Contact tracing is an imperfect tool for controlling COVID-19 transmission and relies on population adherence.
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ABSTRACT:
SUBMITTER: Davis EL
PROVIDER: S-EPMC8438018 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Simultaneously controlling COVID-19 epidemics and limiting economic and societal impacts presents a difficult challenge, especially with limited public health budgets. Testing, contact tracing, and isolating/quarantining is a key strategy that has been used to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 and other pathogens. However, manual contact tracing is a time-consuming process and as case numbers increase a smaller fraction of cases' contacts can be traced, leading to additional virus spread. Delays between symptom onset and being tested (and receiving results), and a low fraction of symptomatic cases being tested and traced can also reduce the impact of contact tracing on transmission. We examined the relationship between increasing cases and delays and the pathogen reproductive number Rt, and the implications for infection dynamics using deterministic and stochastic compartmental models of SARS-CoV-2. We found that Rt increased sigmoidally with the number of cases due to decreasing contact tracing efficacy. This relationship results in accelerating epidemics because Rt initially increases, rather than declines, as infections increase. Shifting contact tracers from locations with high and low case burdens relative to capacity to locations with intermediate case burdens maximizes their impact in reducing Rt (but minimizing total infections may be more complicated). Contact tracing efficacy decreased sharply with increasing delays between symptom onset and tracing and with lower fraction of symptomatic infections being tested. Finally, testing and tracing reductions in Rt can sometimes greatly delay epidemics due to the highly heterogeneous transmission dynamics of SARS-CoV-2. These results demonstrate the importance of having an expandable or mobile team of contact tracers that can be used to control surges in cases. They also highlight the synergistic value of high capacity, easy access testing and rapid turn-around of testing results, and outreach efforts to encourage symptomatic cases to be tested immediately after symptom onset.
| S-EPMC8241027 | biostudies-literature
Project description:Contact tracing is currently one of the most effective measures to contain the COVID-19 pandemic. In order to identify persons that would otherwise not be known or remembered and to keep the time delay when reporting an infection and when contacting people as short as possible, digital contact tracing using smartphones seems to be a reasonable measure additional to manual contact tracing. Although first modelling studies predicted a positive effect in terms of prompt contact tracing, no empirically reliable data are as yet available, neither on the population-wide benefit nor on the potential risks of contact tracing apps. Risk-benefit assessment of such an app includes investigating whether such an app fulfils its purpose, as also research on the effectiveness, risks and side effects, and implementation processes (e.?g. planning and inclusion of different participants). The aim of this article was to give an overview of possible public health benefits as well as technical, social, legal and ethical aspects of a contact-tracing app in the context of the COVID-19 pandemic. Furthermore, conditions for the widest possible use of the app are presented.
| S-EPMC7536383 | biostudies-literature
Project description:Understanding SARS-CoV-2 transmission within and among communities is critical for tailoring public health policies to local context. However, analysis of community transmission is challenging due to a lack of high-resolution surveillance and testing data. Here, using contact tracing records for 644,029 cases and their contacts in New York City during the second pandemic wave, we provide a detailed characterization of the operational performance of contact tracing and reconstruct exposure and transmission networks at individual and ZIP code scales. We find considerable heterogeneity in reported close contacts and secondary infections and evidence of extensive transmission across ZIP code areas. Our analysis reveals the spatial pattern of SARS-CoV-2 spread and communities that are tightly interconnected by exposure and transmission. We find that locations with higher vaccination coverage and lower numbers of visitors to points-of-interest had reduced within- and cross-ZIP code transmission events, highlighting potential measures for curtailing SARS-CoV-2 spread in urban settings.
| S-EPMC9588776 | biostudies-literature
Project description:Understanding SARS-CoV-2 transmission within and among communities is critical for tailoring public health policies to local context. However, analysis of community transmission is challenging due to a lack of high-resolution surveillance and testing data. Here, using contact tracing records for 644,029 cases and their contacts in New York City during the second pandemic wave, we provide a detailed characterization of the operational performance of contact tracing and reconstruct exposure and transmission networks at individual and ZIP code scales. We find considerable heterogeneity in reported close contacts and secondary infections and evidence of extensive transmission across ZIP code areas. Our analysis reveals the spatial pattern of SARS-CoV-2 spread and communities that are tightly interconnected by exposure and transmission. We find that higher vaccination coverage and reduced numbers of visitors to points-of-interest are associated with fewer within- and cross-ZIP code transmission events, highlighting potential measures for curtailing SARS-CoV-2 spread in urban settings.
