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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
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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
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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
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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
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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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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/
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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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