Effectiveness of Contact Tracing, Mask Wearing and Prompt Testing on Suppressing COVID-19 Resurgences in Megacities: An Individual-Based Modelling Study

Abstract

Background: Secondary waves of COVID-19 loom in many countries as strict physical distancing measures have been lifted. Since megacities have been hardest hit by the disease, science-based guidelines of non-pharmaceutical interventions are still in need for post-epidemic management in ‘business as usual’ cities before vaccines are widely available. This study aims to investigate the combined effects of contact tracing, mask wearing, and prompt testing on minimizing the risk of next COVID-19 waves in megacities.

Methods: We integrated 5·8 million mobile phone users’ trajectory records into a spatially explicit individual-based model for simulating COVID-19 spread among 4·5 million households, 230 thousand workplaces (including schools), and other public places in 0.6 million buildings in Shenzhen city, China, which has been gradually reopened. Government interventions were incorporated to reconstruct the actual course of the 1st wave epidemic. After validated by empirical data, the model was used to assess the probability of resurgences if sporadic cases occurred in a fully reopened city under different scenarios of contact tracing settings (household, work, school, and public place), mask use, and test-seeking behavior along with receding public vigilance.

Findings: Our model well predicted the spatiotemporal dynamics of the 1st wave epidemic in Shenzhen, by age distribution of symptomatic cases, and household secondary attack rate (11·02%). After city reopens, our results show a 50% chance or less of suppressing disease resurgence if not implementing contact tracing. Tracing household contacts, in combination with mandatory (100% compliance) mask use and prompt testing could limit the probability of next outbreak under 5%. If contact tracing can be expanded to work/class group members, the public compliance of masking and testing can be relaxed to 80% and 40%, respectively, to achieve the same suppression target. Further scaled-up contact tracing that includes casual contacts can suppress resurgences with a low compliance to mask use (40%) and prompt testing (20%-40%).

Interpretation: To minimize the risk of resurgence in a reopened city, the local government is expected to spare no efforts to trace close contacts in household, workplace and school for a confirmed case. The authorities should promote mask use in a public space and encourage people with COVID-19-like symptoms to testing within two days after illness onset, along with measures such as sick leave compensation and extensive temperature screening in public places.

Funding Statement: National Scientific Foundation of China, R & D project of key areas in Guangdong Province, Bill & Melinda Gates Foundation, Joint Engineering Research Center for Health Big Data Intelligent Analysis Technology

Declaration of Interests: We declare no competing interests.

Keywords: COVID-19; individual-based model; contact tracing; mask wearing; prompt testing