New research has found that a public health strategy that combines contact tracing and community-based screening with isolation and quarantine centers can substantially reduce infections, hospitalisations and deaths from Covid-19 while being cost-effective in low-and-middle-income countries like South Africa.
In a paper published in The Lancet Global Health the research team, from Africa Health Research Institute (AHRI) and Massachusetts General Hospital (MGH), reported that this battery of health interventions, implemented either fully or partially, could offer good value for money and, in some scenarios, even reduce health care expenditures in South Africa.
“Our results demonstrate that contact tracing, isolation, and quarantine programs work, and are highly cost-effective, comparing favorably in terms of Rand/year of life saved to many standard healthcare interventions in South Africa – such as vaccination programs,” said lead author Dr Mark Siedner, an AHRI Faculty Member and a clinical epidemiologist at MGH in the Division of Infectious Diseases. “These tools should all be considered as potential elements of ongoing epidemic control, and particularly as something that KwaZulu-Natal should be prepared to scale up quickly if there is a second wave.”
The AHRI and MGH research team developed a Covid-19 microsimulation model to evaluate clinical and economic outcomes of various combinations of five complementary epidemic control interventions in KwaZulu-Natal. Those interventions are health care testing, where diagnostic testing is performed at designated health care centers; contact tracing to identify those who may have come in close contact with someone with Covid-19; isolation centers for people with Covid-19; mass symptom screening of local populations by community health workers; and quarantine centers for people who have been in close contact with someone with Covid-19 but have tested negative.
A public health program built on all five interventions in response to the pandemic could reduce Covid-19 deaths by 94%, compared to the use of health care testing alone over one year, the study found. It also estimated that a program combining all interventions would cost an additional R5200 ($340) per year of life saved, which represents similar or better value than many other established public health initiatives in South Africa, including tuberculosis diagnostic testing and cervical cancer screening. In some epidemic growth scenarios, combinations of interventions saved health care costs over one year compared with health care testing alone. “Our results show that these upfront investments can both save lives and actually lower health care costs by substantially reducing the need for hospitalisations for Covid-19,” said Dr Siedner.
Many countries have the infrastructures in place for some or all of these interventions, the researchers pointed out. Contact tracing and community-based screening, for example, have frequently been deployed in the past through networks of community health workers. And isolation centers, which are likely to require the greatest investment, have been implemented successfully in response to Ebola epidemics in West Africa and the Democratic Republic of Congo, where health care resources are among the scarcest in the world. According to the research team, isolation centers would be particularly effective in areas with high household density and limited capacity for in-home isolation. Quarantine centers were also shown by the MGH microsimulation model to be a cost-effective way to reduce the health impact of epidemics, but their implementation must recognise social and human rights issues that have plagued mandatory quarantine in some settings.
“Even where quarantine centers are not feasible due to lack of public support, implementing the other interventions we described can provide major clinical benefits in an economical manner,” said investigator Dr Krishna Reddy, who is with the Medical Practice Evaluation Center at MGH, and is the corresponding author of the study. “The bottom line is that prevention goes a long way, and we’re hopeful that decision makers will work to translate the evidence we’ve uncovered into effective public policy and interventions for pandemic control.”