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Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection
Daniel F. Patiño-Lugo; Marcela Vélez; Pamela Velásquez Salazar;
Daniel F. Patiño-Lugo; Marcela Vélez; Pamela Velásquez Salazar; Claudia Yaneth Vera-Giraldo; Viviana Vélez; Isabel Cristina Marín; Paola Andrea Ramírez; Sebastián Pemberthy Quintero; Esteban Castrillón Martínez; Daniel Andrés Pineda Higuita; Gilma Henandez
Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection
Intervenciones no farmacéuticas para la contención, mitigación y supresión de la infección por COVID-19
Colombia Medica, vol. 51, no. 2, e4266, , 2020
Universidad del Valle
resúmenes
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referencias
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Abstract

Background: The best scientific evidence is required to design effective Non-pharmaceutical interventions to help policymakers to contain COVID-19.

Aim: To describe which Non-pharmaceutical interventions used different countries and a when they use them. It also explores how Non-pharmaceutical interventions impact the number of cases, the mortality, and the capacity of health systems.

Methods: We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria.

Result: Some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a combination of mandatory quarantine and other drastic social distancing measures. The timing to implement the interventions varied from the first fifteen days after detecting the first case to more than 30 days. The effectiveness of isolated non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months. The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions could have a substantial effect on those objectives.

Keywords: COVID-19, Coronavirus, Review, Public Health, Quarantine, Health Impact Assessment.

Resumen

Antecedentes: Se requiere la mejor evidencia científica para diseñar intervenciones no farmacológicas efectivas para ayudar a los formuladores de políticas a contener COVID-19.

Objetivo: Describir qué intervenciones no farmacológicas utilizaron diferentes países y cuándo las implementaron. También explora cómo las intervenciones no farmacológicas afectan el número de casos, la mortalidad y la capacidad de los sistemas de salud.

Métodos: Consultamos ocho páginas web de organizaciones transnacionales, 17 de medios internacionales, 99 de instituciones gubernamentales en los 19 países incluidos, y además, incluimos nueve estudios (de 34 identificados) que cumplían con los criterios de inclusión.

Resultados: Algunos países implementaron restricciones de viaje, aislamiento de casos identificados y personas de alto riesgo. Otros combinaron varias medidas más drásticas de distanciamiento social. El tiempo para implementar las intervenciones varió desde los primeros quince días después de detectar el primer caso hasta más de 30 días. La efectividad de las intervenciones no farmacológicas combinadas ha demostrado ser efectivas para reducir la transmisibilidad de la enfermedad, el colapso de los servicios de salud y la mortalidad. Cuando se controle el número de casos nuevos, es necesario mantener medidas de distanciamiento social, autoaislamiento y rastreo de contactos durante varios meses. La toma de decisiones políticas en este momento debe tener como objetivo optimizar las oportunidades de salvar vidas, reducir el colapso de los servicios de salud y minimizar el impacto económico y social sobre la población en general, pero principalmente sobre los más vulnerables.

Palabras clave: COVID-19, Coronavirus, Revisión, Salud pública, Cuarentena, Evaluación del impacto en la salud.

Carátula del artículo

Review

Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection

Intervenciones no farmacéuticas para la contención, mitigación y supresión de la infección por COVID-19

Daniel F. Patiño-Lugo
Universidad de Antioquia, Colombia
Marcela Vélez
Universidad de Antioquia, Colombia
Pamela Velásquez Salazar
Universidad de Antioquia, Colombia
Claudia Yaneth Vera-Giraldo
Universidad de Antioquia, Colombia
Viviana Vélez
Universidad de Antioquia, Colombia
Isabel Cristina Marín
Universidad de Antioquia, Colombia
Paola Andrea Ramírez
Universidad de Antioquia, Colombia
Sebastián Pemberthy Quintero
Universidad de Antioquia, Colombia
Esteban Castrillón Martínez
Universidad de Antioquia, Colombia
Daniel Andrés Pineda Higuita
Universidad de Antioquia, Colombia
Gilma Henandez
Universidad de Antioquia, Colombia
Colombia Medica, vol. 51, no. 2, e4266, 2020
Universidad del Valle

Received: 02 April 2020

Revised document received: 25 April 2020

Accepted: 04 May 2020

DOI: https://doi.org/10.25100/cm.v51i2.4266

Remark




Introduction

Coronavirus disease 2019 (COVID-19) is a new, rapidly emerging infectious disease, which constitutes a major global health threat 1. On January 30th, 2020, the World Health Organization (WHO) declared the outbreak a global health emergency 2, while Colombia did it on March 12th 3.

The virus SARS-CoV-2 appears to have high transmissibility, the basic reproduction number (R0) range from 2.8 to 5.5, in the absence of full quarantine and social distancing measures, in comparison to the average R0 for seasonal influenza viruses which is about 1.8 4.

