JMIR Publications

ABSTRACT

Background:

Making testing available to everyone and tracing contacts might be the gold standard towards the control of COVID19. Many countries including the UK have relied on symptom-based test and trace in bringing the coronavirus pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable, for failing to meet testing and tracing needs. This is further exacerbated by it not being delivered at point-of-care, leading to rising cases and deaths. Rising COVID-19 cases and the death toll in the UK amid performing the highest number of tests in Europe are suggestive of the fact that symptom-based test and trace might not be effective as a control strategy. An alternative strategy is making testing available to all. This study evaluated the effectiveness of mass testing and contact tracing in the suppression of COVID-19 compared to conventional Test and Trace in the UK.

Objective:

The primary objective was to compare mass testing and contact tracing with test and trace in the control of community spread of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic cases of SARS-CoV-2 reported during mass testing interventions.

Methods:

English literature was searched in September through December 2020 in Google Scholar, ScienceDirect, Mendeley and PubMed. Search terms included [mass testing], [test and trace], [contact tracing], [COVID-19], [SARS-CoV-2], [effectiveness], [asymptomatic], [symptomatic], [community screening], [UK] and [2020]. Search results were synthesized without meta-analysis using the direction of effect as the standardized metric and vote counting as the synthesis metric. A statistical synthesis was performed using STATA 14.2. The tabular and graphical methods were used to present study findings.

Results:

The literature search yielded 286 articles from Google Scholar, 20 from Science Direct, 14 from Mendeley, 27 from Pubmed and 15 through manual search. Altogether 35 articles were included, making a sample size of close to a million participants. This review found a 76.9% (95% CI: 46.2–95.0, P = .09) majority vote in favour of the intervention under the primary objective. The overall proportion of asymptomatic cases among those tested positive and tested sample populations under the secondary objective was 40.7% (95% CI: 38.8–42.5) and 0.01% (95% CI: 0.010–0.012) respectively.

Conclusions:

There was a very low level but promising evidence that mass testing and contact tracing could be more effective in bringing the virus under control and even more effective if combined with social distancing and face coverings. Conventional test and trace should be superseded by decentralised and regular mass rapid testing and contact tracing, championed by GP surgeries and low-cost community services.services