: A total of 32 articles were found. All were observational or modelling studies, so the quality of the evidence was low. Observational studies (n=14) all reported that contact tracing (alone or in combination with other interventions) was associated with better control of COVID-19. Results of modelling studies (n=18) depended on their assumptions. Under assumptions of prompt and thorough tracing with no further transmission, they found that contact tracing could stop an outbreak (e.g. by reducing the reproduction number from 2.2 to 0.57) or that it could reduce infections (e.g. by 24%-71% with a mobile tracing app). Under assumptions of slower, less efficient tracing, modelling studies suggested that tracing could slow, but not stop COVID-19. Conclusions: Observational and modelling studies suggest that contact tracing is associated with better control of COVID-19. Its effectiveness likely depends on a number of factors, including how many and how fast contacts are traced and quarantined, and how effective quarantines are at preventing further transmission. A cautious interpretation suggests that to stop the spread of COVID-19, public health practitioners have 2-3 days from the time a new case develops symptoms to isolate the case and quarantine at least 80% of its contacts, and that once isolated, cases and contacts should infect zero new cases. Less efficient tracing may slow, but not stop, the spread of COVID-19. Inefficient tracing (with delays of 4-5+ days or less than 60% of contacts quarantined with no further transmission) may not contribute meaningfully to control of COVID-19.

Background In an unparalleled global response, during the COVID-19 pandemic, 90 countries asked 3.9 billion people to stay home. Yet other countries avoided lockdowns and focused on other strategies, like contact tracing. How effective and cost-effective are these strategies? We aimed to provide a comprehensive summary of the evidence on past pandemic controls, with a focus on cost-effectiveness. Methods Following PRISMA guidelines, MEDLINE (1946 to April week 2, 2020) and EMBASE (1974 to April 17, 2020) were searched using a range of terms related to pandemic control. Articles reporting on the effectiveness or cost-effectiveness of at least one intervention were included. Results We found 1653 papers; 62 were included. The effectiveness of hand-washing and face masks was supported by randomized trials. These measures were highly cost-effective. For other interventions, only observational and modelling studies were found. They suggested that (1) the most cost-effective interventions are swift contact tracing and case isolation, surveillance networks, protective equipment for healthcare workers, and early vaccination (when available); (2) home quarantines and stockpiling antivirals are less cost-effective; (3) social distancing measures like workplace and school closures are effective but costly, making them the least cost-effective options; (4) combinations are more cost-effective than single interventions; and (5) interventions are more cost-effective when adopted early. For 2009 H1N1 influenza, contact tracing was estimated to be 4363 times more cost-effective than school closure ($2260 vs. $9,860,000 per death prevented). Conclusions and contributions For COVID-19, a cautious interpretation suggests that (1) workplace and school closures are effective but costly, especially when adopted late, and (2) scaling up as early as possible a combination of interventions that includes hand-washing, face masks, ample protective equipment for healthcare workers, and swift contact tracing and case isolation is likely to be the most cost-effective strategy.

No abstract

No abstract