Quarantäne alleine oder in Kombination mit weiteren
Public-Health-Maßnahmen zur Eindämmung der COVID-19 Pandemie:
Ein Cochrane Rapid Review

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Zusammenfassung

Hintergrund Die Coronavirus-Krankheit COVID-19 ist eine neue, sich rasch ausbreitende zoonotische Infektionskrankheit, die der Weltgesundheitsorganisation (WHO) erstmals am 31. Dezember 2019 gemeldet wurde. Da zurzeit keine wirksamen Medikamente oder Impfstoffe zur Behandlung oder Prävention von COVID-19 zur Verfügung stehen, rücken nicht-pharmakologische Public-Health-Maßnahmen zur Eindämmung der COVID-19 Pandemie stärker in den Fokus.

Studienziele Ziel dieses Rapid Reviews war es, den Effekt von Quarantäne – alleine oder in Kombination mit weiteren Public-Health-Maßnahmen – zur Eindämmung von COVID-19 zu untersuchen.

Methodik Der vorliegende Rapid Review wurde von der WHO in Auftrag gegeben. Um der Dringlichkeit der Anfrage gerecht zu werden, wurde die Methodik eines systematischen Reviews punktuell abgeändert. Die vorliegende Publikation umfasst die wichtigsten Aspekte des Rapid Reviews und wurde vom WHO Collaborating Centre an der Donau Universität Krems (Österreich) auf Deutsch übersetzt.

Ergebnisse Insgesamt wurden 29 Studien eingeschlossen. Zehn Modellierungsstudien befassten sich direkt mit COVID-19, 15 weitere Modellierungsstudien und 4 Beobachtungsstudien lieferten indirekte Evidenz zu SARS und MERS. Die Studien zeichneten alle ein ähnliches Bild – einen Vorteil von Quarantäne. Beispielsweise schätzten Modellierungsstudien, dass durch Quarantäne von Personen, die Kontakt mit Infizierten hatten 44–81% neuer Fälle und 31–63% an Todesfällen verhindert werden können, im Vergleich zu keinen Maßnahmen. Zwei Studien zu SARS zeigten, dass Quarantäne effektiver war und weniger kostete, je früher sie startete. Alleinige Quarantäne von Personen, die Kontakt mit Infizierten hatten, würde aber wahrscheinlich nicht ausreichen, um den Ausbruch von COVID-19 einzudämmen. Die Kombination mit anderen Maßnahmen wie physische Distanzierung oder Schulschließungen zeigte größere Effekte als Quarantäne alleine. Bei der individuellen Quarantäne für Rückkehrende aus Risikogebieten fand der Review vergleichsweise geringe Effekte.

Schlussfolgerung Die Vertrauenswürdigkeit der Evidenz ist niedrig bzw. sehr niedrig, da die einzigen Studien zu COVID-19 Modellierungsstudien sind, die zwar aktuelle aber noch unsichere und unterschiedliche Parameter zur Modellberechnung verwendeten. Die indirekte Evidenz von SARS und MERS ist nur begrenzt auf COVID-19 übertragbar. Trotz dieser Limitationen, kommen alle Studien zu dem Schluss, dass Quarantäne eine wichtige Maßnahme ist, um die Pandemie einzudämmen. Im Hinblick auf die kommenden Monate ist es wichtig, das Infektionsgeschehen sowie die Auswirkungen der Maßnahmen genau zu überwachen, um die bestmögliche Balance der Maßnahmen zu finden.

Translated abstract

Abstract

Background COVID-19 (coronavirus disease 2019) is a new, rapidly emerging zoonotic infectious disease, that was reported to the World Health Organization for the first time on 31 December 2019. Currently, no effective pharmacological interventions or vaccines are available to treat or prevent COVID-19, therefore nonpharmacological public health measures are more in focus.

Objectives The aim was to assess the effects of quarantine – alone or in combination with other measures – during coronavirus outbreaks.

Methods Because of the current COVID-19 pandemic, WHO commissioned a rapid review. To save time, the method of systematic reviews was slightly and with caution modified. This publication is a summary of the most important aspects of the rapid review, translated into German by members of the WHO Collaborating Centre at the Danube University Krems (Austria).

