Combination of handwashing, mask-wearing and social distancing best for preventing COVID-19, model finds

Both self-imposed prevention measures such as hand-washing, mask-wearing and social distancing, as well as government-imposed social distancing can help mitigate and delay a COVID-19 epidemic, according to a new study published this week in PLOS Medicine by Alexandra Teslya of University Medical Center Utrecht, Utrecht, The Netherlands and colleagues.

The coronavirus disease COVID-19 has spread to nearly every country in the world and public health policymakers are seeking recommendations on how to delay or flatten its peak. In the new study, researchers developed a computational model of the spread of COVID-19 based on known information about the epidemiology of the disease. They used the model to study the predicted effect of various prevention measures on the number and timing of coronavirus cases.

If a population quickly becomes aware of the coronavirus and effective prevention measures, self-imposed prevention measures can both diminish and postpone the peak number of cases, the model showed. If the efficacy of the self-imposed measures exceeds 50%, a large epidemic can be prevented. If self-imposed prevention measures are slow to catch on, however, they may only reduce the number of cases but not delay a peak. Early implementation of government-imposed social distancing, however, was found to delay but not reduce the peak of the COVID-19 epidemic. Combining self-imposed prevention measures—particularly if adopted quickly and by a large portion of the population—with government-imposed social distancing has the potential to both delay and shrink the peak of the epidemic. The model did not account for demographics or heterogeneity in contact patterns of different people.

“We stress the importance of disease awareness in controlling the ongoing epidemic and recommend that, in addition to policies on social distancing, government and public health institutions mobilize people to adopt self-imposed measures with proven efficacy in order to successfully tackle COVID-19,” the authors say.

In an accompanying Perspective, Professor Yuming Guo of Monash University, Australia, and colleagues write that the new findings are important not only in minimizing initial outbreaks of COVID-19, but in strategies to prevent second epidemics. Improving awareness of self-imposed interventions is critical to prevent wide-spreading epidemics, particularly among ethnic minorities and elderly populations who are at risk. “Many of the self-imposed prevention strategies have very limited impact on the economy but contribute very significantly to epidemic control and are likely to play a very substantial role in control,” they write.

Research Article

Funding: This study was funded by the following: Fundação para a Ciência e a Tecnologia, project reference 131_596787873, awarded to GR, https://www.fct.pt; ZonMw 91216062, awarded to MEK, funded MEK and AT, https://www.zonmw.nl/en/; One Health European Joint Programme Horizon 2020 project 773830 (award recipient is not an author of this manuscript) funded NGG and MCJB, https://ec.europa.eu/programmes/horizon2020/en; and Aidsfonds Netherlands project P-29704 (award recipient is not an author of this manuscript) funded GR, https://aidsfonds.nl/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 

Competing Interests: MEK is a member of the Editorial Board of PLOS Medicine. The other authors have declared that no competing interests exist. 

Citation: Teslya A, Pham TM, Godijk NG, Kretzschmar ME, Bootsma MCJ, Rozhnova G (2020) Impact of self-imposed prevention measures and short-term government-imposed social distancing on mitigating and delaying a COVID-19 epidemic: A modelling study. PLoS Med 17(7): e1003166. https://doi.org/10.1371/journal.pmed.1003166

Author Affiliations: University Medical Center Utrecht, Utrecht, the Netherlands

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Perspective 

Funding: The work is supported by the Bill & Melinda Gates Foundation. LZ is supported by the National Natural Science Foundation of China (Grant number: 8191101420); Outstanding Young Scholars Funding (Grant number: 3111500001); Xi’an Jiaotong University Basic Research and Profession Grant (Grant number: xtr022019003) and Xi’an Jiaotong University Young Talent Support Grant (Grant number: YX6J004). YG is supported by Career Development Fellowships of the Australian National Health and Medical Research Council (Grant number: APP1163693). 

Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: YG is a member of the Editorial Board of PLOS Medicine. 

Citation: Zhang L, Tao Y, Shen M, Fairley CK, Guo Y (2020) Can self-imposed prevention measures mitigate the COVID-19 epidemic? PLoS Med 17(7): e1003240. https://doi.org/10.1371/journal.pmed.1003240  

Author Affiliations: Monash University; Zhengzhou University, Zhengzhou, Henan, China; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, PR China

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