International researchers have conducted a review of the published scientific evidence on early infection control, and identified seven strategies that they say are essential for stopping not just COVID-19, but any future pandemic
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:
1) Border control
Border controls, restricted entry and inbound traveller quarantine applied early in the pandemic have both reduced the spread of COVID-19 and facilitated case finding.
2) Testing
During the initial response to a pandemic, repurposing of an existing laboratory network for testing should be implemented where possible while establishing new testing sites to meet increasing needs as the pandemic progresses.
Pooled testing can be used to improve testing efficiency. Repeated testing may be necessary to minimise false-negative results.
Testing high-risk populations (such as healthcare workers or residents of long-term care facilities) is important for active case finding, especially during the early stages.
3) Track and trace
Digital tools such as apps, GPS and mobile geopositioning data have been deployed effectively by some countries for contact tracing and to monitor compliance with self-isolation.
As an individual infected by SARS-CoV-2 can actively shed the virus 3 weeks or longer after symptoms onset, the duration of quarantine may vary. A 2-week quarantine period with extension when required has been adopted by various countries.
4) Support
Support can be in the form of mental health or physical health promotion or monetary aid, such as timely and adequate information to reduce uncertainty and anxiety, providing adequate supplies or allowance for individuals.
These support measures also facilitate public trust that is fundamental in the joint COVID-19 response in the population, as it relies on individuals to voluntarily provide their information and adhere to disease control regulations.
5) Integrated system
A successful FTTIS requires seamless integration of all the components and the ability to integrate vulnerable populations or ethnic minorities.
Linked health service data can contribute to the cooperation and communications among responsible authorities (central and local government, borders, laboratories and the medical care system) through real-time data sharing and dashboards.
The level of preparedness, timely implementation and scale-up of effective measures has made all the difference between or within countries. For instance, insufficient testing and quarantine led to the undetected wide transmission of SARS-CoV-2, resulting in high case fatality during the first month of COVID-19 epidemic in Italy and similarly in the Middle East or during the first wave in the UK.
6) Public collaboration
In addition to support for individuals, regular press conferences by the central outbreak control team to provide a briefing on the progress of the pandemic, changes in policies and correcting misinformation can increase public awareness of the need for FTTIS.
Open and balanced discussions on public concerns, such as personal data privacy and protection and limitations on individuals’ freedom for the public good, are essential.
7) Flexible and swift responses to emerging challenges
The uncertainty and rapid progression of the pandemic make it important to have the flexibility to adapt rapidly to emerging challenges. A rolling-wave approach to planning can help authorities learn, apply and refine tools for prevention and control, with an agile process allowing better responses to emergencies.