| S-EPMC9347284 | biostudies-literature
Project description:BackgroundAs of 24th of August 2020, the number of global COVID-19 confirmed cases is nearly 24 million. In the same period, the number of recorded infections in Thailand has remained at approximately 3300. This paper explores the specifics of COVID-19 or SARS-CoV-2 transmissions in Phuket, Thailand's second most visited tourist destination.MethodsHigh-risk contacts recorded by Phuket Provincial Public Health Office were analysed using the Probit model to investigate the risk factors for transmission from confirmed COVID-19 cases to their high-risk contacts. The analysis was further focused on the impact of quarantine measures in state provided facilities on contacts' probability of infection.Findings15.6% of 1108 high-risk contacts were found to be infected, and they accounted for 80% of 214 confirmed cases in Phuket till 29th April 2020. Moreover, 10.68% of all high-risk contacts were confirmed to be infected before the quarantine, and 4.55% after the policy was enforced. In addition, a contact who lived within the same household with a confirmed case was 25% more exposed to infection when compared to a contact who did not share a household.InterpretationResults confirmed that the quarantine policy, which mandated individual isolation in the state provided facilities for all high-risk contacts, diminished contact's chance of infection from the confirmed cases, especially in the epicenter districts. Our findings confirmed that sharing accommodation with an infected case, and exposure to a case with several documented secondary transmission, generally increased the SARS-CoV-2 infection probability. Finally, some confirmed cases do exhibit a higher risk of spreading SARS-CoV-2 to their contacts compared to a typical confirmed case. Further studies of high reproduction groups of infected patients are recommended.FundingNo funding was received for this research.
| S-EPMC7503192 | biostudies-literature
Project description:When a novel infectious disease emerges, enhanced contact tracing and isolation are implemented to prevent a major epidemic, and indeed, they have been successful for the control of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which have been greatly reduced without causing a global pandemic. Considering that asymptomatic and pre-symptomatic infections are substantial for the novel coronavirus disease (COVID-19), the feasibility of preventing the major epidemic has been questioned. Using a two-type branching process model, the present study assesses the feasibility of containing COVID-19 by computing the probability of a major epidemic. We show that if there is a substantial number of asymptomatic transmissions, cutting chains of transmission by means of contact tracing and case isolation would be very challenging without additional interventions, and in particular, untraced cases contribute to lowering the feasibility of containment. Even if isolation of symptomatic cases is conducted swiftly after symptom onset, only secondary transmissions after the symptom onset can be prevented.
| S-EPMC7600034 | biostudies-literature
Project description:Objective Contact tracing is one of the key public health response actions to control the outbreak of a novel virus. This paper describes the preparation process, activation and operational experience for contact tracing of individuals in response to confirmed COVID-19 cases in Wales. Study design A descriptive approach has been adopted and lessons learned from our initial public health response to COVID-19 will be used to develop a new operational model for contact tracing in Wales. Methods As part of preparations for the response in Wales, Public Health Wales formed a Contact Tracing Cell (CTC) ready to be mobilised in the event of a confirmed case. Results Trial activation of the CTC during the preparation period helped to resolve some issues before ‘real’ activation. A highly flexible approach was needed due to the constant changes to the guidance that required rapid understanding, updates to pathways and clear communication to contact tracers. Conclusions Our experience and recommendations may benefit future efforts to control the spread of the virus in Wales and elsewhere, particularly in supporting COVID-19 outbreaks in enclosed settings such as care homes or in geographically localised areas. Learning from the initial public health response to COVID-19 will guide the delivery and implementation of a new contact tracing model as we move to a later stage of the pandemic when containment measures become feasible in localised outbreaks. This may include scaling-up the CTC to mobilise contact tracers to local teams and the potential use of digital technologies to support the next operational model of the CTC in Wales. Highlights • Contact tracing is one of the key public health response actions to control the outbreak of a novel virus.• For a CTC to be effective, identification and training of adequate numbers of staff needs to be done as early as possible.• A highly flexible approach was needed due to the logistical complexities of dealing with constant changes to the guidelines.• The mobilisation of non-health protection staff freed up health protection teams to deal with more complex issues.• Learning is needed to enhance future contact tracing activities when containment becomes feasible in localised outbreaks.
| S-EPMC7425711 | biostudies-literature
Project description:The WHO recommended intervention of Directly Observed Treatment, Short-course (DOTS) appears to have been less successful than expected in reducing the burden of TB in some high prevalence settings. One strategy for enhancing DOTS is incorporating active case-finding through screening contacts of TB patients as widely used in low-prevalence settings. Predictive models that incorporate population-level effects on transmission provide one means of predicting impacts of such interventions. We aim to identify all TB transmission modelling studies addressing contact tracing and to describe and critically assess their modelling assumptions, parameter choices and relevance to policy. We searched MEDLINE, SCOPUS, COMPENDEX, Google Scholar and Web of Science databases for relevant English language publications up to February 2012. Of the 1285 studies identified, only 5 studies met our inclusion criteria of models of TB transmission dynamics in human populations designed to incorporate contact tracing as an intervention. Detailed implementation of contact processes was only present in two studies, while only one study presented a model for a high prevalence, developing world setting. Some use of relevant data for parameter estimation was made in each study however validation of the predicted impact of interventions was not attempted in any of the studies. Despite a large body of literature on TB transmission modelling, few published studies incorporate contact tracing. There is considerable scope for future analyses to make better use of data and to apply individual based models to facilitate more realistic patterns of infectious contact. Combined with a focus on high burden settings this would greatly increase the potential for models to inform the use of contract tracing as a TB control policy. Our findings highlight the potential for collaborative work between clinicians, epidemiologists and modellers to gather data required to enhance model development and validation and hence better inform future public health policy.
