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Public Health Interventions for COVID-19Emerging Evidence and Implications for an Evolving Public Health Crisis

Educational Objective
To understand how Public Health Interventions can affect the spread of COVID-19
1 Credit CME

For decades, leading scientists and influential professional societies have warned of the dangers of emerging infections and the specter of a global pandemic.1,2 The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its subsequent spread has lived up to and surpassed many of the warnings and has caused an evolving global public health and economic crisis. Significantly, no pharmaceutical agents are known to be safe and effective at preventing or treating coronavirus disease 2019 (COVID-19), the resulting illness.3 This leaves the medical and public health community with only nonpharmaceutical interventions (NPIs) to rely on for reducing the burden of COVID-19. These measures aim to reduce disease transmission both locally and globally and include bans on public gatherings, compulsory stay-at-home policies, mandating closures of schools and nonessential businesses, face mask ordinances, quarantine and cordon sanitaire (ie, a defined quarantine area from which those inside are not allowed to leave), among others. The effectiveness of NPIs has been studied theoretically,4 especially within the context of pandemic influenza, and also through analysis of historical observational data.57 A common finding of these studies is that implementing NPIs, especially when done rapidly after initial detection of a new contagious pathogen, can reduce transmission.

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Article Information

Corresponding Author: Eli N. Perencevich, MD, MS, Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246 (eli-perencevich@uiowa.edu).

Published Online: April 10, 2020. doi:10.1001/jama.2020.5910

Conflict of Interest Disclosures: None reported.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

References
1.
Lederberg  J , Shope  RE , Oaks  SC  Jr , eds. Institute of Medicine.  Emerging infections: Microbial Threats to Health in the United States. National Academy Press; 1992.
2.
Smolinski  MS , Hamburg  MA , Lederberg  J , eds.  Microbial Threats to Health: Emergence, Detection, and Response. National Academy Press; 2003.
3.
Fauci  AS , Lane  HC , Redfield  RR .  Covid-19: navigating the uncharted.   N Engl J Med. 2020;382(13):1268-1269. doi:10.1056/NEJMe2002387PubMedGoogle ScholarCrossref
4.
Peak  CM , Childs  LM , Grad  YH , Buckee  CO .  Comparing nonpharmaceutical interventions for containing emerging epidemics.   Proc Natl Acad Sci U S A. 2017;114(15):4023-4028. doi:10.1073/pnas.1616438114PubMedGoogle ScholarCrossref
5.
Markel  H , Lipman  HB , Navarro  JA ,  et al.  Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic.   JAMA. 2007;298(6):644-654. doi:10.1001/jama.298.6.644PubMedGoogle ScholarCrossref
6.
Hatchett  RJ , Mecher  CE , Lipsitch  M .  Public health interventions and epidemic intensity during the 1918 influenza pandemic.   Proc Natl Acad Sci U S A. 2007;104(18):7582-7587. doi:10.1073/pnas.0610941104PubMedGoogle ScholarCrossref
7.
Fong  MW , Gao  H , Wong  JY ,  et al.  Nonpharmaceutical measures for pandemic influenza in nonhealthcare settings—social distancing measures.   Emerg Infect Dis. 2020;26(5). doi:10.3201/eid2605.190995PubMedGoogle Scholar
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Pan  A , Liu  L , Wang  C ,  et al.  Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China.   JAMA. Published online April 10, 2020. doi:10.1001/jama.2020.6130Google Scholar
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Lauer  SA , Grantz  KH , Bi  Q ,  et al.  The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application.  Ann Intern Med. Published online March 10, 2020. doi:10.7326/M20-0504PubMedGoogle Scholar
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Intensive Care National Audit & Research Centre. ICNARC report on COVID-19 in critical care. Published April 4, 2020. Accessed April 5, 2020. https://www.icnarc.org/DataServices/Attachments/Download/76a7364b-4b76-ea11-9124-00505601089b
11.
Gostin  LO . Could–or should–the government impose a mass quarantine on an American city? Health Affairs Blog. Published March 10, 2020. Accessed April 5, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200310.824973/full/
12.
Tian  H , Liu  Y , Li  Y ,  et al.  An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China.   Science. Published online March 31, 2020. doi:10.1126/science.abb6105PubMedGoogle Scholar
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Remuzzi  A , Remuzzi  G .  COVID-19 and Italy: what next?   Lancet. Published online March 13, 2020;S0140-6736(20)30627-9. doi:10.1016/S0140-6736(20)30627-9PubMedGoogle Scholar
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CDC COVID-19 Response Team.  Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12-March 16, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346. doi:10.15585/mmwr.mm6912e2PubMedGoogle ScholarCrossref
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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
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  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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