COVID-19 Management: Containment, Mitigation, Suppression

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

It was first identified in December 2019 in Wuhan, the capital of China’s Hubei province, and has since spread globally, resulting in an ongoing pandemic. A pandemic is an epidemic occurring on a scale that crosses international boundaries, usually affecting people on a worldwide scale.

The basic strategies for management are: Containment, Mitigation, Suppression.

Containment may be undertaken in the early stages of the outbreak, including contact tracing and isolating infected individuals to stop the disease from spreading to the rest of the population, other public health interventions on infection control, and therapeutic countermeasures such as vaccinations which may be effective if available.

When it becomes apparent that it is no longer possible to contain the spread of the disease, management will then move on to the mitigation stage, in which measures are taken to slow the spread of the disease and mitigate its effects on society and the healthcare system. In reality, containment and mitigation measures may be undertaken simultaneously.

Another strategy, suppression, requires more extreme long-term non-pharmaceutical interventions so as to reverse the pandemic by reducing the basic reproduction number to less than 1. The suppression strategy, which includes stringent population-wide social distancing, home isolation of cases, and household quarantine, where entire cities may be placed under lockdown, but such strategy carries with it considerable social and economic costs.

A key part of managing an infectious disease outbreak is trying to decrease the epidemic peak, known as “flattening the epidemic curve”. This helps decrease the risk of health services being overwhelmed, and provides more time for a vaccine and treatment to be developed. Non-pharmaceutical interventions may be taken to manage the outbreak. In a flu pandemic, these actions may include: personal preventive measures such as hand hygiene, wearing face-masks, and self-quarantine; community measures aimed at social distancing such as closing schools and cancelling mass gatherings; community engagement to encourage acceptance and participation in such interventions; and environmental measures such as cleaning of surfaces.

20200410 Flatten the curve, raise the line - pandemic (English).gif
By RCraig09Own work, CC BY-SA 4.0, Link

Goals of mitigation include delaying and reducing peak burden on healthcare (flattening the curve) and lessening overall cases and health impact. Moreover, progressively greater increases in healthcare capacity (raising the line) such as by increasing bed count, personnel, and equipment, helps to meet increased demand.

20200409 Pandemic resurgence - effect of inadequate mitigation.gif
By RCraig09Own work, CC BY-SA 4.0, Link

Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of physical distancing rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation.

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3. “3. Strategies for Disease Containment”. Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary.
4. Baird, Robert P. (11 March 2020). “What It Means to Contain and Mitigate the Coronavirus”. The New Yorker.
5. “Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand” (PDF). Imperial College COVID-19 Response Team. 16 March 2020.
6. Cohen, MS; Hellmann, N; Levy, JA; DeCock, K; Lange, J (April 2008). “The spread, treatment, and prevention of HIV-1: evolution of a global pandemic”. The Journal of Clinical Investigation. 118 (4): 1244–54. doi:10.1172/JCI34706. PMC 2276790. PMID 18382737.
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