With community transmission of #COVID19 in multiple countries it appears that containment of the virus in China will not happen (this outcome was not unexpected). Emphasis in many places could turn from containment to “mitigation”. What does mitigation mean?
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Studies of the US public during H1N1 found that people actually did change their hygiene behaviors: in one survey 59% of Americans reported washing hands more frequently and 25% said they avoided public places like sporting events, malls, and public transportation.
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CDC guidelines also support social distancing in some cases, including school closures, canceling public gatherings, and workplace closures/telework.
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During H1N1, CDC recommended communities with confirmed cases consider closing child care facilities and schools. From Aug–Dec 2009, communities in 46 states implemented 812 dismissals (in a single school or all schools in a district), affecting 1,947 schools.
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This number of schools represented 0.7% and 3.3% of all urban and rural schools, respectively, in the U.S. Evidence from TX indicated school closures there reduced acute respiratory illness in households with school-age children by 45%–72%.
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Interestingly, surveys of parents whose children were affected by school closures found strong support for, and belief in the effectiveness of these measures: 90% of parents agreed with dismissal decisions, and 85% believed dismissals reduced transmission.
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Even so, closing schools was disruptive, and a systematic review of US school closures during H1N1 was not able to determine whether the benefits outweighed the cost in this “mild” epidemic, though they did recommend such measures during a “severe” pandemic.
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CDC guidelines also note there are practical obstacles to asking people to stay home from school and work: in 2009 a major difficulty was that many people did not have access to paid leave, and therefore had a hard time following guidance.
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Another challenge for mitigation in the U.S. is that while CDC can offer recommendations and guidance, implementation of these policies mostly occurs at local district, county, & state levels. This can lead to a patchwork of different mitigation approaches across locations.
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A recent publication looked at US local health department decision-making around social distancing during outbreaks, and concluded resources available and actions implemented are inconsistent and unpredictable across the country. …https://journals-sagepub-com.proxy1.library.jhu.edu/doi/pdf/10.1177/0033354918819755 …
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CDC guidance urges flexibility in implementing mitigation measures, and continual re-assessment of their effectiveness as new information comes in. A “targeted, layered” approach that addresses current circumstances is the best practice.
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The ultimate goal of such measures is to reduce the intensity of an outbreak, flattening out the epidemic curve and therefore reducing strain on the health system, and on social economic well-being (see this graphic representation).pic.twitter.com/fWOCq453Bx
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I would add that because these activities happen at the local level, mitigation also implies every jurisdiction, school district, business, and even every household could have a role to play.
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For businesses for example, here are a few things to think about (thread also contains a link to CDC guidance for businesses) https://twitter.com/marcelsalathe/status/1231828462735896577?s=19 …
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