ABSTRACT
OBJECTIVES: Conducting contact tracing (CT) programs in low- and middle-income countries is challenging, and there is no evidence of their effectiveness in Latin America. We evaluated the effectiveness of CT on reducing fatality from COVID-19 in Colombia. STUDY DESIGN: The study design is a retrospective cohort study with nation-wide data of suspected and confirmed cases of severe acute respiratory syndrome (SARS-CoV-2) infection and their registered contacts. METHODS: We analyzed confirmed and suspected COVID-19 cases and their chains of contact using a nation-wide registry from March 28, 2020 to January 13, 2021. To estimate the effect of CT on fatality, we adjusted a multilevel negative binomial model using the number of deaths and the number of people within a chain of contacts as the outcome variable and offset variable, respectively. Sensitivity analysis was conducted using different cutoff values of contacts traced and a logistic model for the effect of CT on death at an individual level. RESULTS: We analyzed 1.4 million cases, 542,936 chains of contact, and 46,087 deaths. Only, 5.8% of total cases and contacts were included in a chain of a case and five or more contacts. We found that tracing of at least five contacts per case reduces fatality by 48% (95% confidence interval: 45-51), and, at the current levels of tracing in Colombia, it prevents 1.8% of deaths. Results obtained from the sensitivity analysis were consistent with the reduction of fatality at an individual level and higher protective effect with the higher number of contacts traced. CONCLUSIONS: In Colombia, tracing of at least five contacts per case reduces fatality from COVID-19. The coverage and intensity of tracing needs to be increased as a strategy to mitigate fatality in Colombia.