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Projected effects of nonpharmaceutical public health interventions to prevent resurgence of SARS-CoV-2 transmission in Canada.
CMAJ. 2020 09 14; 192(37):E1053-E1064.CMAJ

Abstract

BACKGROUND

Continual efforts to eliminate community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will be needed to prevent additional waves of infection. We explored the impact of nonpharmaceutical interventions on projected SARS-CoV-2 transmission in Canada.

METHODS

We developed an age-structured agent-based model of the Canadian population simulating the impact of current and projected levels of public health interventions on SARS-CoV-2 transmission. Interventions included case detection and isolation, contact tracing and quarantine, physical distancing and community closures, evaluated alone and in combination.

RESULTS

Without any interventions, 64.6% (95% credible interval [CrI] 63.9%-65.0%) of Canadians will be infected with SARS-CoV-2 (total attack rate) and 3.6% (95% CrI 2.4%-3.8%) of those infected and symptomatic will die. If case detection and contact tracing continued at baseline levels without maintained physical distancing and reimplementation of restrictive measures, this combination brought the total attack rate to 56.1% (95% CrI 0.05%-57.1%), but it dropped to 0.4% (95% CrI 0.03%-23.5%) with enhanced case detection and contact tracing. Combining the latter scenario with maintained physical distancing reduced the total attack rate to 0.2% (95% CrI 0.03%-1.7%) and was the only scenario that consistently kept hospital and intensive care unit bed use under capacity, prevented nearly all deaths and eliminated the epidemic. Extending school closures had minimal effects but did reduce transmission in schools; however, extending closures of workplaces and mixed-age venues markedly reduced attack rates and usually or always eliminated the epidemic under any scenario.

INTERPRETATION

Controlling SARS-CoV-2 transmission will depend on enhancing and maintaining interventions at both the community and individual levels. Without such interventions, a resurgent epidemic will occur, with the risk of overwhelming our health care systems.

Authors+Show Affiliations

Public Health Risk Sciences Division (Ng, Fazil, Waddell, Turgeon, Otten, Ogden), National Microbiology Laboratory, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Guelph, Ont., and St. Hyacinthe, Que.; Centre for Immunization and Respiratory Infectious Diseases (Bancej), Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ont.; Office of Biosecurity Programs and Planning (Atchessi), Centre for Biosecurity, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ont. victoria.ng@canada.ca.Public Health Risk Sciences Division (Ng, Fazil, Waddell, Turgeon, Otten, Ogden), National Microbiology Laboratory, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Guelph, Ont., and St. Hyacinthe, Que.; Centre for Immunization and Respiratory Infectious Diseases (Bancej), Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ont.; Office of Biosecurity Programs and Planning (Atchessi), Centre for Biosecurity, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ont.Public Health Risk Sciences Division (Ng, Fazil, Waddell, Turgeon, Otten, Ogden), National Microbiology Laboratory, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Guelph, Ont., and St. Hyacinthe, Que.; Centre for Immunization and Respiratory Infectious Diseases (Bancej), Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ont.; Office of Biosecurity Programs and Planning (Atchessi), Centre for Biosecurity, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ont.Public Health Risk Sciences Division (Ng, Fazil, Waddell, Turgeon, Otten, Ogden), National Microbiology Laboratory, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Guelph, Ont., and St. Hyacinthe, Que.; Centre for Immunization and Respiratory Infectious Diseases (Bancej), Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ont.; Office of Biosecurity Programs and Planning (Atchessi), Centre for Biosecurity, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ont.Public Health Risk Sciences Division (Ng, Fazil, Waddell, Turgeon, Otten, Ogden), National Microbiology Laboratory, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Guelph, Ont., and St. Hyacinthe, Que.; Centre for Immunization and Respiratory Infectious Diseases (Bancej), Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ont.; Office of Biosecurity Programs and Planning (Atchessi), Centre for Biosecurity, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ont.Public Health Risk Sciences Division (Ng, Fazil, Waddell, Turgeon, Otten, Ogden), National Microbiology Laboratory, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Guelph, Ont., and St. Hyacinthe, Que.; Centre for Immunization and Respiratory Infectious Diseases (Bancej), Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ont.; Office of Biosecurity Programs and Planning (Atchessi), Centre for Biosecurity, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ont.Public Health Risk Sciences Division (Ng, Fazil, Waddell, Turgeon, Otten, Ogden), National Microbiology Laboratory, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Guelph, Ont., and St. Hyacinthe, Que.; Centre for Immunization and Respiratory Infectious Diseases (Bancej), Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ont.; Office of Biosecurity Programs and Planning (Atchessi), Centre for Biosecurity, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ont.Public Health Risk Sciences Division (Ng, Fazil, Waddell, Turgeon, Otten, Ogden), National Microbiology Laboratory, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Guelph, Ont., and St. Hyacinthe, Que.; Centre for Immunization and Respiratory Infectious Diseases (Bancej), Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Ont.; Office of Biosecurity Programs and Planning (Atchessi), Centre for Biosecurity, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ont.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32778573

