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From Containment to Mitigation of COVID-19 in the US

Educational Objective
Review this viewpoint on moving to a mitigation plan for COVID-19
1 Credit CME

Coronavirus disease 2019 (COVID-19) is a respiratory illness that results from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.1 Following initial reports of disease outbreak in China, COVID-19 has spread worldwide with cases identified in at least 67 countries across 6 continents.2 On March 2, California Governor Gavin Newsom announced $20 million in funding and mobilization of the state’s emergency management system to counteract COVID-19. In addition, 171 patients with SARS-CoV-2 infection were evacuated on February 5 to a US Air Force base in California following exposure on a cruise ship. These patients, who were asymptomatic or only mildly symptomatic, were transferred to local hospitals using a containment strategy.3 When a small number of infected patients are in concentrated locales, containment strategies (ie, quarantine) can halt the spread of infection by isolating infected or exposed individuals from the general population.4 However, disease containment requires the use of airborne isolation rooms, personal protective and other disposable equipment, and significant numbers of health care personnel. As COVID-19 spreads both in the US and around the world, it may not be possible to care for all patients in this manner.

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Article Information

Corresponding Author: Stephen M. Parodi, MD, The Permanente Medical Group, Kaiser Permanente, 1950 Franklin St, Oakland, CA 94612 (stephen.m.parodi@kp.org).

Published Online: March 13, 2020. doi:10.1001/jama.2020.3882

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by The Permanente Medical Group and grant R35GM128672 (awarded to Dr Liu) from the National Institute of General Medical Sciences.

References
1.
US Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): situation summary. Accessed March 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/summary.html
2.
Wu  Z , McGoogan  JM .  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China.   JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648 PubMedGoogle Scholar
3.
Jernigan  DB ; CDC COVID-19 Response Team.  Update: public health response to the coronavirus disease 2019 outbreak—United States, February 24, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(8):216-219. doi:10.15585/mmwr.mm6908e1PubMedGoogle ScholarCrossref
4.
Hellewell  J , Abbott  S , Gimma  A ,  et al.  Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts.   Lancet Glob Health. 2020;S2214-109X(20)30074-7. Published online February 28, 2020.PubMedGoogle Scholar
5.
Bai  Y , Yao  L , Wei  T ,  et al.  Presumed asymptomatic carrier transmission of COVID-19.   JAMA. Published online February 21, 2020. doi:10.1001/jama.2020.2565 PubMedGoogle Scholar
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