Comprehensive case finding, repeat testing, and apps for contact tracing and self-isolation also key

Border controls, restricted entry, and quarantine for inbound travellers are essential for stopping not just COVID-19, but any future pandemic, in its tracks, finds a review of the available published evidence on early infection control in the online journal BMJ Open.

Comprehensive case finding, repeat testing to rule out false results, apps and use of GPS data to enable contact tracing and self isolation, as well as financial support are also key elements in any policies to curb the spread of infection.

While various elements of a find, test, trace, isolate, and support (FTTIS) system have long been core elements of public health, COVID-19 infection has some specific characteristics, such as silent transmission, a strong age gradient in disease severity, plus other features that remain poorly understood, say the researchers.

To inform future pandemic strategy and improve the design and implementation of current systems, the researchers systematically reviewed international studies, published in the English language, which evaluated contact tracing, testing, self-isolation and quarantine on COVID-19 management.

Some 118 studies, covering the periods May 2019 to May 2020, June 2020, and January 2021, were included in the review.

The results showed that the best strategies for a successful FTTIS to rapidly control COVID-19 (and other pandemics) early on include:

• Border controls, restricted entry, and inbound traveller quarantine
• Testing those most at risk, such as healthcare workers and care home residents
• Repurposing an existing laboratory network plus creating new testing sites to meet demand. Pooled testing can be used to improve testing efficiency; repeated testing to minimise falsely negative results
• Use of smartphone apps and GPS data for contact tracing and monitoring compliance with self-isolation
• Timely and adequate information to reduce uncertainty and anxiety; financial support to enable people to stick to infection control regulations
• Seamless integration of all the components; linked health service data at local, regional, and national level through real-time data sharing and dashboards
• Regular press conferences by the central outbreak control team to update the public on the progress of the pandemic, changes in policies and to correct misinformation
• Open and balanced discussions on public concerns, such as personal data privacy, protection, and curbs on personal freedoms for the public good
• Short to medium term plans, with regular reviews to respond rapidly to emerging challenge

“Our findings can inform policy in future pandemics,” conclude the researchers. And they “may inform countries considering implementing these measures.”