Effect of non-pharmaceutical interventions for containing the COVID-19 outbreak in China
Shengjie Lai*, Nick W Ruktanonchai*, Liangcai Zhou, Olivia Prosper, Wei Luo, Jessica R Floyd, Amy Wesolowski, Mauricio Santillana, Chi Zhang,
Xiangjun Du,
Hongjie Yu, and
Andrew J Tatem *These authors contributed equally to this article. WorldPop, School of Geography and Environmental Science, University of Southampton, UK (S Lai PhD, N W R Ruktanonchai PhD, J R Floyd, Prof A J Tatem PhD); Wuhan Center for Disease Control and Prevention, Wuhan, Hubei Province, China (L Zhou MD); Department of Mathematics, University of Tennessee, Knoxville, TN, USA (O Prosper PhD); Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, USA (W Luo PhD, M Santillana PhD); Department of Pediatrics, Harvard Medical School, Boston, MA, USA (W Luo, M Santillana); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA (A Weolowski PhD); School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (C Zhang, Prof X Du PhD); School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China (Prof H Yu PhD, S Lai). Corresponding authors: Shengjie Lai (Shengjie.Lai@soton.ac.uk) and Andrew J Tatem (A.J.Tatem@soton.ac.uk), WorldPop, School of Geography and Environmental Science, University of Southampton, UK
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Abstract
Background
The COVID-19 outbreak containment strategies in China based on non-pharmaceutical interventions (NPIs) appear to be effective. Quantitative research is still needed however to assess the efficacy of different candidate NPIs and their timings to guide ongoing and future responses to epidemics of this emerging disease across the World.
Methods
We built a travel network-based susceptible-exposed-infectious-removed (SEIR) model to simulate the outbreak across cities in mainland China. We used epidemiological parameters estimated for the early stage of outbreak in Wuhan to parameterise the transmission before NPIs were implemented. To quantify the relative effect of various NPIs, daily changes of delay from illness onset to the first reported case in each county were used as a proxy for the improvement of case identification and isolation across the outbreak. Historical and near-real time human movement data, obtained from Baidu location-based service, were used to derive the intensity of travel restrictions and contact reductions across China. The model and outputs were validated using daily reported case numbers, with a series of sensitivity analyses conducted.
Results
We estimated that there were a total of 114,325 COVID-19 cases (interquartile range [IQR] 76,776 - 164,576) in mainland China as of February 29, 2020, and these were highly correlated (p<0.001, R
2
=0.86) with reported incidence. Without NPIs, the number of COVID-19 cases would likely have shown a 67-fold increase (IQR: 44 - 94), with the effectiveness of different interventions varying. The early detection and isolation of cases was estimated to prevent more infections than travel restrictions and contact reductions, but integrated NPIs would achieve the strongest and most rapid effect. If NPIs could have been conducted one week, two weeks, or three weeks earlier in China, cases could have been reduced by 66%, 86%, and 95%, respectively, together with significantly reducing the number of affected areas. However, if NPIs were conducted one week, two weeks, or three weeks later, the number of cases
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author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the
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The copyright holder for this preprint .https://doi.org/10.1101/2020.03.03.20029843doi: medRxiv preprint
could have shown a 3-fold, 7-fold, and 18-fold increase across China, respectively. Results also suggest that the social distancing intervention should be continued for the next few months in China to prevent case numbers increasing again after travel restrictions were lifted on February 17, 2020.
Conclusion
The NPIs deployed in China appear to be effectively containing the COVID-19 outbreak, but the efficacy of the different interventions varied, with the early case detection and contact reduction being the most effective. Moreover, deploying the NPIs early is also important to prevent further spread. Early and integrated NPI strategies should be prepared, adopted and adjusted to minimize health, social and economic impacts in affected regions around the World.
Funding
Bill & Melinda Gates Foundation; EU Horizon 2020; National Natural Science Fund of China; Wellcome Trust.
Keywords
: COVID-19; coronavirus; SARS-CoV-2; outbreak; non-pharmaceutical interventions; population movement; travel restriction; social distancing; model.
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the
(which was not peer-reviewed)
The copyright holder for this preprint .https://doi.org/10.1101/2020.03.03.20029843doi: medRxiv preprint