In past experiences, like the 1918-19 H1N1 influenza pandemic, no effective interventions or vaccines were available to treat or prevent the disease; this has taught us that in these circumstances, a variety of non-pharmaceutical interventions (Non-pharmaceutical interventions) are successful at reducing case numbers 4. Non-pharmaceutical interventions include isolating ill persons, contact tracing, quarantine of exposed persons, social distancing, travel restrictions, school, churches and workplace closure, and cancellation of mass gathering events 4-9. Those interventions have shown to be effective ways to respond to the outbreak when implemented early in the epidemic (4-6). Past epidemics have also shown that while the interventions remained in place, mortality is reduced; however, “transmission rebounded once controls are lifted” 4.

Three groups of Non-pharmaceutical interventions strategies have been recognized, 1) containment, 2) mitigation, and 3) suppression 6,7. Containment interventions are those implemented when the first cases are detected in order to interrupt the transmission of the disease, prevent its spread and give time to the healthcare system to make the preparations for attending patients, and waiting for the development of vaccines and effective interventions 9. Mitigation interventions are used when the number of cases increases and the possibility of finding a relationship between cases is complicated, mitigation is not aimed to interrupt transmission completely, but to reduce the health impact of an epidemic over the mortality and the collapse of the health system 4,10. And suppression is intended to reduce the average number of secondary cases each case generates 4.

According to the Imperial College, suppression carries enormous social and economic costs, which may themselves have a significant impact on health and well-being in the short and longer-term. Mitigation will never be able to protect those at risk from severe disease or death entirely, and the resulting mortality may, therefore, still be high 4.

In China, three major Non-pharmaceutical interventions have been implemented to control the spread and reduce the outbreak size of COVID-19 9. First, inter-city travel bans and the establishment of a cordon sanitaire of Wuhan and surrounding cities in Hubei Province 9,11-13. Second, measures for improving the screening, contact tracing, identification, diagnosis, isolation, and reporting of suspected ill persons and confirmed cases 9,14. And third, implementing inner-city travel and contact restrictions, which included limiting individual social contact, using personal hygiene and protective measures, and increasing the physical distance between those who have COVID-19 and those who do not 9,15. The Chinese government also encouraged people to stay at home as much as possible, canceled or postponed large public events and mass gatherings, and closed libraries, museums, and workplaces 8,9.

The progressive spread of the disease has allowed many countries to anticipate that a pandemic is approaching 9,16. In the case of Colombia, some local governments, as well as the national government, rapidly and drastically implemented a quarantine in all the national territory, as well as other Non-pharmaceutical interventions aimed at the contention, suppression, and mitigation of the COVID-19 disease.

The best available scientific evidence is required to design effective Non-pharmaceutical interventions and disseminate the knowledge urgently to help policymakers assess the potential benefits and costs of Non-pharmaceutical interventions to contain COVID-19 outbreaks. It is essential to describe how different countries implement Non-pharmaceutical interventions, and at what point of the epidemic. It is also necessary to explore how those Non-pharmaceutical interventions have impacted the number of cases, the mortality, and the capacity of health care facilities to deliver healthcare services. There are still crucial knowledge gaps on the effectiveness of different interventions to adequately justify the preparation, implementation, or cancellation of various Non-pharmaceutical interventions, policymakers across the World need evidence as to the combination and timings of each, which remains lacking.

Materials and Methods

A rapid evidence synthesis focused on identifying Non-pharmaceutical interventions implemented in the city of Wuhan and 19 countries (i.e., Argentina, Australia, Brazil, Canada, Chile, China, Colombia, Cuba, Germany, Iran, Italy, Japan, Mexico, Norway, Russia, South Korea, Spain, United Kingdom, and the United States) was carried out. Three criteria were applied to select the countries and territories, 1) a comparatively high number of cases, 2) a political or social particularity that allows the understanding of different types of Non-pharmaceutical interventions or different pace in their implementation; and 3) balance between countries in Europe, Asia, and North, Central, and South America.

Eight web pages of transnational organizations, 17 webpages of international magazines and newspapers, and 99 webpages of governmental institutions in the 19 countries included were searched from January 1st to March 25th, 2020. Additionally, the databases Medline and Embase were searched for studies evaluating the effectiveness of Non-pharmaceutical interventions for the containment, suppression, and mitigation of COVID-19 (Appendix 1with the search sources).

Official documents and media articles were used to determine the date when different countries implemented Non-pharmaceutical interventions. The eligibility criteria of academic papers were that the article was focused on exploring the effectiveness and impact of Non-pharmaceutical interventions on the containment, suppression, or mitigation of COVID-19, with no language, neither study design restrictions. Eligible studies included observational studies (cohorts, time series, series report), simulations studies, and health system or political system guidance.

