Public health mitigation of COVID-19

Part of managing an infectious disease outbreak is trying to delay and decrease the epidemic peak, known as flattening the epidemic curve.^[1] This decreases the risk of health services being overwhelmed and provides more time for vaccines and treatments to be developed.^[1] Non-pharmaceutical interventions that may manage the outbreak include personal preventive measures such as hand hygiene, wearing face masks, and self-quarantine; community measures aimed at physical distancing such as closing schools and cancelling mass gathering events; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such surface cleaning.^[5] It has also been suggested that improving ventilation and managing exposure duration can reduce transmission.^[6][7]

During early outbreaks, speed and scale were considered key to mitigation of COVID-19, due to the fat-tailed nature of pandemic risk and the exponential growth of COVID-19 infections.^[8] For mitigation to be effective, (a) chains of transmission must be broken as quickly as possible through screening and containment, (b) health care must be available to provide for the needs of those infected, and (c) contingencies must be in place to allow for effective rollout of (a) and (b).^{[citation needed]}

By May 2023, in most countries restrictions had been lifted and everyday life had returned to how it was before the pandemic due to improvement in the pandemic's situation.^[9][10]

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Initial containment measures

More drastic actions aimed at containing the outbreak were taken in China once the severity of the outbreak became apparent, such as quarantining entire cities or imposing strict travel bans.

Simulations for Great Britain and the United States show that mitigation (slowing but not stopping epidemic spread) and suppression (reversing epidemic growth) have major challenges. Optimal mitigation policies might reduce peak healthcare demand by two-thirds and deaths by half, but still result in hundreds of thousands of deaths and overwhelmed health systems. Suppression can be preferred but needs to be maintained for as long as the virus is circulating in the human population (or until a vaccine becomes available), as transmission otherwise quickly rebounds when measures are relaxed. Until now, the evidence for public health (nonpharmaceutical) interventions such as social distancing, school closure, and case isolation comes mainly from epidemiological compartmental models and, in particular, agent-based models (ABMs).^[18] Such models have been criticized for being based on simplifying and unrealistic assumptions.^[19][20] Still, they can be useful in informing decisions regarding mitigation and suppression measures in cases when ABMs are accurately calibrated.^[21] An Argentinian modelling study asserted that complete lockdowns and healthcare system overextension could be avoided if 45 percent of asymptomatic patients were detected and isolated.^[22] Long-term intervention to suppress the pandemic has considerable social and economic costs.^[23]

Efficacy

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In August 2020, a working paper by the

Many reviews find high efficacy of mitigation measures such as vaccines, face masks and social distancing. For instance, a systematic review and meta-analysis found that mask-wearing cuts the incidence of COVID-19 by 53% overall.^[26][27] The efficacy may also be substantially higher, especially if certain types of masks are worn or under specific conditions and settings.

Contact tracing

Contact tracing is an important method for health authorities to determine the source of infection and to prevent further transmission.^[28] The use of location data from mobile phones by governments for this purpose has prompted privacy concerns, with Amnesty International and more than a hundred other organisations issuing a statement calling for limits on this kind of surveillance.^[29]

An unincentivized and always entirely voluntary use of such digital contact tracing apps by the public was found to be low^[30][31][32] even if the apps are built to preserve privacy (which may however compete with alternative domestic apps that don't do so and can't always be used), leading to low usefulness of the software for pandemic mitigation as of April 2021. A lack of possible features, prevalent errors and possibly other issues reduced their usefulness further.^[33] Use of such an app in general or during specific times is in many or all cases not provable or requirable.

Moreover, contact-tracing apps may be designed criteria (<1 metre; and > 15 minutes contact) insufficient for controlling danger.^[34]

Information technology

Several mobile apps have been implemented or proposed for voluntary use, and as of 7 April 2020 more than a dozen expert groups were working on privacy-friendly solutions such as using Bluetooth to log a user's proximity to other cellphones.^[29] (Users are alerted if they have been near someone who subsequently tests positive.)^[29]

On 10 April 2020, Google and

In February 2020, China launched a mobile app to deal with the disease outbreak.^[39] Users are asked to enter their name and ID number. The app can detect 'close contact' using surveillance data and therefore a potential risk of infection. Every user can also check the status of three other users. If a potential risk is detected, the app not only recommends self-quarantine, it also alerts local health officials.^[40]

Big data analytics on cellphone data, facial recognition technology, mobile phone tracking, and artificial intelligence are used to track infected people and people whom they contacted in South Korea, Taiwan, and Singapore.^[41][42] In March 2020, the Israeli government enabled security agencies to track mobile phone data of people supposed to have coronavirus. According to the Israeli government, the measure was taken to enforce quarantine and protect those who may come into contact with infected citizens. The Association for Civil Rights in Israel, however, said the move was "a dangerous precedent and a slippery slope".^[43] Also in March 2020, Deutsche Telekom shared aggregated phone location data with the German federal government agency, Robert Koch Institute, to research and prevent the spread of the virus.^[44] Russia deployed facial recognition technology to detect quarantine breakers.^[45] Italian regional health commissioner Giulio Gallera said he has been informed by mobile phone operators that "40% of people are continuing to move around anyway".^[46] The German Government conducted a 48-hour weekend hackathon, which had more than 42,000 participants.^[47][48] Three million people in the UK used an app developed by King's College London and Zoe to track people with COVID-19 symptoms.^[49][50] The president of Estonia, Kersti Kaljulaid, made a global call for creative solutions against the spread of coronavirus.^[51]

Health care

Increasing capacity and adapting healthcare for the needs of COVID-19 patients is described by the WHO as a fundamental outbreak response measure.[52] The ECDC and the European regional office of the WHO have issued guidelines for hospitals and primary healthcare services for shifting of resources at multiple levels, including focusing laboratory services towards COVID-19 testing, cancelling elective procedures whenever possible, separating and isolating COVID-19 positive patients, and increasing intensive care capabilities by training personnel and increasing the number of available ventilators and beds.^[52][53] In addition, in an attempt to maintain physical distancing, and to protect both patients and clinicians, in some areas non-emergency healthcare services are being provided virtually.^[54][55][56]

Research and development

There are research-based developments that aim to mitigate COVID-19 spread beyond vaccines, repurposed and new medications and similar conventional measures.

Researchers investigate for safe ways of public transport during the COVID-19 pandemic.^[57][58]

Novel vaccine passports have been developed.

Researchers are developing face-masks which could be more effective at reducing SARS-CoV-2 spread than existing ones and/or have other desired properties such as

Ventilation and air cleaners are also the subject of research and development.[65]^[66]

Researchers report the development of

See also

• Treatment and management of COVID-19#Prevention of onward transmission
• Impact of the COVID-19 pandemic on science and technology

References