Researchers from Imperial have analysed the likely impact of multiple public health measures on slowing and suppressing the spread of coronavirus.

The latest analysis comes from a team modelling the spread and impact COVID-19 and whose data are informing current UK government policy on the pandemic.

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The findings are published in the 9^th report from the WHO Collaborating Centre for Infectious Disease Modelling within the MRC Centre for Global Infectious Disease Analysis, J-IDEA, Imperial College London. . .

“We use the latest estimates of severity to show that policy strategies which aim to mitigate the epidemic might halve deaths and reduce peak healthcare demand by two-thirds, but that this will not be enough to prevent health systems being overwhelmed. More intensive, and socially disruptive interventions will therefore be required to suppress transmission to low levels. It is likely such measures – most notably, large scale social distancing – will need to be in place for many months, perhaps until a vaccine becomes available.”

Combining multiple measures

In the current absence of vaccines and effective drug treatments, there are several public health measures countries can take to help slow the spread of the COVID-19. The team focused on the impact of five such measures, alone and in combination:

• Home isolation of cases – whereby those with symptoms of the disease (cough and/or fever) remain at home for 7 days following the onset of symptoms
• Home quarantine – whereby all household members of those with symptoms of the disease remain at home for 14 days following the onset of symptoms
• Social distancing – a broad policy that aims to reduce overall contacts that people make outside the household, school or workplace by three-quarters.
• Social distancing of those over 70 years – as for social distancing but just for those over 70 years of age who are at highest risk of severe disease
• Closure of schools and universities

Modelling available data, the team found that depending on the intensity of the interventions, combinations would result in one of two scenarios.

In the first scenario, they show that interventions could slow down the spread of the infection but would not completely interrupt its spread. They found this would reduce the demand on the healthcare system while protecting those most at risk of severe disease. Such epidemics are predicted to peak over a three to four-month period during the spring/summer.

In the second scenario, more intensive interventions could interrupt transmission and reduce case numbers to low levels. However, once these interventions are relaxed, case numbers are predicted to rise. This gives rise to lower case numbers, but the risk of a later epidemic in the winter months unless the interventions can be sustained.

Slowing and suppressing the outbreak

The report details that for the first scenario (slowing the spread), the optimal policy would combine home isolation of cases, home quarantine and social distancing of those over 70 years. This could reduce the peak healthcare demand by two-thirds and reduce deaths by half. However, the resulting epidemic would still likely result in an estimated 250,000 deaths and therefore overwhelm the health system (most notably intensive care units).

In the second scenario (suppressing the outbreak), the researchers show this is likely to require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members (and possible school and university closure). The researchers explain that by closely monitoring disease trends it may be possible for these measures to be relaxed temporarily as things progress, but they will need to be rapidly re-introduced if/when case numbers rise. They add that the situation in China and South Korea in the coming weeks will help to inform this strategy further.

(Excerpt from Imperial College London. Article by Dr. Sabine L. van Elsland and Ryan O’Hare.)