Results Overall, 29 studies were included. Ten modeling studies focused on COVID-19, 4 observational studies and 15 modeling studies focused on SARS and MERS. The modeling studies consistently reported a benefit of the simulated quarantine measures. For example, the models estimated that quarantine of people exposed to confirmed or suspected cases of COVID-19 prevented between 44 and 81% of the cases that would otherwise have happened and 31 to 63% of the deaths, when compared to no such measures. In regard to costs, the earlier the quarantine measures are implemented, the greater the cost savings will be.

Conclusion Our confidence in the evidence is very limited. This is mainly because the COVID-19 studies based their models on the limited data that have been available in the early weeks of the pandemic and made different assumptions about the virus. The studies of SARS and MERS are not completely generalizable to COVID-19. Despite only having limited evidence, all the studies found quarantine to be important for controlling the spread of severe coronavirus diseases. Looking to the coming months, in order to maintain the best possible balance of measures, decision makers must continue to constantly monitor the outbreak situation and the impact of the measures they implement.

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Estimation of the Transmission Risk of the 2019-nCoV and Its Implication for Public Health Interventions

Biao Tang, Xia Wang, Qian Li … (2020)

Since the emergence of the first cases in Wuhan, China, the novel coronavirus (2019-nCoV) infection has been quickly spreading out to other provinces and neighboring countries. Estimation of the basic reproduction number by means of mathematical modeling can be helpful for determining the potential and severity of an outbreak and providing critical information for identifying the type of disease interventions and intensity. A deterministic compartmental model was devised based on the clinical progression of the disease, epidemiological status of the individuals, and intervention measures. The estimations based on likelihood and model analysis show that the control reproduction number may be as high as 6.47 (95% CI 5.71–7.23). Sensitivity analyses show that interventions, such as intensive contact tracing followed by quarantine and isolation, can effectively reduce the control reproduction number and transmission risk, with the effect of travel restriction adopted by Wuhan on 2019-nCoV infection in Beijing being almost equivalent to increasing quarantine by a 100 thousand baseline value. It is essential to assess how the expensive, resource-intensive measures implemented by the Chinese authorities can contribute to the prevention and control of the 2019-nCoV infection, and how long they should be maintained. Under the most restrictive measures, the outbreak is expected to peak within two weeks (since 23 January 2020) with a significant low peak value. With travel restriction (no imported exposed individuals to Beijing), the number of infected individuals in seven days will decrease by 91.14% in Beijing, compared with the scenario of no travel restriction.

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Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review

Barbara Nussbaumer-Streit, Verena Mayr, Andreea Iulia Dobrescu … (2020)

