A prospect on the use of antiviral drugs to control local outbreaks of COVID-19.
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
25 06 2020
25 06 2020
Historique:
received:
03
04
2020
accepted:
15
05
2020
entrez:
27
6
2020
pubmed:
27
6
2020
medline:
16
7
2020
Statut:
epublish
Résumé
Current outbreaks of COVID-19 are threatening the health care systems of several countries around the world. Control measures, based on isolation, contact tracing, and quarantine, can decrease and delay the burden of the ongoing epidemic. With respect to the ongoing COVID-19 epidemic, recent modeling work shows that these interventions may be inadequate to control local outbreaks, even when perfect isolation is assumed. The effect of infectiousness prior to symptom onset combined with asymptomatic infectees further complicates the use of contact tracing. We aim to study whether antivirals, which decrease the viral load and reduce infectiousness, could be integrated into control measures in order to augment the feasibility of controlling the epidemic. Using a simulation-based model of viral transmission, we tested the efficacy of different intervention measures to control local COVID-19 outbreaks. For individuals that were identified through contact tracing, we evaluate two procedures: monitoring individuals for symptoms onset and testing of individuals. Additionally, we investigate the implementation of an antiviral compound combined with the contact tracing process. For an infectious disease in which asymptomatic and presymptomatic infections are plausible, an intervention measure based on contact tracing performs better when combined with testing instead of monitoring, provided that the test is able to detect infections during the incubation period. Antiviral drugs, in combination with contact tracing, quarantine, and isolation, result in a significant decrease of the final size and the peak incidence, and increase the probability that the outbreak will fade out. In all tested scenarios, the model highlights the benefits of control measures based on the testing of traced individuals. In addition, the administration of an antiviral drug, together with quarantine, isolation, and contact tracing, is shown to decrease the spread of the epidemic. This control measure could be an effective strategy to control local and re-emerging outbreaks of COVID-19.
Sections du résumé
BACKGROUND
Current outbreaks of COVID-19 are threatening the health care systems of several countries around the world. Control measures, based on isolation, contact tracing, and quarantine, can decrease and delay the burden of the ongoing epidemic. With respect to the ongoing COVID-19 epidemic, recent modeling work shows that these interventions may be inadequate to control local outbreaks, even when perfect isolation is assumed. The effect of infectiousness prior to symptom onset combined with asymptomatic infectees further complicates the use of contact tracing. We aim to study whether antivirals, which decrease the viral load and reduce infectiousness, could be integrated into control measures in order to augment the feasibility of controlling the epidemic.
METHODS
Using a simulation-based model of viral transmission, we tested the efficacy of different intervention measures to control local COVID-19 outbreaks. For individuals that were identified through contact tracing, we evaluate two procedures: monitoring individuals for symptoms onset and testing of individuals. Additionally, we investigate the implementation of an antiviral compound combined with the contact tracing process.
RESULTS
For an infectious disease in which asymptomatic and presymptomatic infections are plausible, an intervention measure based on contact tracing performs better when combined with testing instead of monitoring, provided that the test is able to detect infections during the incubation period. Antiviral drugs, in combination with contact tracing, quarantine, and isolation, result in a significant decrease of the final size and the peak incidence, and increase the probability that the outbreak will fade out.
CONCLUSION
In all tested scenarios, the model highlights the benefits of control measures based on the testing of traced individuals. In addition, the administration of an antiviral drug, together with quarantine, isolation, and contact tracing, is shown to decrease the spread of the epidemic. This control measure could be an effective strategy to control local and re-emerging outbreaks of COVID-19.
Identifiants
pubmed: 32586336
doi: 10.1186/s12916-020-01636-4
pii: 10.1186/s12916-020-01636-4
pmc: PMC7315692
doi:
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
191Subventions
Organisme : EpiPose project from the European Union's SC1-PHE-CORONAVIRUS-2020 programme
ID : 101003688
Pays : International
Organisme : European Union's Horizon 2020 research and innovation programme
ID : 682540
Pays : International
Organisme : the European Union's Horizon 2020 research and innovation program
ID : 101003627
Pays : International
Références
Int J Infect Dis. 2020 May;94:154-155
pubmed: 32179137
BMC Res Notes. 2020 Jun 16;13(1):293
pubmed: 32546245
Philos Trans R Soc Lond B Biol Sci. 2015 Apr 19;370(1666):
pubmed: 25750242
Cell Res. 2020 Mar;30(3):269-271
pubmed: 32020029
N Engl J Med. 2020 May 28;382(22):2158-2160
pubmed: 32329972
Science. 2020 May 1;368(6490):489-493
pubmed: 32179701
Lancet Infect Dis. 2020 Jul;20(7):793-802
pubmed: 32247326
Nat Rev Immunol. 2020 Jun;20(6):355-362
pubmed: 32376901
J Clin Med. 2020 Feb 17;9(2):
pubmed: 32079150
N Engl J Med. 2020 May 28;382(22):2081-2090
pubmed: 32329971
Proc Natl Acad Sci U S A. 1997 Jun 24;94(13):6971-6
pubmed: 9192676
Math Biosci. 2007 Jul;208(1):300-11
pubmed: 17174352
Lancet. 2003 May 24;361(9371):1761-6
pubmed: 12781533
N Engl J Med. 2020 Jun 11;382(24):2327-2336
pubmed: 32275812
Lancet. 2020 Mar 21;395(10228):947
pubmed: 32145187
Euro Surveill. 2020 Apr;25(17):
pubmed: 32372755
Euro Surveill. 2020 Feb;25(5):
pubmed: 32046819
Nature. 2020 Mar;579(7798):270-273
pubmed: 32015507
N Engl J Med. 2020 Mar 26;382(13):1199-1207
pubmed: 31995857
Science. 2020 May 8;368(6491):638-642
pubmed: 32234804
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Lancet Glob Health. 2020 Apr;8(4):e488-e496
pubmed: 32119825
Lancet Infect Dis. 2020 Apr;20(4):411-412
pubmed: 32105638
Lancet. 2020 May 16;395(10236):1569-1578
pubmed: 32423584
N Engl J Med. 2020 Mar 19;382(12):1177-1179
pubmed: 32074444
JAMA. 2020 Apr 22;:
pubmed: 32320003
Nature. 2016 Mar 17;531(7594):381-5
pubmed: 26934220
Nat Commun. 2020 Jan 10;11(1):222
pubmed: 31924756
Science. 2020 May 1;368(6490):493-497
pubmed: 32213647
Lancet. 2020 May 16;395(10236):1525-1527
pubmed: 32423580
PLoS One. 2006 Dec 20;1:e12
pubmed: 17183638
PLoS Med. 2008 Mar 25;5(3):e74
pubmed: 18366252