Key epidemiological drivers and impact of interventions in the 2020 SARS-CoV-2 epidemic in England.

Edward S Knock ORCID logo; Lilith K Whittles ORCID logo; John A Lees ORCID logo; Pablo N Perez-Guzman ORCID logo; Robert Verity ORCID logo; Richard G FitzJohn ORCID logo; Katy AM Gaythorpe ORCID logo; Natsuko Imai ORCID logo; Wes Hinsley ORCID logo; Lucy C Okell ORCID logo; +21 more... Alicia Rosello ORCID logo; NikolasKantas; Caroline E Walters ORCID logo; Sangeeta Bhatia ORCID logo; Oliver J Watson ORCID logo; Charlie Whittaker ORCID logo; Lorenzo Cattarino ORCID logo; Adhiratha Boonyasiri ORCID logo; Bimandra A Djaafara ORCID logo; Keith Fraser ORCID logo; Han Fu ORCID logo; Haowei Wang ORCID logo; XiaoyueXi; Christl A Donnelly ORCID logo; Elita Jauneikaite ORCID logo; Daniel J Laydon ORCID logo; Peter J White ORCID logo; Azra C Ghani ORCID logo; Neil M Ferguson ORCID logo; AnneCori; Marc Baguelin ORCID logo; (2021) Key epidemiological drivers and impact of interventions in the 2020 SARS-CoV-2 epidemic in England. Science translational medicine, 13 (602). eabg4262-. ISSN 1946-6234 DOI: 10.1126/scitranslmed.abg4262
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We fitted a model of SARS-CoV-2 transmission in care homes and the community to regional surveillance data for England. Compared with other approaches, our model provides a synthesis of multiple surveillance data streams into a single coherent modeling framework, allowing transmission and severity to be disentangled from features of the surveillance system. Of the control measures implemented, only national lockdown brought the reproduction number (Rt eff) below 1 consistently; if introduced 1 week earlier, it could have reduced deaths in the first wave from an estimated 48,600 to 25,600 [95% credible interval (CrI): 15,900 to 38,400]. The infection fatality ratio decreased from 1.00% (95% CrI: 0.85 to 1.21%) to 0.79% (95% CrI: 0.63 to 0.99%), suggesting improved clinical care. The infection fatality ratio was higher in the elderly residing in care homes (23.3%, 95% CrI: 14.7 to 35.2%) than those residing in the community (7.9%, 95% CrI: 5.9 to 10.3%). On 2 December 2020, England was still far from herd immunity, with regional cumulative infection incidence between 7.6% (95% CrI: 5.4 to 10.2%) and 22.3% (95% CrI: 19.4 to 25.4%) of the population. Therefore, any vaccination campaign will need to achieve high coverage and a high degree of protection in vaccinated individuals to allow nonpharmaceutical interventions to be lifted without a resurgence of transmission.



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