Contact Tracing

A critical component to controlling the spread of COVID-19 has been prompt and effective contact tracing.  By identifying close contacts, spread of the disease is reduced.  Contact tracing is an effective disease control strategy yet little data are available regarding the relationship between contact tracing and COVID-19 case fatality rates.  This study evaluates the association between contact tracing policies and COVID-19 case fatality rates using data on diagnostic tests, non-pharmaceutical measures, healthcare capabilities, population characteristics, and economic indicators from 138 countries.  For data analysis, panel estimations with the presence of time fixed effects to investigate the relationship between contact tracing policy and death rates were utilized.  Time fixed-effect models were used for the longitudinal data analysis which helped to analyze the lagged effects of various contact tracing policies on case fatality rates.  Additionally, country-level variables were included as controls.  Case fatality rates were regressed on four sets of predictors: testing policy variables (the number of tests and contact tracing policy), healthcare system capabilities (the number of hospital beds and physicians), country characteristics (population, the percentage of the population over 70 years old, GDP per capita, the percentage of smokers and people with diabetes in the population), economic measures against COVID-19 (fiscal stimulus) and stringency score (non-pharmaceutical public health control measures adopted by countries). Controlling for these variables, the association between contact tracing policy in a 2-week period on case fatality rates in the following two weeks was examined.  The results showed that contact tracing policy had a significant negative association with case fatality rates (β = −0.13, p < 0.05).  Furthermore, the regression analysis with longitudinal data showed that the number of physicians was significantly associated with case fatality rates (countries with a higher number of physicians had lower case fatality rates).  Those countries that had greater testing capacity had lower rates of case fatalities. Moreover, countries with higher proportion of people over 70 years old have higher case fatality rates.

Research Agenda for Healthcare Epidemiology

A new research agenda was developed by 40 leading experts in healthcare epidemiology and infectious diseases.   The research agenda identified essential areas of study that can further inform clinical practice, policy, and prevention strategies for COVID-19.  These areas of study could also be beneficial when handling future pandemics. COVID-19 Research Agenda for Healthcare Epidemiology identified gaps in the understanding of the epidemiology, transmission, and individual as well as public health consequences of viral diseases that were revealed through some of the worst phases of the COVID-19 pandemic.

The working group of experts identified immediate research priorities in epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment, environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel occupational safety, and return to work policies.

The most critical areas for research they identified were:

• Understanding the spread of the virus through asymptomatic and pre-symptomatic patients.
• Determining how risk factors impact disease severity, as well as understanding long-term cardiometabolic, respiratory, neurological, and psychological impacts of the virus.
• Developing tools to identify outbreaks more rapidly in hospitals, nursing homes, and other healthcare settings leading to early interventions to curtail outbreaks.
• Improving the understanding of PPE including socio-behavioral reasons for not following PPE guidance and the continued need for PPE during and after the pandemic.

To date, numerous studies have been done regarding various aspects of COVID-19.  However, more rigorous studies need to be conducted.  The article concluded by stating that the research conducted needs to range from translational studies from laboratory-based basic science research to well-designed, large scale studies and health outcomes research