Effectiveness of isolation, testing, contact tracing, and physical distancing on reducing transmission of SARS-CoV-2 in different settings: a mathematical modelling study.
Effectiveness of isolation, testing, contact tracing, and physical distancing on reducing transmission of SARS-CoV-2 in different settings: a mathematical modelling study.
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DOI：
10.1016/s1473-3099(20)30457-6
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
CMMID COVID-19 working group
中科院分区：
文献类型：
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作者：
Kucharski AJ;Klepac P;Conlan AJK;Kissler SM;Tang ML;Fry H;Gog JR;Edmunds WJ;CMMID COVID-19 working group
隔离有症状的病例和追踪接触者已被许多国家用作COVID-19的早期遏制措施，随着疫情的发展，还采取了额外的物理距离措施。为了保持对感染的控制，同时减少对人群的干扰，有必要了解可能需要采取哪些措施组合，包括新的数字追踪方法和较低强度的物理距离，以减少传播。我们的目的是估计在不同的控制措施下，在不同的环境中传播的减少，以及在给定的症状性病例发病率水平下，每天有多少接触者将被隔离。在这项数学建模研究中，我们使用了一个根据来自40 162名英国参与者的BBC大流行数据按设置（家庭，工作，学校或其他）分层的个人水平传播模型。 我们模拟了一系列不同的测试、隔离、跟踪和物理距离场景的效果。在乐观但合理的假设下，我们估计了有效繁殖数量的减少以及在不同策略下每天新隔离的接触者数量。我们估计，隔离和追踪相结合的策略将比大规模检测或自我隔离更能减少传播：每周对5%的人群进行大规模随机检测，平均传播减少2%，对有症状的病例在家庭内单独进行自我隔离，平均传播减少29%，在家庭外单独进行自我隔离，平均传播减少35%，自我隔离加家庭隔离，平均传播减少37%，64%用于自我隔离和家庭隔离，并增加了对所有接触者的手动接触者追踪，57%仅增加了对熟人的手动追踪，47%仅增加了基于应用程序的追踪。如果对家庭、学校或工作场所以外的聚会加以限制，那么仅对熟人进行手动接触追踪就可以产生类似于详细接触追踪的传播减少效果。在每天发生1000例符合触发接触者追踪定义的新症状病例的情况下，我们估计，在大多数接触者追踪策略中，每天将新隔离15000 - 41000名接触者。 与先前的模型研究和迄今为止针对特定国家的COVID-19应对措施一致，我们的分析估计，在没有其他措施的情况下，高比例的病例需要自我隔离，高比例的接触者需要成功追踪，以确保有效繁殖数低于1。如果结合适度的物理距离措施，自我隔离和接触者追踪将更有可能控制严重急性呼吸系统综合征冠状病毒2的传播。威康基金会、英国工程和物理科学研究理事会、欧洲委员会、皇家学会、医学研究理事会。
The isolation of symptomatic cases and tracing of contacts has been used as an early COVID-19 containment measure in many countries, with additional physical distancing measures also introduced as outbreaks have grown. To maintain control of infection while also reducing disruption to populations, there is a need to understand what combination of measures—including novel digital tracing approaches and less intensive physical distancing—might be required to reduce transmission. We aimed to estimate the reduction in transmission under different control measures across settings and how many contacts would be quarantined per day in different strategies for a given level of symptomatic case incidence. For this mathematical modelling study, we used a model of individual-level transmission stratified by setting (household, work, school, or other) based on BBC Pandemic data from 40 162 UK participants. We simulated the effect of a range of different testing, isolation, tracing, and physical distancing scenarios. Under optimistic but plausible assumptions, we estimated reduction in the effective reproduction number and the number of contacts that would be newly quarantined each day under different strategies. We estimated that combined isolation and tracing strategies would reduce transmission more than mass testing or self-isolation alone: mean transmission reduction of 2% for mass random testing of 5% of the population each week, 29% for self-isolation alone of symptomatic cases within the household, 35% for self-isolation alone outside the household, 37% for self-isolation plus household quarantine, 64% for self-isolation and household quarantine with the addition of manual contact tracing of all contacts, 57% with the addition of manual tracing of acquaintances only, and 47% with the addition of app-based tracing only. If limits were placed on gatherings outside of home, school, or work, then manual contact tracing of acquaintances alone could have an effect on transmission reduction similar to that of detailed contact tracing. In a scenario where 1000 new symptomatic cases that met the definition to trigger contact tracing occurred per day, we estimated that, in most contact tracing strategies, 15 000–41 000 contacts would be newly quarantined each day. Consistent with previous modelling studies and country-specific COVID-19 responses to date, our analysis estimated that a high proportion of cases would need to self-isolate and a high proportion of their contacts to be successfully traced to ensure an effective reproduction number lower than 1 in the absence of other measures. If combined with moderate physical distancing measures, self-isolation and contact tracing would be more likely to achieve control of severe acute respiratory syndrome coronavirus 2 transmission. Wellcome Trust, UK Engineering and Physical Sciences Research Council, European Commission, Royal Society, Medical Research Council.