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The quarantine of identified close contacts has been vital to reducingtransmission rates and averting secondary infection risk before symptom onsetand by asymptomatic cases. The effectiveness of this contact tracing strategyto mitigate transmission is sensitive to the adherence to quarantines, whichmay be lower for longer quarantine periods or in vaccinated populations (whereperceptions of risk are reduced). This study develops a simulation model toevaluate contact tracing strategies based on the sequential testing ofidentified contacts after exposure as an alternative to quarantines, in whichcontacts are isolated only after confirmation by a positive test. The analysisconsiders different number and types of tests (PCR and lateral flow antigentests (LFA)) to identify the cost-effective testing policies that minimize theexpected infecting days post-exposure considering different levels of testingcapacity. This analysis suggests that even a limited number of tests can beeffective at reducing secondary infection risk: two LFA tests (with optimaltiming) avert infectiousness at a level that is comparable to 14-day quarantinewith 80-90% adherence, or equivalently, 7-9 day quarantine with full adherence(depending on the sensitivity of the LFA test). Adding a third test (PCR orLFA) reaches the efficiency of a 14-day quarantine with 90-100% adherence.These results are robust to the exposure dates of the contact, test sensitivityof LFA and alternative models of viral load evolution, which suggests thatsimple testing rules can be effective for improving contact tracing in settingswhere strict quarantine adherence is difficult to implement.

Replacing quarantine of COVID-19 contacts with periodic testing is also effective in mitigating the risk of transmission