Johns Hopkins University
Background The COVID-19 outbreak containment strategies in China based on non-pharmaceutical interventions (NPIs) appear to be effective. Quantitative research is still needed however to assess the efficacy of different candidate NPIs and their timings to guide ongoing and future responses to epidemics of this emerging disease across the World. Methods We built a travel network-based susceptible-exposed-infectious-removed (SEIR) model to simulate the outbreak across cities in mainland China. We used epidemiological parameters estimated for the early stage of outbreak in Wuhan to parameterise the transmission before NPIs were implemented. To quantify the relative effect of various NPIs, daily changes of delay from illness onset to the first reported case in each county were used as a proxy for the improvement of case identification and isolation across the outbreak. Historical and near-real time human movement data, obtained from Baidu location-based service, were used to derive the intensity of travel restrictions and contact reductions across China. The model and outputs were validated using daily reported case numbers, with a series of sensitivity analyses conducted. Results We estimated that there were a total of 114,325 COVID-19 cases (interquartile range [IQR] 76,776 - 164,576) in mainland China as of February 29, 2020, and these were highly correlated (p<0.001, R2=0.86) with reported incidence. Without NPIs, the number of COVID-19 cases would likely have shown a 67-fold increase (IQR: 44 - 94), with the effectiveness of different interventions varying. The early detection and isolation of cases was estimated to prevent more infections than travel restrictions and contact reductions, but integrated NPIs would achieve the strongest and most rapid effect. If NPIs could have been conducted one week, two weeks, or three weeks earlier in China, cases could have been reduced by 66%, 86%, and 95%, respectively, together with significantly reducing the number of affected areas. Results suggest that the social distancing intervention should be continued for the next few months in China to prevent case numbers increasing again after travel restrictions were lifted on February 17, 2020. Conclusion The NPIs deployed in China appear to be effectively containing the COVID-19 outbreak, but the efficacy of the different interventions varied, with the early case detection and contact reduction being the most effective. Moreover, deploying the NPIs early is also important to prevent further spread. Early and integrated NPI strategies should be prepared, adopted and adjusted to minimize health, social and economic impacts in affected regions around the World.
### Competing Interest Statement
The authors have declared no competing interest.
### Funding Statement
This study was supported by the grants from the Bill & Melinda Gates Foundation (OPP1134076); the European Union Horizon 2020 (MOOD 874850); the National Natural Science Fund of China (81773498); National Science and Technology Major Project of China (2016ZX10004222-009); Program of Shanghai Academic/Technology Research Leader (18XD1400300). AJT is supported by funding from the Bill & Melinda Gates Foundation (OPP1106427, OPP1032350, OPP1134076, OPP1094793), the Clinton Health Access Initiative, the UK Department for International Development (DFID) and the Wellcome Trust (106866/Z/15/Z, 204613/Z/16/Z). HY is supported by funding from the National Natural Science Fund for Distinguished Young Scholars of China (No. 81525023); Program of Shanghai Academic/Technology Research Leader (No. 18XD1400300); and the United States National Institutes of Health (Comprehensive International Program for Research on AIDS grant U19 AI51915).
### Author Declarations
All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
The data of COVID-19 cases reported by county, city, and province across China are availalable from data sources detailed in the Supplementary, and the average days from illness onset to report of the first case by each county used in the modelling are detailed in appendix Tabel S2. The mobile phone datasets analysed during the current study are not publicly available since this would compromise the agreement with the data provider, but the information on the process of requesting access to the data that support the findings of this study are available from the corresponding authors, and the data of travel and contact reductions derived from the datasets and used in our model are detailed in appendix Tabel S1.
Lai Shengjie, Ruktanonchai Nick W, Zhou Liangcai, Prosper Olivia, Luo Wei, Floyd Jessica R, Wesolowski Amy, Zhang Chi, Du Xiangjun, Yu Hongjie, Tatem Andrew J. (2020). Effect of non-pharmaceutical interventions for containing the COVID-19 outbreak: an observational and modelling study. Cold Spring Harbor Laboratory Press