Case isolation, contact tracing, and physical distancing are pillars of COVID-19 pandemic control, not optional choices.
Case isolation, contact tracing, and physical distancing are pillars of COVID-19 pandemic control, not optional choices.
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DOI：
10.1016/s1473-3099(20)30512-0
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
MacIntyre CR
中科院分区：
文献类型：
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作者：
MacIntyre CR
《柳叶刀传染病》1提醒我们，所有可用的控制措施都应该一起使用，以使有效繁殖数（Reff）低于1。流行病这个词被广泛滥用，但真正的流行性呼吸道感染（当R> 1时）在几天或几周内呈指数级增长，因此我们没有时间。疾病控制中的延误或错误可能会付出高昂的代价。利用来自BBC Pandemic研究的40162名英国参与者的英国接触数据和乐观的假设，Kucharski及其同事模拟了COVID-19大流行期间的个人层面传播，该传播按环境（家庭，工作，学校或其他）分层，有和没有各种非药物干预措施（NPI），包括不同的检测，隔离，追踪和物理距离情景。他们的研究结果表明，我们没有奢侈品在可用的NPI之间挑选和选择来控制COVID-19。需要查明和隔离的病例比例很高（在医院或家中），接触者追踪和隔离率很高，沿着进行物理隔离，以实现和维持疫情控制。这一发现听起来似乎很明显，但在2020年2月18日，英国紧急情况科学咨询小组第八次会议得出结论，“当英国出现持续传播时，接触者追踪将不再有用”。2在Kucharski及其同事的研究中，病例隔离与接触者追踪相结合将传播减少了47%。（自我隔离与基于应用程序的追踪相结合）至64%（自我隔离与所有接触者的手动接触者追踪相结合）与大规模检测和单独病例隔离相比，这将传播减少了2%（每周对5%的人口进行大规模随机检测）至37%（自我隔离加家庭隔离）。COVID-19大流行是我们一生中前所未有的事件，我们在过去的世纪中享受了疫苗控制严重流行性感染的奢侈品。因此，我们很少需要大规模控制流行病的其他支柱。在没有疫苗的情况下，COVID-19的控制依赖于
The Lancet Infectious Diseases1 reminds us that all available control measures should be used together to drive the effective reproduction number (Reff) below 1. The word epidemic is widely misused, but true epidemic respiratory infections (when R> 1) grow exponentially within days or weeks and thus we do not have time on our side. Delays or mistakes in disease control can be costly. Using UK contact data from 40 162 UK participants of the BBC Pandemic study and optimistic assumptions, Kucharski and colleagues modelled individual-level transmission during the COVID-19 pandemic stratified by setting (household, work, school, or other) with and without various non-pharmaceutical interventions (NPIs) including different testing, isolation, tracing, and physical distancing scenarios. Their findings showed that we do not have the luxury of picking and choosing between available NPIs to control COVID-19. A high proportion of cases need to be identified and isolated (in hospital or at home), with a high rate of contact tracing and quarantine along with physical distancing, to achieve and maintain epidemic control.This finding might sound obvious, but on Feb 18, 2020, the eighth meeting of the Scientific Advisory Group for Emergencies in the UK concluded that “when there is sustained transmission in the UK, contact tracing will no longer be useful”. 2 In Kucharski and colleagues’ study, combinations of case isolation with contact tracing reduced transmission by 47%(self-isolation combined with app-based tracing) to 64%(self-isolation com bined with manual contact tracing of all contacts) compared with mass testing and case isolation alone, which reduced transmission by 2%(mass random testing of 5% of the population each week) to 37%(self-isolation plus household quarantine). The COVID-19 pandemic is an unprecedented event in our lifetimes, and we have enjoyed the luxury of vaccines to control serious epidemic infections in the past century. As a result, we have rarely needed some of the other pillars of epidemic control on a mass scale. In the absence of a vaccine, control of COVID-19 relies