Quality assessment of observational studies was performed with the Johana Briggs criteria for appraisal. In contrast, simulation studies were not formally quality assessed. Still, a judgement was provided according to the completeness of variables to perform the simulation, the strength of the assumptions, and the quality of the description of the statistical procedure. All stages of the review process were performed by one researcher and checked by a second.

Information about the number of new cases and new deaths caused by COVID-19 in the countries and territories chosen was reached from the John Hopkins Center for Systems Science and Engineering after realizing that its dashboard has more updated information than the situation reports of WHO 1. The first case reported in each country was documented from official sources or from WHO, with this information, we determined how many days elapsed between the first case reported and the NPI decision taken by the government. The number of days to make the decision was used to develop a timeline of events, a heat map, and a joint figure that represents new cases day by day and the point in which the Non-pharmaceutical interventions were decided. The heat map was developed with R software 17.

Results

All countries have implemented several Non-pharmaceutical interventions to control COVID-19 infection. However, there is variability in the amount and type of interventions. In countries like Brazil, Canada, Mexico, and Russia, we identified few interventions, and none of them were among the most drastic measures of social distancing, for example, Mexico has only implemented the closure of schools and colleges 18. These countries have focused mainly on avoiding the entry of cases by using travel restrictions and isolating the identified cases and high-risk people.

Another group of countries applied several interventions, including one of the drastic social distancing ones. South Korea, United Kingdom, and the United States, for example, have implemented more drastic social distancing interventions combined with rules of detection, contact tracing, and isolation of cases and contacts. Notably, South Korean is recognized for the rapid implementation of a mass case detection strategy 19, while recently in some of the States in the United States have begun the implementation of social distancing measures 20.

The third group of countries has applied an intense combination of drastic interventions for containment, mitigation, and suppression of infection. Argentina, Chile, China, Colombia, Italy, Spain, all implemented mandatory quarantine for the entire population, after closing schools and universities, canceling all events that concentrated more than 200 people and suspending public transportation for all who do not carry out essential work for infection control. In addition, they have also employed case isolation and contact tracing, borders closings, and some are implementing mass case detection.

Regarding the pace for implementing the strategies, some countries such as Argentina, Chile, and Colombia, which reported the first case in March, implemented interventions in the early fifteen days after the detection of the first case (Table 1 for further details), or even before the notification of the first case, as it is the case of Chile. Argentina, Chile, and Colombia have had the opportunity to anticipate and learn from the policy decision made in other countries, such as China and South Korea, affected as early as December 2019 and January 2020 (Figure 1 that exhibits a heat map of the time to implement the interventions). Countries such as Italy, Spain, and the United States, took more than 30 days to implement drastic measures of social distancing, and they are displaying an extreme situation of the collapse of their health systems. These experiences have served to apprentice countries to making decisions early after the first case is reported (Figure 2 for information about the moment in which some countries have implemented some decisions and the number of new cases they had at that time).

Table 1
Non-pharmaceutical interventions and number of days to implement them after the first case of COVID-19 (as march 28 of 2020)

Table 1 shows the non-pharmaceutical interventions (NON-PHARMACEUTICAL INTERVENTIONS) that countries have implemented as of March 28th of 2020 and the number of days in which they were implemented after their first case report. The Non-pharmaceutical interventions are presented in the following order: 1) those related to the most drastic measures of social distancing; 2) isolation measures of cases and contacts, 3) travel restrictions, and 4) early case detection and contact tracing. The countries are organized from left to right, according to the detection date of their first case. The numbers in the table are the number of days between the application of the intervention and the appearance of the first case in each country. The references that were consulted in each country are presented in the appendix 1 * The social distancing strategy recently used in South Korea is not mandatory as in other countries. However, the campaign is quite comprehensive, so we decided to put it in this box. Note: due to the large amount of different information that is circulating in this pandemic, the different languages in which the information is published, and the reporting limitations of some countries, some data may not be accurate. Negative numbers indicate that action was taken before the first case came. For example, Chile declared a state of alert on February 8, which is 24 days before the first case.


Figure 1
Heat map of Non-pharmaceutical interventions and number of days in which they were implement them after the first case of COVID-19


Figure 2
Number of new COVID-19 cases and day of implementation of some Non-pharmaceutical interventions

Other Non-pharmaceutical interventions implemented by the countries analyzed include interventions to improve the infrastructure of the health system and strength the human resources capacity (e.g., expand the capacity of beds, enable the use of stadiums and other spaces), strategies aimed at populations at risk (e.g., special measures for the people deprived of liberty), social support interventions (e.g., tax relieves), strategies to support the production of goods and services (e.g., facilitate loans to companies), and strategies for accurate information, timely communication, and support for social distancing (Appendix 2).

