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Differential effects of intervention timing on COVID-19 spread in the United States.

ABSTRACT: Assessing the effects of early nonpharmaceutical interventions on coronavirus disease 2019 (COVID-19) spread is crucial for understanding and planning future control measures to combat the pandemic. We use observations of reported infections and deaths, human mobility data, and a metapopulation transmission model to quantify changes in disease transmission rates in U.S. counties from 15 March to 3 May 2020. We find that marked, asynchronous reductions of the basic reproductive number occurred throughout the United States in association with social distancing and other control measures. Counterfactual simulations indicate that, had these same measures been implemented 1 to 2 weeks earlier, substantial cases and deaths could have been averted and that delayed responses to future increased incidence will facilitate a stronger rebound of infections and death. Our findings underscore the importance of early intervention and aggressive control in combatting the COVID-19 pandemic.

SUBMITTER: Pei S

PROVIDER: S-EPMC7821895 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Differential effects of intervention timing on COVID-19 spread in the United States.

Pei Sen S Kandula Sasikiran S Shaman Jeffrey J

Science advances 20201204 49

Assessing the effects of early nonpharmaceutical interventions on coronavirus disease 2019 (COVID-19) spread is crucial for understanding and planning future control measures to combat the pandemic. We use observations of reported infections and deaths, human mobility data, and a metapopulation transmission model to quantify changes in disease transmission rates in U.S. counties from 15 March to 3 May 2020. We find that marked, asynchronous reductions of the basic reproductive number occurred th ...[more]

PMID: 33158911

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Project description:From January 21 through February 23, 2020, public health agencies detected 14 U.S. cases of coronavirus disease 2019 (COVID-19), all related to travel from China (1,2). The first nontravel-related U.S. case was confirmed on February 26 in a California resident who had become ill on February 13 (3). Two days later, on February 28, a second nontravel-related case was confirmed in the state of Washington (4,5). Examination of four lines of evidence provides insight into the timing of introduction and early transmission of SARS-CoV-2, the virus that causes COVID-19, into the United States before the detection of these two cases. First, syndromic surveillance based on emergency department records from counties affected early by the pandemic did not show an increase in visits for COVID-19-like illness before February 28. Second, retrospective SARS-CoV-2 testing of approximately 11,000 respiratory specimens from several U.S. locations beginning January 1 identified no positive results before February 20. Third, analysis of viral RNA sequences from early cases suggested that a single lineage of virus imported directly or indirectly from China began circulating in the United States between January 18 and February 9, followed by several SARS-CoV-2 importations from Europe. Finally, the occurrence of three cases, one in a California resident who died on February 6, a second in another resident of the same county who died February 17, and a third in an unidentified passenger or crew member aboard a Pacific cruise ship that left San Francisco on February 11, confirms cryptic circulation of the virus by early February. These data indicate that sustained, community transmission had begun before detection of the first two nontravel-related U.S. cases, likely resulting from the importation of a single lineage of virus from China in late January or early February, followed by several importations from Europe. The widespread emergence of COVID-19 throughout the United States after February highlights the importance of robust public health systems to respond rapidly to emerging infectious threats.

Project description:The outbreak of the novel coronavirus disease (COVID-19) severely threatens the public health worldwide, but the transmission mechanism and the effectiveness of mitigation measures remain uncertain. Here we assess the role of airborne transmission in spreading the disease and the effectiveness of face covering in preventing inter-human transmission for the top-fifteen infected U.S. states during March 1 and May 18, 2020. For all fifteen states, the curve of total confirmed infections exhibits an initial sub-exponential growth and a subsequent linear growth after implementing social distancing/stay-at-home orders. The linearity extends one to two months for the six states without mandated face covering and to the onset of mandated face covering for the other nine states with this measure, reflecting a dynamic equilibrium between first-order transmission kinetics and intervention. For the states with mandated face covering, significant deviation from this linearity and curve flattening occur after the onset of this measure for seven states, with exceptions for two states. Most states exhibit persistent upward trends in the daily new infections after social distancing/stay-at-home orders, while reversed downward or slowing trends occur for eight states after implementing mandated face covering. The inadequacy of social distancing and stay-at-home measures alone in preventing inter-human transmission is reflected by the continuous linear growth in the total infection curve after implementing these measures, which is mainly driven by airborne transmission. We estimate that the number of the total infections prevented by face covering reaches ~252,000 on May 18 in seven states, which is equivalent to ~17% of the total infections in the nation. We conclude that airborne transmission and face covering play the dominant role in spreading the disease and flattening the total infection curve, respectively. Our findings provide policymakers and the public with compelling evidence that universal face covering, in conjunction with social distancing and hand hygiene, represents the maximal protection against inter-human transmission and the combination of these intervention measures with rapid and extensive testing as well as contact tracing is crucial in containing the COVID-19 pandemic.

Dataset Information

Differential effects of intervention timing on COVID-19 spread in the United States.

Publications

Differential effects of intervention timing on COVID-19 spread in the United States.

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