Effectiveness of SARS-CoV-2 testing strategies in reducing COVID-19 cases, hospitalisations, and deaths

K M Saif-Ur-Rahman ^1,2, Nadra Nurdin ³, Ani Movsisyan ⁴

¹Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland.
²Centre for Health Research Methodology, School of Nursing and Midwifery, University of Galway, Galway, Ireland.
³Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin 7, Ireland.
⁴Pettenkofer School of Public Health, Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany.
⁵Consultant to Library & Digital Information Networks, World Health Organization, Kobe, Japan.
⁶Physiotherapy Department, St James's Hospital, Dublin, Ireland.
⁷HRB-Trials Methodology Research Network, University of Galway, Galway, Ireland.
⁸Cochrane Evidence Synthesis Unit Germany/UK - Sub-Unit Düsseldorf, Institute of General Practice, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
⁹Public Health, Health Service Executive, Dublin, Ireland.
¹⁰Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
¹¹Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹²Biostatistics, Evidence Synthesis, Test Evaluation and Modelling, Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK.
¹³National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.

⁰Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland.

The Cochrane Database of Systematic Reviews +

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October 2, 2025

View abstract on PubMed

Summary

The effectiveness of SARS-CoV-2 testing strategies in reducing COVID-19 cases, hospitalizations, and deaths is uncertain due to very low-certainty evidence. More research is needed to understand the benefits and harms of different testing approaches for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Area Of Science

Public Health
Infectious Diseases
Epidemiology

Background

Sustainable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing practices are crucial for managing COVID-19's impact.
The effectiveness of various SARS-CoV-2 testing strategies for symptomatic and asymptomatic individuals remains unclear.

Purpose Of The Study

To evaluate the effectiveness of different SARS-CoV-2 testing strategies in reducing COVID-19 cases, hospitalizations, and deaths.
To assess the impact of testing on suspected cases and asymptomatic individuals.

Main Methods

Systematic review including RCTs, NRSIs, CBA, matched cohort, and observational studies.
Searched multiple databases (CENTRAL, MEDLINE, Embase, etc.) up to October 7, 2024.
Used Risk of Bias 2 (RoB 2) and ROBINS-I tools for bias assessment; employed Synthesis Without Meta-analysis (SWiM) and GRADE for evidence certainty.

Main Results

Included 21 studies (10 RCTs, 11 NRSIs) with over 13 million participants.
Very low-certainty evidence suggests SARS-CoV-2 RT-PCR testing may not significantly reduce hospitalizations or mortality compared to no testing.
No studies measured COVID-19 cases avoided or serious adverse events related to testing.

Conclusions

Available data are of very low certainty, preventing conclusions on the impact of testing strategies on hospitalizations and mortality.
Further research with standardized outcomes is recommended.
Qualitative evidence synthesis could identify barriers and facilitators for routine SARS-CoV-2 testing.

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