Impact of Non-pharmaceutical interventions

In exploring the effectiveness of non-pharmaceutical interventions on containment, suppression, and mitigation of COVID-19 infection, we included nine over 34 studies identified (one policy guidance, one rapid systematic review, two cohort studies, one time series study, and four simulations) 4-6,11-13,21,22. Appendix 3 summarizes the findings of these studies.

The effectiveness of any isolated Non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective and have a high impact in reducing the transmissibility of the disease, the collapse of health care services, and mortality. Seven of nine studies included explicitly suggest the early implementation of combined and strict interventions; mainly, quarantine, social distancing, suspension of public transportation, early detection of cases and home isolation of mild cases 4,5,9,12,13,21,22 (Table 2).

Table 2
Impact of non-pharmaceutical interventions for the control of COVID-19 infection

Without the implementation of Non-pharmaceutical interventions, one study in China claims that the number of COVID-19 cases would have a 51-fold increase in Wuhan, a 92-fold increase in other Hubei cities, and a 125-fold increase in other provinces 9. Combined Non-pharmaceutical interventions might reduce the maximum demand for medical care and mortality by half or even two thirds 4. A simulation study for the United Kingdom and the United States shows that, in an uncontrolled epidemic, demand for intensive care beds is predicted to exceed as early as the second week of April, with peak demand for care beds of more than 30 times the maximum supply in both countries 4.

After the peak of the disease, and when the number of new cases has been controlled, it is necessary to maintain social distancing measures, control of public transportation, work-at-home strategies, case detection and isolation, and contact tracing. Contact tracing and case isolation are suggested to be highly effective in controlling a new COVID-19 outbreak. However, the probability of control decreases with 1) long delays from onset of symptoms until deciding isolation, 2) few contacts tracked per case, and 3) when the transmission before symptoms increases 22. In most of the simulation scenarios and from the public health experience of previous epidemics, it is identified that, if the social contact resumes to normal levels, the contagions could increase again. Therefore several Non-pharmaceutical interventions, including social distancing, should be continued for several months, 9 it is even proposed that restrictive measures should be maintained until a vaccine is available (potentially 18 months or more) since it is predicted that transmission will recover quickly if interventions are relaxed 4.

When the number of new cases demonstrates the control of the disease, evidence suggests that measures that can be lifted first are border closures, case detection procedures at airports, and the closings of schools and daycares. The evidence also suggests that both the establishment and removal of Non-pharmaceutical interventions depend on several political, social, and cultural factors, not only on the behavior of the disease 5,9,21.

Discussion
Summary of the main findings

We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria. We found that some countries are mainly focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a more intense combination of mandatory quarantine for the entire population, closure of all educational centers, and suspension of public transportation for all those who do not perform essential work. Some of the countries have implemented interventions in the first fifteen days after detecting the first case, while others have taken more than 30 days to implement drastic measures of social distancing. The effectiveness of isolated Non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective and have a high impact in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, public transportation control, work at home strategies, case detection, self-isolation, and contact tracing for several months.

Comparison with other studies

A modeling study made in Colombia to predict the impact of the COVID-19 pandemic according to mitigation measures that have been implemented in the country resonates with our findings that combined interventions could be effective and have a high impact on reducing the transmissibility of the disease. The study of González-Jaramillo et al. 23, concludes that the combination of mitigation strategies taken by the Colombian government could reduce the number of patients that would require intensive care units from 36,782 in the scenario of no intervention to 1,176 in the scenario that combines case isolation, home quarantine, and social distancing of people over 70 years old.

Our finding of the need to maintain social distancing measures, control of public transportation, work-at-home strategies, case detection and isolation, and contact tracing has also been supported in the literature. The model developed by Prem et al., suggests that the sudden lifting of interventions could lead to an earlier secondary peak, which could be prevented by relaxing the interventions gradually 14. In this regard, Colburn suggests that testing, contact tracing, and quarantine of suspected cases could be the main strategies after the relaxation of drastic social distancing Non-pharmaceutical interventions to prevent healthcare system overload. Colburn calls for the incorporation of these strategies into models to allow countries to have a better picture of the testing capacity they will need and to decide if such policies could be successful in suppressing COVID-19 spread in a given country 24.

Non-pharmaceutical interventions also have adverse effects on individuals, communities, and the national economy. A recent rapid review reported that quarantine could have harmful psychological effects such as post-traumatic stress symptoms, confusion, and anger, which can lead to adverse long-term psychological effects 21,25. Many articles have highlighted the economic implications that quarantine interventions might have over the economy in 2020; however, the goal at this moment is saving as many lives as our resources allowed 4,5,8,9,12,13,21,26.

Limitations of this review

Given the time constraints imposed by the ongoing coronavirus outbreak, we made some critical methodological decisions that need to be considered. The inclusion criteria and the extraction of information of the studies included in this synthesis were applied by one reviewer. In addition, simulation studies were not formally quality assessed.

