Outbreak

The goal of community mitigation, (1) delay outbreak peak (2) decompress peak burden on healthcare, known as flattening the curve (3) diminish overall cases and health impact.[352][353]

There are a number of strategies in the control of an outbreak: containment, mitigation, and suppression. Containment is undertaken in the early stages of the outbreak and aims to trace and isolate those infected as well as other measures of infection control and vaccinations to stop the disease from spreading to the rest of the population. When it is no longer possible to contain the spread of the disease, efforts then move to the mitigation stage, when measures are taken to slow the spread and mitigate its effects on the health care system and society. A combination of both containment and mitigation measures may be undertaken at the same time.[354] Suppression requires more extreme measures so as to reverse the pandemic by reducing the basic reproduction number to less than 1.[355]

Part of managing an infectious disease outbreak is trying to decrease the epidemic peak, known as flattening the epidemic curve.[352] This decreases the risk of health services being overwhelmed and provides more time for vaccines and treatments to be developed.[352] Non-pharmaceutical interventions that may manage the outbreak include personal preventive measures, such as hand hygiene, wearing face-masks and self-quarantine; community measures aimed at physical distancing such as closing schools and cancelling mass gathering events; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such surface cleaning.[356]

More drastic actions aim at suppressing the outbreak were taken in China once the severity of the outbreak became apparent, such as quarantining entire cities affecting 60 million individuals in Hubei, and strict travel bans.[357] Other countries adopted a variety of measures aimed at limiting the spread of the virus. For example, South Korea introduced mass screening, localized quarantines, and issuing alerts on the movements of affected individuals. Singapore provided financial support for those infected who quarantine themselves and imposed large fines for those who failed to do so. Taiwan increased face-mask production and penalized hoarding of medical supplies.[358] Some countries require people to report flu-like symptoms to their doctor, especially if they have visited mainland China.[359]

Simulations for Great Britain and the US show that mitigation (slowing but not stopping epidemic spread), as well as suppression (reversing epidemic growth), has major challenges. Optimal mitigation policies might reduce peak healthcare demand by 2/3 and deaths by half, still resulting in hundreds of thousands of deaths and health systems being overwhelmed. Suppression can be preferred but need to be maintained until a vaccine becomes available (at least 18 months later) as transmission quickly rebounds when relaxed, while long-term intervention causes social and economic costs.[355]

Treatment

There are no specific antiviral medications approved for COVID-19, but development efforts are underway, including testing of existing medications. Attempts to relieve the symptoms may include taking regular (over-the-counter) cold medications,[360] drinking fluids, and resting.[306] Depending on the severity, oxygen therapyintravenous fluids and breathing support may be required.[361] The use of steroids may worsen outcomes.[362] Several compounds, which were previously approved for treatment of other viral diseases, are being investigated.[363]