Optimal strategies for social distancing and testing to control COVID-19

Highlights • We examined control strategies minimizing COVID-19 infection and intervention costs. • Social distancing and testing are considered intervention strategies. • Testing should be intensified in the early phases and after the epidemic peak. • Social distancing should be intensified if prevalence is greater than 15%. • As social distancing relaxes, testing with contact tracing becomes important.
The coronavirus disease (COVID-19) has infected more than 24 million individuals, with 825,381 deaths worldwide. Several countries have implemented social distancing and testing policies with contact tracing as a measure to flatten the curve of the ongoing pandemic. Optimizing these control measures is urgent if the substantial societal and economic impacts associated with infection and interventions are considered. To determine the optimal social distancing and testing strategies, we developed a mathematical model of COVID-19 transmission and applied optimal control theory, identifying the best approach to reduce the epidemiological burden of COVID-19 at a minimal cost. The results demonstrate that testing as a standalone optimal strategy does not have a significant effect on the final size of an epidemic, but it would delay the peak of the pandemic. If social distancing is the sole control strategy, it would be optimal to gradually increase the level of social distancing as the incidence curve of COVID-19 grows, and relax the measures after the curve has reached its peak. Compared with a single strategy, combined social distancing and testing strategies are demonstrated to be more efficient at reducing the disease burden, and they can delay the peak of the disease. To optimize these strategies, testing should be maintained at a maximum level in the early phases and after the peak of the epidemic, whereas social distancing should be intensified when the prevalence of the disease is greater than 15%. Accordingly, public health agencies should implement early testing and switch to social distancing when the incidence level begins to increase. After the peak of the pandemic, it would be optimal to gradually relax social distancing and switch back to testing.