Conclusion

The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions is likely to have a substantial effect on those objectives.

Supplementary material
Appendices
Appendix 1. Search sources

WHO PAHO. WHO Situation Dashboard. https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd

WHO. 2019 Novel Coronavirus (2019nCoV): Strategic preparedness and response plan. 03 de Febrero. https://www.who.int/docs/default-source/coronaviruse/srp-04022020.pdf

Enfermedad por el Coronavirus ‎‎(COVID-19)‎. https://www.paho.org/es/temas/coronavirus/enfermedad-por-coronavirus-covid-19

UNION EUROPEA

Eurosurvelliance. https://www.eurosurveillance.org/content/eurosurveillance/browse

EU Commision COVID-19 Coronavirus data. https://data.europa.eu/euodp/en/data/dataset/covid-19-coronavirus-data/resource/62eb477f-be00-462a-831a-594095f7306a

Politico. Coronavirus in Europe https://www.politico.eu/coronavirus-in-europe/

ECDC. European Centre for Disease Prevention and Control https://www.ecdc.europa.eu/en

IATA. International Air Transport Association. Government Measures Related to Coronavirus (COVID-19). https://www.iata.org/en/programs/safety/health/diseases/government-measures-related-to-coronavirus/

Johns Hopkins University and Medicine. Coronavirus Resource Center. Interactive maps and news https://coronavirus.jhu.edu/

COVID-19 Expert Reality Check. Johns Hopkins Bloomberg School of Public Health. https://www.globalhealthnow.org/2020-02/coronavirus-expert-reality-check#quammen

Worldometer owned by Dadax. https://www.worldometers.info/coronavirus/

Evidence Aid https://www.evidenceaid.org/coronavirus-resources/

Otros medios de comunicación

Science Magazine. Mass testing, school closings, lockdowns: Countries pick tactics in ‘war’ against coronavirus. By Jon Cohen, Kai KupferschmidtMar. 18, 2020 , 11:30 AM. https://www.sciencemag.org/news/2020/03/mass-testing-school-closings-lockdowns-countries-pick-tactics-war-against-coronavirus

The Economist. The politics of pandemics. All governments will struggle. Some will struggle more than others. https://www.economist.com/leaders/2020/03/12/the-politics-of-pandemics

Prospect Magazine UK. Coronavirus: Why scientists are divided over the effectiveness of the UK’s strategy by Philip Ball / March 16, 2020. https://www.prospectmagazine.co.uk/science-and-technology/coronavirus-uk-herd-immunity-boris-johnson-government-plan-cure

StateNews. Understanding what works: How some countries are beating back the coronavirus by Helen Branswell March 20, 2020. https://www.statnews.com/2020/03/20/understanding-what-works-how-some-countries-are-beating-back-the-coronavirus/

The NY Times. The Coronavirus Outbreake https://www.nytimes.com/news-event/coronavirus?action=click&pgtype=Article&state=default&module=STYLN_coronahub&variant=show&region=header&context=menu

Wikipedia . Resumen de decisiones de los gobiernos. https://en.wikipedia.org/wiki/National_responses_to_the_2019%E2%80%9320_coronavirus_pandemic

International restrictions. https://en.wikipedia.org/wiki/Travel_restrictions_related_to_the_2019%E2%80%9320_coronavirus_pandemic

BBC News. Coronavirus pandemic. https://www.bbc.com/news/explainers

The Guardian. Coronavirus Outbreak. https://www.theguardian.com/world/coronavirus-outbreak

The Washington Post. Coronavirus news and maps. https://www.washingtonpost.com/world/2020/03/27/coronavirus-latest-news/

Aljazeera. Coronavirus Pandemic News. https://www.aljazeera.com/topics/events/coronavirus-outbreak.html

El Espectador. Coronavirus hoy: ¿Qué están haciendo otros países de América Latina para contener la pandemia?. https://www.elespectador.com/noticias/el-mundo/coronavirus-hoy-que-estan-haciendo-otros-paises-de-america-latina-para-contener-la-pandemia-articulo-910367

¿Qué está haciendo cada país de América Latina para frenar el nuevo coronavirus?. https://rpp.pe/mundo/actualidad/coronavirus-covid-19-que-esta-haciendo-cada-pais-de-america-latina-para-frenar-el-nuevo-coronavirus-noticia-1252868

Semana. Semana Tendencias Coronavirus. https://www.semana.com/noticias/coronavirus/126948

El Colombiano. Coronavirus en Colombia contra el miedo. https://www.elcolombiano.com/coronavirus-en-colombia-contra-el-miedo

Europapres. Agencia Europa Press https://www.europapress.es/

RFI. Noticias Coronavirus http://www.rfi.fr/es/tag/coronavirus/

CNN Noticias Coronavirus CNN https://cnnespanol.cnn.com/category/coronavirus.