Background Coronavirus disease 2019 (COVID‐19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). To support WHO with their recommendations on quarantine, we conducted a rapid review on the effectiveness of quarantine during severe coronavirus outbreaks. Objectives We conducted a rapid review to assess the effects of quarantine (alone or in combination with other measures) of individuals who had contact with confirmed cases of COVID‐19, who travelled from countries with a declared outbreak, or who live in regions with high transmission of the disease. Search methods An information specialist searched PubMed, Ovid MEDLINE, WHO Global Index Medicus, Embase, and CINAHL on 12 February 2020 and updated the search on 12 March 2020. WHO provided records from daily searches in Chinese databases up to 16 March 2020. Selection criteria Cohort studies, case‐control‐studies, case series, time series, interrupted time series, and mathematical modelling studies that assessed the effect of any type of quarantine to control COVID‐19. We also included studies on SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) as indirect evidence for the current coronavirus outbreak. Data collection and analysis Two review authors independently screened 30% of records; a single review author screened the remaining 70%. Two review authors screened all potentially relevant full‐text publications independently. One review author extracted data and assessed evidence quality with GRADE and a second review author checked the assessment. We rated the certainty of evidence for the four primary outcomes: incidence, onward transmission, mortality, and resource use. Main results We included 29 studies; 10 modelling studies on COVID‐19, four observational studies and 15 modelling studies on SARS and MERS. Because of the diverse methods of measurement and analysis across the outcomes of interest, we could not conduct a meta‐analysis and conducted a narrative synthesis. Due to the type of evidence found for this review, GRADE rates the certainty of the evidence as low to very low. Modeling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases averted 44% to 81% incident cases and 31% to 63% of deaths compared to no measures based on different scenarios (incident cases: 4 modelling studies on COVID‐19, SARS; mortality: 2 modelling studies on COVID‐19, SARS, low‐certainty evidence). Very low‐certainty evidence suggests that the earlier quarantine measures are implemented, the greater the cost savings (2 modelling studies on SARS). Very low‐certainty evidence indicated that the effect of quarantine of travellers from a country with a declared outbreak on reducing incidence and deaths was small (2 modelling studies on SARS). When the models combined quarantine with other prevention and control measures, including school closures, travel restrictions and social distancing, the models demonstrated a larger effect on the reduction of new cases, transmissions and deaths than individual measures alone (incident cases: 4 modelling studies on COVID‐19; onward transmission: 2 modelling studies on COVID‐19; mortality: 2 modelling studies on COVID‐19; low‐certainty evidence). Studies on SARS and MERS were consistent with findings from the studies on COVID‐19. Authors' conclusions Current evidence for COVID‐19 is limited to modelling studies that make parameter assumptions based on the current, fragmented knowledge. Findings consistently indicate that quarantine is important in reducing incidence and mortality during the COVID‐19 pandemic. Early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness. In order to maintain the best possible balance of measures, decision makers must constantly monitor the outbreak situation and the impact of the measures implemented. Testing in representative samples in different settings could help assess the true prevalence of infection, and would reduce uncertainty of modelling assumptions. This review was commissioned by WHO and supported by Danube‐University‐Krems. Does quarantine control coronavirus (COVID‐2019) either alone or in combination with other public health measures? Background   Coronavirus disease 2019 (COVID‐19) is caused by a new virus that has spread quickly throughout the world. COVID‐19 spreads easily between people who are in close contact, or through coughs and sneezes. Most infected people suffer mild, flu‐like symptoms but some become seriously ill and even die.  There is no effective treatment or vaccine (a medicine that stops people catching a specific disease) for COVID‐19, so other ways of slowing (controlling) its spread are needed. One of the World Health Organization’s (WHO) recommendations for controlling the disease is quarantine. This means separating healthy people from other healthy people, in case they have the virus and could spread it. Other similar recommendations include isolation (like quarantine, but for people with COVID‐19 symptoms) and social distancing (where people without symptoms keep a distance from each other physically).   What did we want to find out?   We wanted to find out whether and how effectively quarantine stops COVID‐19 spreading and if it prevents death. We wanted to know if it was more effective when combined with other measures, such as closing schools. We also wanted to know what it costs.   Study characteristics   COVID‐19 is spreading rapidly, so we needed to answer this question as quickly as possible. This meant we shortened some steps of the normal Cochrane Review process. Nevertheless, we are confident that these changes do not affect our overall conclusions.  We looked for studies that assessed the effect of any type of quarantine, anywhere, on the spread and severity of COVID‐19. We also looked for studies that assessed quarantine alongside other measures, such as isolation, social distancing, school closures and hand hygiene. COVID‐19 is a new disease, so, to find as much evidence as possible, we also looked for studies on similar viruses, such as SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome).  Studies measured the number of COVID‐19, SARS or MERS cases, how many people were infected, how quickly the virus spread, how many people died, and the costs of quarantine.   Key results  We included 29 studies. Ten studies focused on COVID‐19, 15 on SARS, two on SARS plus other viruses, and two on MERS. Most of the studies combined existing data to create a model (a simulation) for predicting how events might occur over time, for people in different situations (called modelling studies). The COVID‐19 studies simulated outbreaks in China, UK, South Korea, and on the cruise ship Diamond Princess. Four studies looked back on the effect of quarantine on 178,122 people involved in SARS and MERS outbreaks (called ‘cohort’ studies). The remaining studies modelled SARS and MERS outbreaks. The modelling studies all found that simulated quarantine measures reduce the number of people with the disease and the number of deaths. With quarantine, estimates showed a minimum reduction in the number of people with the disease of 44%, and a maximum reduction of 81%. Similarly, with quarantine, estimates of the number of deaths showed a minimum reduction of 31%, and a maximum reduction of 63%. Combining quarantine with other measures, such as closing schools or social distancing, is more effective at reducing the spread of COVID‐19 than quarantine alone. The SARS and MERS studies agreed with the studies on COVID‐19. Two SARS modelling studies assessed costs. They found that the costs were lower when quarantine measures started earlier. We cannot be completely certain about the evidence we found for several reasons. The COVID‐19 studies based their models on limited data and made different assumptions about the virus (e.g. how quickly it would spread). The other studies investigated SARS and MERS so we could not assume the results would be the same for COVID‐19.   Conclusion Despite limited evidence, all the studies found quarantine to be important in reducing the number of people infected and the number of deaths. Results showed that quarantine was most effective, and cost less, when it was started earlier. Combining quarantine with other prevention and control measures had a greater effect than quarantine alone. This review includes evidence published up to 12 March 2020.

