Bidirectional contact tracing dramatically improves COVID-19 control

Contact tracing is critical to controlling COVID-19, but most protocols only “forward-trace” to notify people who were recently exposed. Using a stochastic branching-process model, we show that “bidirectional” tracing to identify infector individuals and their other infectees robustly improves outbreak control, reducing the effective reproduction number (R_eff) by at least ∼0.3 while dramatically increasing resilience to low case ascertainment and test sensitivity. Adding smartphone-based exposure notification can further reduce R_eff by 0.25, but only if nearly all smartphones can detect exposure events. Our results suggest that with or without digital approaches, implementing bidirectional tracing will enable health agencies to control COVID-19 more effectively without requiring high-cost interventions.