Note: The following official sources and other media were consulted between March 16 and March 27 to identify the actions and strategies defined by the countries.

ALEMANIA

Fuentes Oficiales

Federal Ministry of Health. https://www.bundesgesundheitsministerium.de/en/press/2020/coronavirus.html#c17182

Robert Koch Institute. https://www.rki.de/EN/Home/homepage_node.html

The Federal Government. Together against Corona. https://www.zusammengegencorona.de/

Chancellor and Federal Government. https://www.bundesregierung.de/breg-en/search/998964!search

Otros medios de comunicación

Deutsche Welle. Coronavirus. https://www.dw.com/en/top-stories/coronavirus/s-32798

Coronavirus en Alemania: últimas noticias. https://www.deutschland.de/es/news/coronavirus-en-alemania-actualizaciones

Noticias Bundesliga. https://www.bundesliga.com/es/bundesliga/noticias/noticias-informacion-actualidad-liga-alemana-3034-2316

Pressemitteilungen. https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/2020/1-quartal/krisenstab-bmg-bmi-sitzung-5.html

Bundesministeriums für Verkehr und digitale Infrastruktur. https://www.bmvi.de/DE/Ministerium/Minister-Staatssekretaere/minister-staatssektretaere.html

Coronavirus: Jens Spahn trifft Gesundheitsminister der Länder. https://www.youtube.com/watch?v=nm5l-uxSeeM&feature=youtu.be

Statement von Jens Spahn bei Pressekonferenz vom 19.03.2020. https://www.youtube.com/watch?v=9dQKFImYaY0&feature=youtu.be

ARGENTINA

Fuentes Oficiales

Ministerio de Salud. Coronavirus. https://www.argentina.gob.ar/salud/coronavirus-COVID-19

Gobierno Nacional. Resumen de medidas. https://www.argentina.gob.ar/coronavirus/medidas-gobierno

Otros medios de comunicación

El Clarin. Coronavirus en Argentina: piden donaciones para ayudar a los que menos tienen. https://www.clarin.com/sociedad/coronavirus-argentina-piden-donaciones-ayudar_0_9O4v1s5nJ.html

Infoabae. Argentina solo recibió ayuda de China para enfrentar la pandemia del coronavirus. https://www.infobae.com/politica/2020/03/22/la-argentina-solo-recibio-ayuda-sanitaria-de-china-para-enfrentar-la-pandemia-del-coronavirus/

RSE Presente. En épocas de coronavirus una ONG contagia solidaridad. https://presenterse.com/en-epocas-de-coronavirus-una-ong-que-contagia-solidaridad/

AUSTRALIA

Fuentes Oficiales

Coronavirus: COVID-19: Western Australian Government response. https://www.wa.gov.au/organisation/department-of-the-premier-and-cabinet/coronavirus-covid-19-western-australian-government-response

Safe Work Australia. https://www.safeworkaustralia.gov.au/doc/coronavirus-covid-19-advice-employers

COVID-19 (Coronavirus) and the Australian border. https://www.homeaffairs.gov.au/news-media/current-alerts/novel-coronavirus

COVID-19 Coronavirus Information for Public Sector Employers. https://www.commerce.wa.gov.au/labour-relations/covid-19-coronavirus-information-public-sector-employers

Departamento de salud Gobierno de Australia. https://www.health.gov.au/news

Health information for western Australia. https://www.healthywa.wa.gov.au/Articles/A_E/COVID-clinics

Conferencia de prensa primer ministro de Australia. https://www.pm.gov.au/media/transcript-press-conference

Actualización medidas primer ministro. https://www.pm.gov.au/media/update-coronavirus-measures

Circular 5/2020 - Licencia COVID-19 y otras flexibilidades laborales. https://www.commerce.wa.gov.au/sites/default/files/atoms/files/pslr_circular_04_2020.pdf

BRASIL

Fuentes Oficiales

Agencia Nacional de Vigilancia Sanitaria. http://portal.anvisa.gov.br/

Ministerio de salud. https://www.saude.gov.br/noticias

Otros medios de comunicación

Infoabae. Brasil cerró sus fronteras a europeos y asiáticos por el coronavirus. https://www.infobae.com/america/america-latina/2020/03/20/brasil-cerro-sus-fronteras-a-europeos-y-asiaticos-por-el-coronavirus/

CANADÁ

Fuentes Oficiales

Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

Página oficial Primer ministro. https://pm.gc.ca/

Página oficial- Gobierno de Canadá. https://www.canada.ca/

CHINA Y HUBEI

Fuentes Oficiales

Chinese Center for Disease Control and Prevention. http://www.chinacdc.cn/en/COVID19/

National Health Commission of the People's Republic of China. http://en.nhc.gov.cn/antivirusfight.html