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Transmission dynamics of the COVID‐19 outbreak and effectiveness of government interventions: A data‐driven analysis

Yaqing Fang, Yiting Nie, Marshare Penny (2020)

Abstract Using the parameterized susceptible‐exposed‐infectious‐recovered model, we simulated the spread dynamics of coronavirus disease 2019 (COVID‐19) outbreak and impact of different control measures, conducted the sensitivity analysis to identify the key factor, plotted the trend curve of effective reproductive number (R), and performed data fitting after the simulation. By simulation and data fitting, the model showed the peak existing confirmed cases of 59 769 arriving on 15 February 2020, with the coefficient of determination close to 1 and the fitting bias 3.02%, suggesting high precision of the data‐fitting results. More rigorous government control policies were associated with a slower increase in the infected population. Isolation and protective procedures would be less effective as more cases accrue, so the optimization of the treatment plan and the development of specific drugs would be of more importance. There was an upward trend of R in the beginning, followed by a downward trend, a temporary rebound, and another continuous decline. The feature of high infectiousness for severe acute respiratory syndrome coronavirus 2(SARS‐CoV‐2) led to an upward trend, and government measures contributed to the temporary rebound and declines. The declines of R could be exploited as strong evidence for the effectiveness of the interventions. Evidence from the four‐phase stringent measures showed that it was significant to ensure early detection, early isolation, early treatment, adequate medical supplies, patients’ being admitted to designated hospitals, and comprehensive therapeutic strategy. Collaborative efforts are required to combat the novel coronavirus, focusing on both persistent strict domestic interventions and vigilance against exogenous imported cases.

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Author and article information

Journal

Journal ID (nlm-ta): Gesundheitswesen

Journal ID (iso-abbrev): Gesundheitswesen

Journal ID (doi): 10.1055/s-00000022

Title: Gesundheitswesen (Bundesverband Der Arzte Des Offentlichen Gesundheitsdienstes (Germany)

ISSN (Print): 0941-3790

ISSN (Electronic): 1439-4421

Publication date (Print): June 2020

Publication date (Electronic): 15 May 2020

Volume: 82

Issue: 6

Pages: 501-506

Affiliations

[1 ]Evidenzbasierte Medizin und Evaluierung, Donau-Universität Krems, Krems, Austria

[2 ]Cochrane Österreich, Donau-Universität Krems Department Evidenzbasierte Medizin und Klinische Epidemiologie, Krems an der Donau, Austria

[3 ]Department für Evidenzbasierte Medizin und Klinische Epidemiologie, Donau-Universität Krems Department Evidenzbasierte Medizin und Klinische Epidemiologie, Krems, Austria

[4 ]Research Triangle Institute International, RTI-UNC Evidence-based Practice Center, Research Triangle Park, United States

Author notes

Korrespondenzadresse Dr. Verena Mayr Evidenzbasierte Medizin und EvaluierungDonau-Universität Krems, Dr.-Karl-Dorrek-Straße 303500 KremsAustria verena.mayr@ 123456donau-uni.ac.at

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Publisher ID: gesu2020-04-1151

DOI: 10.1055/a-1164-6611

PMC ID: 7362393

PubMed ID: 32413914

SO-VID: 38865a09-d77f-49d1-a298-52050127f876

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This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

Quarantäne alleine oder in Kombination mit weiteren Public-Health-Maßnahmen zur Eindämmung der COVID-19 Pandemie: Ein Cochrane Rapid Review Translated title: Quarantine Alone or in Combination with Other Public Health Measures to Control COVID-19: A Rapid Review (Review)

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Novel Coronavirus Disease COVID-19

Most cited references 27

Estimation of the Transmission Risk of the 2019-nCoV and Its Implication for Public Health Interventions

Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review

Transmission dynamics of the COVID‐19 outbreak and effectiveness of government interventions: A data‐driven analysis

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