From Mitigation to Containment of the COVID-19 Pandemic: Putting the SARS-CoV-2 Genie Back in the Bottle | Infectious Diseases | JAMA | JAMA Network
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COVID-19: Beyond Tomorrow
April 17, 2020

From Mitigation to Containment of the COVID-19 Pandemic: Putting the SARS-CoV-2 Genie Back in the Bottle

Author Affiliations
  • 1Division of Infectious Diseases and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
  • 2Harvard University Center for AIDS Research, Harvard Medical School, Boston, Massachusetts
  • 3Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
  • 4Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia
JAMA. 2020;323(19):1889-1890. doi:10.1001/jama.2020.6572

As part of pandemic preparedness, epidemiologists promote “containment strategies” designed to prevent community transmission. For coronavirus disease 2019 (COVID-19), countries like South Korea—an example of successful containment—had a coordinated governmental response, testing on a massive scale, and prompt contact tracing and quarantine.1 The first cases of South Korea’s COVID-19 outbreak were in mid-January; by late February, South Korea was testing more than 10 000 people daily and, as a result, cases peaked on February 28. Since April 5, 2020, no more than 53 new cases daily have occurred nationwide.1

When disease outpaces containment, countries rely on “mitigation strategies.” Countries like China, Italy, Spain, and the US moved from containment to mitigation, albeit at differing paces. Mitigation relies on nonpharmaceutical interventions such as hand hygiene, travel restrictions, school closures, and social distancing. While a blunt and inconvenient tool, social distancing has proven in pandemic influenza (in both 1918 and 2009) to reduce and delay peak attack rates and mortality.2,3

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    2 Comments for this article
    SARS-CoV-2 Testing Requirements
    Gerry Silverstein, PhD Microbiol (Virology) | University
    From the article: "These tests must be easy to perform, quick to result, readily and equitably available outside of the health care setting, and inexpensive."

    Equally important, if not more important, than any of the features detailed in the latter statement is the fact that the tests (RT-PCRs) must be ACCURATE. Some reports have detailed sensitivity of RT-PCR (in community testing) for SARS-CoV-2 as low as 70% (= 30% false negative results). Although specificity is assumed to be 100%, that has not been proven.

    Remember also that a negative test result today means only one
    thing: negative today. Tomorrow and/or a week later the result may be different.

    The same, if not greater, concerns exist for serology. Recent reports detail not all who have been infected by SARS-CoV-2 have measurable antibody (Ab). Is the Ab specific for SARS-CoV-2 or any coronavirus? How long before Ab is detectable? How long will Ab last? If a person has Ab, but it is NOT neutralizing Ab, will they be immune to re-infection? Is any Ab produced "enhancing" Ab?

    And, of course, does humoral immunity (Ab) define immunity to re-infection and/or disease, or is cell-mediated immunity most (more?) important? Antibody versus both HIV and HCV is produced in infected individuals but there is little evidence such Ab defines immunity.

    The public and politicians need to understand it will take time to acquire the data that will allow answers to these critical questions. Too many are expecting quick answers that will being a quick end to the pandemic. Unfortunately advances in scientific knowledge that lead to control of new infectious agents take time.
    I know It’s Not Influenza. But.
    Gregory Roush, MD | Mercy Health Youngstown
    Let's say COVID-19 never happened, but we have a pandemic which manages to kill upward of 30,000 Americans a year, every year, including babies and pregnant women. Let’s say that this is the annual mortality despite a vaccine and effective drug.

    But it doesn’t overwhelm our hospital capacity, PPE or ventilator supplies. Vaccines are encouraged but not compulsory, except for HCWs (and that after quite the pushback) and testing is available but discouraged except in the most at risk, thus reagents are plentiful. Would we tolerate this health care burden “on balance” or impose additional, perhaps quite intrusive
    and economically damaging, mitigation efforts?

    Devil’s advocate question: had the peak not threatened to overwhelm hospitals, perhaps because we were prepared, invested with foresight after SARS-1 to scale them up, how might we have acted differently? By extension, what level of mortality will we eventually accept “on balance” for COVID-19?