CHILE

Fuentes Oficiales

Plan de Acción Coronavirus. https://www.gob.cl/coronavirus/

Ministerio de Salud. Seguimiento de casos. https://www.minsal.cl/nuevo-coronavirus-2019-ncov/casos-confirmados-en-chile-covid-19/

Ministerio de Relaciones Internacionales. Medidas. https://chile.gob.cl/chile/medidas-de-prevencion-ante-el-nuevo-coronavirus

Servicio Informativo del Instituto de Previsión Social. Ministerio del Trabajo. https://www.chileatiende.gob.cl/coronavirus

Fuentes Oficiales

Ministerio de Salud y Protección Social. Coronavirus. https://d2jsqrio60m94k.cloudfront.net/

Ministerio de salud. https://www.minsalud.gov.co/

Instituto Nacional de Salud. https://www.ins.gov.co/Noticias/Paginas/Coronavirus.aspx

Presidencia de la República. https://id.presidencia.gov.co

Ministerio de Transporte. https://www.mintransporte.gov.co

Aeronáutica Civil de Colombia. http://www.aerocivil.gov.co/

COREA DEL SUR

Korean Centers for Disease Control and Prevention. http://www.cdc.go.kr/board.es?mid=a30402000000&bid=0030

CUBA

Fuentes Oficiales

Presidencia de Cuba. Noticias y medidas. https://www.presidencia.gob.cu/es/noticias/

Ministerio de Comercio. Medidas coronavirus. https://www.mincin.gob.cu/content/medidas-de-protecci%C3%B3n-tomadas-en-el-sector-del-comercio-para-prevenir-cualquier-contagio-0

Ministerio Relaciones Internacionales. Medidas coronavirus. http://misiones.minrex.gob.cu/es/coronavirus

Ministerio de Salud Pública de la República de Cuba. https://salud.msp.gob.cu/

Otros medios de comunicación

Cibercuba. Mapa del Coronavirus en Cuba. https://www.cibercuba.com/tags/coronavirus-cuba

Infomed, Portal de la Red de Salud de Cuba. http://www.sld.cu/

ESPAÑA

Fuentes Oficiales

Alertas en Salud Pública de actualidad. MinSalud España. https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/home.htm

Instituto de Salud Carlos III. Situación de COVID-19 en España. https://covid19.isciii.es/

Portal de La Moncloa. https://www.lamoncloa.gob.es/Paginas/buscadoravanzado.aspx

Instituto de Mayores y Servicios Sociales. https://www.imserso.es/imserso_02/actualidad/2020/marzo/IM_130154

Ministerio del Interior no a Penitenciarias. www.interior.gob.es

Otros medios de comunicación

Lista de Medidas del gobierno de El Diario. https://www.eldiario.es

ESTADOS UNIDOS

Fuentes Oficiales

Centers for Disease Control and Prevention. https://www.cdc.gov/

Página oficial del coronavirus de CDC. https://www.coronavirus.gov

White house. https://www.whitehouse.gov/

Departamento de Estado. https://travel.state.gov/

Departamento de defensa. https://www.defense.gov/

Asociación de médicos de los Estados Unidos. https://www.ama-assn.org

Gobierno de los Estados Unidos. https://www.usa.gov/

ITALIA

Fuentes Oficiales

Ministero della Salute. Nuovo coronavirus. http://www.salute.gov.it/nuovocoronavirus

Ministero della Salute. Situazione in Italia. http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?lingua=italiano&id=5351&area=nuovoCoronavirus&menu=vuoto

Protezione Civile. Emergenza Coronavirus. http://www.protezionecivile.gov.it/

Instituto Superiore di Sanitá. http://www.iss.it/coronavirus

Trova norme salute. http://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=73532

Guida per prevenire e affrontare lo stigma sociale. http://www.salute.gov.it/imgs/C_17_notizie_4149_0_file.pdf

Aeroporti di Roma. http://www.adr.it/it/web/guest/coronavirus

Governo Italiano Presidenza del Consiglio dei Ministri. http://www.governo.it/it/articolo/comunicato-stampa-del-consiglio-dei-ministri-n-33/14204

L'epidemiologia per la sanità pubblica Istituto Superiore di Sanità. https://www.epicentro.iss.it/

IRÁN

Fuentes Oficiales

Ministry of Health and Medical Education. News. http://irangov.ir/cat/509

Ayatollah Khamenei. Official website. http://english.khamenei.ir/

Otros medios de comunicación

Islamic Republic News Agency. https://en.irna.ir/ y https://es.irna.ir/

Iran Daily. http://www.iran-daily.com/

JAPÓN

Fuentes Oficiales

Ministry of Health, Labour and Welfare. About coronavirus Disease 2019. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/newpage_00032.html

Prime Minister of Japan and His Cabinet. Basic responses to COVID2019. http://japan.kantei.go.jp/ongoingtopics/coronavirus_info_e.html