Citation

Ng, Victoria, et al. "Projected Effects of Nonpharmaceutical Public Health Interventions to Prevent Resurgence of SARS-CoV-2 Transmission in Canada." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 192, no. 37, 2020, pp. E1053-E1064.
Ng V, Fazil A, Waddell LA, et al. Projected effects of nonpharmaceutical public health interventions to prevent resurgence of SARS-CoV-2 transmission in Canada. CMAJ. 2020;192(37):E1053-E1064.
Ng, V., Fazil, A., Waddell, L. A., Bancej, C., Turgeon, P., Otten, A., Atchessi, N., & Ogden, N. H. (2020). Projected effects of nonpharmaceutical public health interventions to prevent resurgence of SARS-CoV-2 transmission in Canada. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 192(37), E1053-E1064. https://doi.org/10.1503/cmaj.200990
Ng V, et al. Projected Effects of Nonpharmaceutical Public Health Interventions to Prevent Resurgence of SARS-CoV-2 Transmission in Canada. CMAJ. 2020 09 14;192(37):E1053-E1064. PubMed PMID: 32778573.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Projected effects of nonpharmaceutical public health interventions to prevent resurgence of SARS-CoV-2 transmission in Canada. AU - Ng,Victoria, AU - Fazil,Aamir, AU - Waddell,Lisa A, AU - Bancej,Christina, AU - Turgeon,Patricia, AU - Otten,Ainsley, AU - Atchessi,Nicole, AU - Ogden,Nicholas H, Y1 - 2020/08/09/ PY - 2020/07/21/accepted PY - 2020/8/12/pubmed PY - 2020/9/25/medline PY - 2020/8/12/entrez SP - E1053 EP - E1064 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 192 IS - 37 N2 - BACKGROUND: Continual efforts to eliminate community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will be needed to prevent additional waves of infection. We explored the impact of nonpharmaceutical interventions on projected SARS-CoV-2 transmission in Canada. METHODS: We developed an age-structured agent-based model of the Canadian population simulating the impact of current and projected levels of public health interventions on SARS-CoV-2 transmission. Interventions included case detection and isolation, contact tracing and quarantine, physical distancing and community closures, evaluated alone and in combination. RESULTS: Without any interventions, 64.6% (95% credible interval [CrI] 63.9%-65.0%) of Canadians will be infected with SARS-CoV-2 (total attack rate) and 3.6% (95% CrI 2.4%-3.8%) of those infected and symptomatic will die. If case detection and contact tracing continued at baseline levels without maintained physical distancing and reimplementation of restrictive measures, this combination brought the total attack rate to 56.1% (95% CrI 0.05%-57.1%), but it dropped to 0.4% (95% CrI 0.03%-23.5%) with enhanced case detection and contact tracing. Combining the latter scenario with maintained physical distancing reduced the total attack rate to 0.2% (95% CrI 0.03%-1.7%) and was the only scenario that consistently kept hospital and intensive care unit bed use under capacity, prevented nearly all deaths and eliminated the epidemic. Extending school closures had minimal effects but did reduce transmission in schools; however, extending closures of workplaces and mixed-age venues markedly reduced attack rates and usually or always eliminated the epidemic under any scenario. INTERPRETATION: Controlling SARS-CoV-2 transmission will depend on enhancing and maintaining interventions at both the community and individual levels. Without such interventions, a resurgent epidemic will occur, with the risk of overwhelming our health care systems. SN - 1488-2329 UR - https://www.unboundmedicine.com/medline/citation/32778573/Projected_effects_of_nonpharmaceutical_public_health_interventions_to_prevent_resurgence_of_SARS_CoV_2_transmission_in_Canada_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=32778573 DB - PRIME DP - Unbound Medicine ER -