Background The coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to nearly every country in the world since it first emerged in China in December 2019. Many countries have implemented social distancing as a measure to “flatten the curve” of the ongoing epidemics. Evaluation of the impact of government-imposed social distancing and of other measures to control further spread of COVID-19 is urgent, especially because of the large societal and economic impact of the former. The aim of this study was to compare the individual and combined effectiveness of self-imposed prevention measures and of short-term government-imposed social distancing in mitigating, delaying, or preventing a COVID-19 epidemic. Methods and findings We developed a deterministic compartmental transmission model of SARS-CoV-2 in a population stratified by disease status (susceptible, exposed, infectious with mild or severe disease, diagnosed, and recovered) and disease awareness status (aware and unaware) due to the spread of COVID-19. Self-imposed measures were assumed to be taken by disease-aware individuals and included handwashing, mask-wearing, and social distancing. Government-imposed social distancing reduced the contact rate of individuals irrespective of their disease or awareness status. The model was parameterized using current best estimates of key epidemiological parameters from COVID-19 clinical studies. The model outcomes included the peak number of diagnoses, attack rate, and time until the peak number of diagnoses. For fast awareness spread in the population, self-imposed measures can significantly reduce the attack rate and diminish and postpone the peak number of diagnoses. We estimate that a large epidemic can be prevented if the efficacy of these measures exceeds 50%. For slow awareness spread, self-imposed measures reduce the peak number of diagnoses and attack rate but do not affect the timing of the peak. Early implementation of short-term government-imposed social distancing alone is estimated to delay (by at most 7 months for a 3-month intervention) but not to reduce the peak. The delay can be even longer and the height of the peak can be additionally reduced if this intervention is combined with self-imposed measures that are continued after government-imposed social distancing has been lifted. Our analyses are limited in that they do not account for stochasticity, demographics, heterogeneities in contact patterns or mixing, spatial effects, imperfect isolation of individuals with severe disease, and reinfection with COVID-19. Conclusions Our results suggest that information dissemination about COVID-19, which causes individual adoption of handwashing, mask-wearing, and social distancing, can be an effective strategy to mitigate and delay the epidemic. Early initiated short-term government-imposed social distancing can buy time for healthcare systems to prepare for an increasing ...
1Background: With new cases of COVID-19 surging around the world, many countries have to prepare for mov-2 ing beyond the containment phase. Prediction of the effectiveness of non-case-based interventions for mitigating, 3 delaying or preventing the epidemic is urgent, especially for countries affected by the ongoing seasonal influenza 4 activity. 5Methods:We developed a transmission model to evaluate the impact of self-imposed prevention measures 6 (handwashing, mask-wearing, and social distancing) due to the spread of COVID-19 awareness and of short-7 term government-imposed social distancing on the peak number of diagnoses, attack rate and time until the 8 peak number of diagnoses. 9 Findings: For fast awareness spread in the population, self-imposed measures can significantly reduce the attack 10 rate, diminish and postpone the peak number of diagnoses. A large epidemic can be prevented if the efficacy 11 of these measures exceeds 50%. For slow awareness spread, self-imposed measures reduce the peak number 12 of diagnoses and attack rate but do not affect the timing of the peak. Early implementation of short-term 13 government interventions can only delay the peak (by at most 7 months for a 3-month intervention). 14 Interpretation:Handwashing, mask-wearing and social distancing as a reaction to information dissemination 15 about COVID-19 can be effective strategies to mitigate and delay the epidemic. We stress the importance of 16 rapidly spreading awareness on the use of these self-imposed prevention measures in the population. Early-17 initiated short-term government-imposed social distancing can buy time for healthcare systems to prepare for 18 an increasing COVID-19 burden.Evidence to date suggests that containment of SARS-CoV-2 using quarantine, travel restrictions, isolation of symp-26 tomatic cases, and contact tracing may need to be supplemented by other interventions. Given its rapid spread 27 across the world and immense implications for public health, it is urgent to understand whether non-case-based 28 interventions can mitigate, delay or even prevent a COVID-19 epidemic. One such strategy is a broader-scale 29 contact rate reduction enforced by governments which was used during previous outbreaks, e.g., the 1918 influenza 30 pandemic and the 2009 influenza A/H1N1 pandemic in Mexico. Alternatively, governments and media may stimu-31 late self-imposed prevention measures (handwashing, mask-wearing, and social distancing) by generating awareness 32 about COVID-19, especially when economic and societal consequences are taken into account. Both of these strate-33 gies may have a significant impact on the outbreak dynamics. Currently, there are no comparative studies that 34 investigate their viability for controlling a COVID-19 epidemic. 35Added value of this study 36 Using a transmission model parameterized with current best estimates of epidemiological parameters, we evaluated 37 the impact of handwashing, mask-wearing, and social distancing due to COVID-19 awareness and of government-38 imposed soc...
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