Editors' ChoiceCORONAVIRUS

An ounce of public health for COVID-19?

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Science Translational Medicine  29 Apr 2020:
Vol. 12, Issue 541, eabb5675
DOI: 10.1126/scitranslmed.abb5675

Abstract

Multifaceted nonpharmaceutical interventions supported by data restricted spread of COVID-19 in China.

As of 22 April 2020, coronavirus disease 2019 (COVID-19) has resulted in 2.6 million infections with a worldwide mortality rate of approximately 6.6%. As of the same date, no pharmaceutical agents have been demonstrated to be safe and efficacious in randomized controlled trials. Thus, to limit the public health, societal, and economic damages caused by COVID-19, only public health interventions can be relied on. These public health interventions include stay-at-home policies, mandated closures of nonessential services, face mask ordinances, and quarantines, among others.

Because a pandemic of this scale had not struck the world in recent history, the utility of these interventions had only been studied in simulations. In a new study, Pan et al. examined disease spread after implementation of multifaceted public health interventions during the COVID-19 outbreak in Wuhan, China. The authors used a cohort of 32,583 patients with laboratory-confirmed coronavirus infection in Wuhan and computed a standardized number of infections per day per million people, effective reproduction numbers (Ro), and the proportions of severe disease from December 2019 through March 2020. They divided this time span into five periods, each characterized by particular combinations of public health interventions or the lack thereof. These included social distancing, travel restrictions, quarantine (centralized and at home), and community screening. The authors observed that this series of multifaceted public health interventions was associated with improved control of the COVID-19 outbreak. The daily confirmed case rate per million people increased in the periods with no interventions and decreased dramatically in those periods where a combination of interventions was in place. In parallel, the proportion of severe cases decreased with application of these interventions. Lastly, strict travel restrictions and home quarantine were the dominant factors associated with reducing spread in the early days of the outbreak.

This study has important implications for the rest of the world struggling with the COVID-19 outbreak. In the absence of proven pharmaceutical interventions, application of multifaceted public health interventions guided by monitoring infection rates and widespread testing and monitoring of infection rates may allow for an effective weapon in our armamentarium against COVID-19.

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