Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus
Authors: Ngonghala Calistus N. , Iboi Enahoro , Eikenberry Steffen , Scotch Matthew , MacIntyre Chandini Raina , Bonds Matthew H. , Gumel Abba B. 
Published: April 2020

A pandemic of a novel Coronavirus emerged in December of 2019 (COVID-19), causing devastating public health impact across the world. In the absence of a safe and effective vaccine or antivirals, strategies for controlling and mitigating the burden of the pandemic are focused on non-pharmaceutical interventions, such as social-distancing, contact-tracing, quarantine, isolation and the use of face-masks in public. We develop a new mathematical model for assessing the population-level impact of the aforementioned control and mitigation strategies. Rigorous analysis of the model shows that the disease-free equilibrium is locally-asymptotically stable if a certain epidemiological threshold, known as thereproduction number(denoted by ℛc), is less than unity. This equilibrium is globally-asymptotically stable, for a special case of the model where quarantined-susceptible individuals do not acquire COVID-19 infection during quarantine, when ℛcis less than unity. The epidemiological consequence of this theoretical result is that, the community-wide implementation of control interventions that can bring (and maintain) ℛcto a value less than unity will lead to the effective control (or elimination) of COVID-19 in the community. Simulations of the model, using data relevant to COVID-19 transmission dynamics in the US state of New York and the entire US, show that the pandemic burden will peak in mid and late April, respectively. The worst-case scenario projections for cumulative mortality (based on baseline levels of interventions) are 105, 100 for New York state and 164, 000 for the entire US by the end of the pandemic. These numbers dramatically decreased by 80% and 64%, respectively, if adherence to strict social-distancing measures is improved and maintained until the end of May or June. The duration and timing of the relaxation or termination of the strict social-distancing measures are crucially-important in determining the future trajectory of the COVID-19 pandemic. This study shows that early termination of the strict social-distancing measures could trigger a devastating second wave with burden similar to those projected before the onset of the strict social-distance measures were implemented. The use of efficacious face-masks (such as surgical masks, with estimated efficacy ≥ 70%) in public could lead to the elimination of the pandemic if at least 70% of the residents of New York state use such masks in public consistently (nationwide, a compliance of at least 80% will be required using such masks). The use of low efficacy masks, such as cloth masks (of estimated efficacy less than 30%), could also lead to significant reduction of COVID-19 burden (albeit, they are not able to lead to elimination). Combining low efficacy masks with improved levels of the other anti-COVID-19 intervention strategies can lead to the elimination of the pandemic. This study emphasizes the important role social-distancing plays in curtailing the burden of COVID-19. Increases in the adherence level of social-distancing protocols result in dramatic reduction of the burden of the pandemic, and the timely implementation of social-distancing measures in numerous states of the US may have averted a catastrophic outcome with respect to the burden of COVID-19. Using face-masks in public (including the low efficacy cloth masks) is very useful in minimizing community transmission and burden of COVID-19, provided their coverage level is high. The masks coverage needed to eliminate COVID-19 decreases if the masks-based intervention is combined with the strict social-distancing strategy.