Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China
Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China
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DOI：
10.1001/jama.2020.6130
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发表时间：
2020-05-19
影响因子：
120.7
通讯作者：
Wu, Tangchun
中科院分区：
文献类型：
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作者：
Pan, An;Liu, Li;Wu, Tangchun
公共卫生干预措施是否与中国武汉COVID-19疫情控制的改善有关？结果在这项队列研究，包括32 & x202 f; 2019年12月8日至2020年3月8日，武汉市583例实验室确诊的COVID-19患者，实施了包括警戒线、交通限制、社交距离、居家隔离、集中隔离等干预措施，普遍症状调查在时间上与SARS-CoV-2（二次传播）的有效繁殖数减少以及不同年龄组、性别和地理区域每天确诊病例数减少相关。2019冠状病毒病（COVID-19）已成为一种流行病，目前尚不清楚综合公共卫生干预措施是否能改善对疫情的控制。2019冠状病毒病（COVID-19）已成为一种流行病，目前尚不清楚是否能改善对疫情的控制。目的根据武汉市2019冠状病毒病（COVID-19，COVID-19）爆发的关键事件和干预措施，分5个阶段评价公共卫生干预措施与疫情流行特征的关系。设计、设置和参与者在这项队列研究中，从市法定传染病报告系统中提取了2019年12月8日至2020年3月8日期间报告的32583例实验室确诊的COVID-19病例的个人水平数据，包括患者的年龄、性别、居住地、职业和严重程度分类。非药物公共卫生干预措施，包括防疫线、交通限制、社交距离、家庭隔离、集中隔离和普遍症状调查。主要结果和措施实验室确诊的COVID-19感染率（定义为每百万人每天的病例数），跨年龄，性别和地理位置计算了5个时期：12月8日至1月9日（无干预），1月10日至22日（由于中国新年假期，大量人员流动），1月23日至2月1日（警戒线、交通限制和居家隔离）、2月2日至16日（集中隔离和治疗）和2月17日至3月8日（全面症状调查）。SARS-CoV-2的有效繁殖数（二次传播的指标）也在这段时间内进行了计算。结果在32583例实验室确诊的COVID-19病例中，患者年龄中位数为56.7岁（范围：0-103岁;四分位数范围：43.4-66.8岁），16817例（51.6%）为女性。每日确诊病例率在第三个时期达到峰值，随后在各地理区域、性别和年龄组之间下降，但儿童和青少年除外，他们的确诊病例率继续上升。在整个期间，当地卫生保健工作者的每日确诊病例率（每百万人130.5例[95%CI，123.9-137.2]）高于一般人群（每百万人41.5例[95%CI，41.0-41.9]）。重症和危重症病例的比例在5个时期内从53.1%下降到10.3%。严重性风险随年龄增加而增加：与20 - 39岁人群（严重和危重病例比例，12.1%）相比，老年人（≥ 80岁）患严重或危重疾病的风险更高（比例，41.3%;风险比，3.61 [95%CI，3.31-3.95]），而年轻人（
Question Was there an association of public health interventions with improved control of the COVID-19 outbreak in Wuhan, China? Findings In this cohort study that included 32 & x202f;583 patients with laboratory-confirmed COVID-19 in Wuhan from December 8, 2019, through March 8, 2020, the institution of interventions including cordons sanitaire, traffic restriction, social distancing, home quarantine, centralized quarantine, and universal symptom survey was temporally associated with reduced effective reproduction number of SARS-CoV-2 (secondary transmission) and the number of confirmed cases per day across age groups, sex, and geographic regions. Meaning A series of multifaceted public health interventions was temporally associated with improved control of the COVID-19 outbreak in Wuhan and may inform public health policy in other countries and regions.Importance Coronavirus disease 2019 (COVID-19) has become a pandemic, and it is unknown whether a combination of public health interventions can improve control of the outbreak. Objective To evaluate the association of public health interventions with the epidemiological features of the COVID-19 outbreak in Wuhan by 5 periods according to key events and interventions. Design, Setting, and Participants In this cohort study, individual-level data on 32 & x202f;583 laboratory-confirmed COVID-19 cases reported between December 8, 2019, and March 8, 2020, were extracted from the municipal Notifiable Disease Report System, including patients' age, sex, residential location, occupation, and severity classification. Exposures Nonpharmaceutical public health interventions including cordons sanitaire, traffic restriction, social distancing, home confinement, centralized quarantine, and universal symptom survey. Main Outcomes and Measures Rates of laboratory-confirmed COVID-19 infections (defined as the number of cases per day per million people), across age, sex, and geographic locations were calculated across 5 periods: December 8 to January 9 (no intervention), January 10 to 22 (massive human movement due to the Chinese New Year holiday), January 23 to February 1 (cordons sanitaire, traffic restriction and home quarantine), February 2 to 16 (centralized quarantine and treatment), and February 17 to March 8 (universal symptom survey). The effective reproduction number of SARS-CoV-2 (an indicator of secondary transmission) was also calculated over the periods. Results Among 32 583 laboratory-confirmed COVID-19 cases, the median patient age was 56.7 years (range, 0-103; interquartile range, 43.4-66.8) and 16 817 (51.6%) were women. The daily confirmed case rate peaked in the third period and declined afterward across geographic regions and sex and age groups, except for children and adolescents, whose rate of confirmed cases continued to increase. The daily confirmed case rate over the whole period in local health care workers (130.5 per million people [95% CI, 123.9-137.2]) was higher than that in the general population (41.5 per million people [95% CI, 41.0-41.9]). The proportion of severe and critical cases decreased from 53.1% to 10.3% over the 5 periods. The severity risk increased with age: compared with those aged 20 to 39 years (proportion of severe and critical cases, 12.1%), elderly people (>= 80 years) had a higher risk of having severe or critical disease (proportion, 41.3%; risk ratio, 3.61 [95% CI, 3.31-3.95]) while younger people (