MÉXICO

Fuentes Oficiales

Gobierno de México. Comunicados y decisiones. https://coronavirus.gob.mx/noticias/

Dirección General de Epidemiología. Mapa de casos. http://ncov.sinave.gob.mx/mapa.aspx

Sistema de Información de la Secretaría de Salud. http://sinaiscap.salud.gob.mx:8080/DGIS/

Instituto Mexicano del Seguro Social. http://www.imss.gob.mx/

Otros medios de comunicación

Diario AS México. Covid-19. https://mexico.as.com/tikitakas/tag/covid_19/a/

NORUEGA

Fuentes Oficiales

Norwegian Institute of Public Health. https://www.fhi.no/en/id/infectious-diseases/coronavirus/

Ministry of Health and Care Services. https://www.regjeringen.no/en/dep/hod/id421/

REINO UNIDO

Fuentes Oficiales

Government UK. Coronavirus. https://www.gov.uk/coronavirus

Coronavirus (COVID-19): UK government response. https://www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response

The Health Protection (Coronavirus) Regulations 2020. http://www.legislation.gov.uk/uksi/2020/129/contents/made

Public Health England. https://www.gov.uk/government/organisations/public-health-england

Departamento de salud pública Inglaterra. https://www.gov.uk/government/organisations/department-of-health-and-social-care

Oficina del primer ministro. https://www.gov.uk/government/organisations/prime-ministers-office-10-downing-street

Ministerio de comunidades y gobierno local. https://www.gov.uk/government/organisations/ministry-of-housing-communities-and-local-government

Departamento de trabajo y pensiones. https://www.gov.uk/government/organisations/department-for-work-pensions

Departamento de negocios, energía e industria. https://www.gov.uk/government/organisations/department-for-business-energy-and-industrial-strategy

http://www.legislation.gov.uk/ukpga/1984/22

Foreign Travel Advice. https://www.gov.uk/foreign-travel-advice

Foreign & Commonwealth Office. https://www.gov.uk/government/organisations/foreign-commonwealth-office

Noticias gobierno de UK. https://www.gov.uk/government/news/

Statutory Sick Pay. Pago estatutario de enfermedad. https://www.gov.uk/statutory-sick-pay

Portal de noticias NHS. https://www.england.nhs.uk/2020/03/nhs-111-online-to-help-people-with-coronavirus/

Appendices
Appendix 2

Appendix 2
Non-pharmaceutical interventions and number of days in which they were implemented (as March 28, 2020)

Appendices
Appendix 3

Appendix 3
Key findings of studies that addressed the impact of non-pharmaceutical interventions

Acknowledgements

The authors want to thank Ivan Dario Flórez and Gabriel Jaime Otálvaro for their important comments and suggestions. They also thank Cristian David Santa Escobar for his contribution in the graphic representation of the results.

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Notes
Conflict of interest declaration
Conflict of interest: the authors declare that they have no competing interests.
Author notes

*Corresponding author: Daniel F. Patiño-Lugo. Facultad de Medicina, Universidad de Antioquia. Postal address: Carrera 51 D # 62-29 oficina MUA 302, Medellín, Colombia. Tel: +57 (4) 2196060. e-mail: felipe.patino@udea.edu.co




Table 1
Non-pharmaceutical interventions and number of days to implement them after the first case of COVID-19 (as march 28 of 2020)

Table 1 shows the non-pharmaceutical interventions (NON-PHARMACEUTICAL INTERVENTIONS) that countries have implemented as of March 28th of 2020 and the number of days in which they were implemented after their first case report. The Non-pharmaceutical interventions are presented in the following order: 1) those related to the most drastic measures of social distancing; 2) isolation measures of cases and contacts, 3) travel restrictions, and 4) early case detection and contact tracing. The countries are organized from left to right, according to the detection date of their first case. The numbers in the table are the number of days between the application of the intervention and the appearance of the first case in each country. The references that were consulted in each country are presented in the appendix 1 * The social distancing strategy recently used in South Korea is not mandatory as in other countries. However, the campaign is quite comprehensive, so we decided to put it in this box. Note: due to the large amount of different information that is circulating in this pandemic, the different languages in which the information is published, and the reporting limitations of some countries, some data may not be accurate. Negative numbers indicate that action was taken before the first case came. For example, Chile declared a state of alert on February 8, which is 24 days before the first case.

Figure 1
Heat map of Non-pharmaceutical interventions and number of days in which they were implement them after the first case of COVID-19

Figure 2
Number of new COVID-19 cases and day of implementation of some Non-pharmaceutical interventions
Table 2
Impact of non-pharmaceutical interventions for the control of COVID-19 infection

Appendix 2
Non-pharmaceutical interventions and number of days in which they were implemented (as March 28, 2020)

Appendix 3
Key findings of studies that addressed the impact of non-pharmaceutical interventions

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