(2020/4/17) From mitigation to containment of the COVID-19 pandemic – Putting the SARS-CoV-2 genie back in the bottle (+中文摘要轉譯)

儘管回答“何時恢復正常”這個問題是多麼具有挑戰性,但是解決“如何恢復正常”這個問題同樣令人生畏。在沒有突破性治療或疫苗的情況下,美國必須如南韓使用強迫手段,從減災過渡到圍堵。受COVID-19影響最嚴重地區共同的特徵是人口密集。除非有廣泛的群體免疫,決策者在決行時必須考慮大型聚會、節日、會議、和體育賽事的風險。

檢測是重要的。首先,血清抗體檢測可提供族群暴露的估計值,並假設(並希望)之前的暴露是可以提供保護的,且保護力可維持到疫苗出現。以再生值2~3來估計,至少需有50%~66%的人受到感染才能產生群體免疫效果。第二,病毒抗原的檢測可偵測正在感染個案,這對阻止傳播是重要的;這些檢測必須易於執行,快速,可在醫療機構外取得,且價格合理。當檢測結果為陽性時,必須立即通知、教育、隔離感染者,並找出他們的接觸者。在資源不足區,必須在不增加汙名化及邊緣化的情況下,最大程度執行檢測、隔離、和接觸者追蹤程度這些介入措施。

美國必須投資公共衛生,以保障人民的福祉,並避免未來流行病再度造成個人及經濟的損失。緊急干預措施包括建立公共衛生基礎設施、紓困計畫、及物資供給計畫,以面對COVID-19或其他流行病再度發生的狀況。

COVID-19的流行帶來了空前的創造力、想像力、和同理心;美國加速整合遠距醫療至患者管理,並促進更順暢及方便的交流。在美國重新開放之前,美國必須確保這場戰役以正確的公共衛生策略作結,其中包括了廣泛的篩檢、為受影響的人們提供資源、及對不茲不倦幫助美國走過這場疾病的醫療工作人員表達感激。(財團法人國家衛生研究院莊淑鈞博士摘要整理)

As part of pandemic preparedness, epidemiologists promote “containment strategies” designed to prevent community transmission. For coronavirus disease 2019 (COVID-19), countries like South Korea—an example of successful containment—had a coordinated governmental response, testing on a massive scale, and prompt contact tracing and quarantine.1 The first cases of South Korea’s COVID-19 outbreak were in mid-January; by late February, South Korea was testing more than 10 000 people daily and, as a result, cases peaked on February 28. Since April 5, 2020, no more than 53 new cases daily have occurred nationwide.1

When disease outpaces containment, countries rely on “mitigation strategies.” Countries like China, Italy, Spain, and the US moved from containment to mitigation, albeit at differing paces. Mitigation relies on nonpharmaceutical interventions such as hand hygiene, travel restrictions, school closures, and social distancing. While a blunt and inconvenient tool, social distancing has proven in pandemic influenza (in both 1918 and 2009) to reduce and delay peak attack rates and mortality.2,3

Author: Rochelle P. Walensky, Carlos del Rio

Link: https://jamanetwork.com/journals/jama/fullarticle/2764956