| S-EPMC3762785 | biostudies-literature
Project description:ObjectiveTo analyse the transmission dynamics of the monkeypox outbreak in the UK, declared a Public Health Emergency of International Concern in July 2022.DesignContact tracing study, linking data on case-contact pairs and on probable exposure dates.SettingCase questionnaires from the UK Health Security Agency (UKHSA), United Kingdom.Participants2746 people with polymerase chain reaction confirmed monkeypox virus in the UK between 6 May and 1 August 2022.Main outcome measuresThe incubation period and serial interval of a monkeypox infection using two bayesian time delay models-one corrected for interval censoring (ICC-interval censoring corrected) and one corrected for interval censoring, right truncation, and epidemic phase bias (ICRTC-interval censoring right truncation corrected). Growth rates of cases by reporting date, when monkeypox virus was confirmed and reported to UKHSA, were estimated using generalised additive models.ResultsThe mean age of participants was 37.8 years and 95% reported being gay, bisexual, and other men who have sex with men (1160 out of 1213 reporting). The mean incubation period was estimated to be 7.6 days (95% credible interval 6.5 to 9.9) using the ICC model and 7.8 days (6.6 to 9.2) using the ICRTC model. The estimated mean serial interval was 8.0 days (95% credible interval 6.5 to 9.8) using the ICC model and 9.5 days (7.4 to 12.3) using the ICRTC model. Although the mean serial interval was longer than the incubation period for both models, short serial intervals were more common than short incubation periods, with the 25th centile and the median of the serial interval shorter than the incubation period. For the ICC and ICRTC models, the corresponding estimates ranged from 1.8 days (95% credible interval 1.5 to 1.8) to 1.6 days (1.4 to 1.6) shorter at the 25th centile and 1.6 days (1.5 to 1.7) to 0.8 days (0.3 to 1.2) shorter at the median. 10 out of 13 linked patients had documented pre-symptomatic transmission. Doubling times of cases declined from 9.07 days (95% confidence interval 12.63 to 7.08) on the 6 May, when the first case of monkeypox was reported in the UK, to a halving time of 29 days (95% confidence interval 38.02 to 23.44) on 1 August.ConclusionsAnalysis of the instantaneous growth rate of monkeypox incidence indicates that the epidemic peaked in the UK as of 9 July and then started to decline. Short serial intervals were more common than short incubation periods suggesting considerable pre-symptomatic transmission, which was validated through linked patient level records. For patients who could be linked through personally identifiable data, four days was the maximum time that transmission was detected before symptoms manifested. An isolation period of 16 to 23 days would be required to detect 95% of people with a potential infection. The 95th centile of the serial interval was between 23 and 41 days, suggesting long infectious periods.
| S-EPMC9627597 | biostudies-literature
Project description:BackgroundMaintaining effective contact tracing to control COVID-19 is challenging. Rapid growth in the number of infected cases can overload tracing and testing capacity, resulting in failure to trace contacts and delays in confirming an infection until after symptom onset (confirmation delay), hence increasing transmissibility. A substantial outbreak in Hong Kong, which was suppressed with non-pharmaceutical interventions (NPIs), provided an opportunity to assess the impact of overloading contact tracing and of efforts to improve its efficiency.MethodsUsing epidemiological-link (epi-link) data, we calculated the probability and duration of confirmation delay for cases with and without an epi-link, among all 3,148 confirmed cases between 5 July and 15 August 2020. Logistic regression was performed to determine the relationship between the number of recently confirmed infections and the probability of confirmation delay for epi-linked (contact-traced) cases. We estimated the impact on this relationship of targeted testing of at-risk groups.FindingsThe probability and duration of confirmation delay were associated with the rise in daily case number during growth of the outbreak. The proportion with confirmation delay among contact-traced cases increased from about 60% to nearly 85% as the number of cases grew from 1 to 50 per day (p-value = 0.003). The subsequent introduction of testing services for at-risk groups substantially reduced the proportion and it did not approach 85% again until the daily number of cases exceeded 125. This 2.5-fold improvement in capacity contributed crucially to suppression of the outbreak.InterpretationThe number of recently confirmed infections is an indicator of the load on the contact-tracing system, the consequence of which can be assessed by the probability of confirmation delay. Measures to monitor and improve contact-tracing efficiency, alongside social distancing interventions, can enable outbreaks to be controlled without lockdown.FundingCity University of Hong Kong and Health and Medical Research Fund.
| S-EPMC8759949 | biostudies-literature