AbstractBackgroundWith new cases of COVID-19 surging around the world, many countries have to prepare for moving beyond the containment phase. Prediction of the effectiveness of non-case-based interventions for mitigating, delaying or preventing the epidemic is urgent, especially for countries affected by the ongoing seasonal influenza activity.MethodsWe developed a transmission model to evaluate the impact of self-imposed prevention measures (handwashing, mask-wearing, and social distancing) due to the spread of COVID-19 awareness and of short-term government-imposed social distancing on the peak number of diagnoses, attack rate and time until the peak number of diagnoses.FindingsFor fast awareness spread in the population, self-imposed measures can significantly reduce the attack rate, diminish and postpone the peak number of diagnoses. 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 interventions can only delay the peak (by at most 7 months for a 3-month intervention).InterpretationHandwashing, mask-wearing and social distancing as a reaction to information dissemination about COVID-19 can be effective strategies to mitigate and delay the epidemic. We stress the importance of rapidly spreading awareness on the use of these self-imposed prevention measures in the population. Early-initiated short-term government-imposed social distancing can buy time for healthcare systems to prepare for an increasing COVID-19 burden.FundingThis research was funded by ZonMw project 91216062, One Health EJP H2020 project 773830, Aidsfonds project P-29704.Research in contextEvidence before this studyEvidence to date suggests that containment of SARS-CoV-2 using quarantine, travel restrictions, isolation of symptomatic cases, and contact tracing may need to be supplemented by other interventions. Given its rapid spread across the world and immense implications for public health, it is urgent to understand whether non-case-based interventions can mitigate, delay or even prevent a COVID-19 epidemic. One such strategy is a broader-scale contact rate reduction enforced by governments which was used during previous outbreaks, e.g., the 1918 influenza pandemic and the 2009 influenza A/H1N1 pandemic in Mexico. Alternatively, governments and media may stimulate self-imposed prevention measures (handwashing, mask-wearing, and social distancing) by generating awareness about COVID-19, especially when economic and societal consequences are taken into account. Both of these strategies may have a significant impact on the outbreak dynamics. Currently, there are no comparative studies that investigate their viability for controlling a COVID-19 epidemic.Added value of this studyUsing a transmission model parameterized with current best estimates of epidemiological parameters, we evaluated the impact of handwashing, mask-wearing, and social distancing due to COVID-19 awareness and of government-imposed social distancing on the peak number of diagnoses, attack rate, and time until the peak number of diagnoses. We show that a short-term (1-3 months) government intervention initiated early into the outbreak can only delay the peak number of diagnoses but neither alters its magnitude nor the attack rate. Our analyses also highlight the importance of spreading awareness about COVID-19 in the population, as the impact of self-imposed measures is strongly dependent on it. When awareness spreads fast, simple self-imposed measures such as handwashing are more effective than short-term government intervention. Self-imposed measures do not only diminish and postpone the peak number of diagnoses, but they can prevent a large epidemic altogether when their efficacy is sufficiently high (above 50%). Qualitatively, these results will aid public health professionals to compare and select interventions for designing effective outbreak control policies.Implications of all available evidenceOur results highlight that dissemination of evidence-based information about effective prevention measures (hand-washing, mask-wearing, and self-imposed social distancing) can be a key strategy for mitigating and postponing a COVID-19 epidemic. Government interventions (e.g., closing schools and prohibiting mass gatherings) implemented early into the epidemic and lasting for a short-time can only buy time for healthcare systems to prepare for an increasing COVID-19 burden.
Reconstructing the COVID-19 epidemic in Delhi, India: infection attack rate and reporting of deaths
