COVID-19 Mitigation: Science to Policy to Practice

The United States is currently experiencing a sixth wave of SARS-CoV-2 transmission with the highest daily number of new COVID-19 cases reported since the pandemic began. The steep epidemic trajectory will require immediate public health action to prevent severe impacts on the health of individuals and the healthcare system. This study describes evidence-based prevention strategies and guidance to reduce SARS-CoV-2 transmission in the United States before and after vaccine introduction. The first section provides a brief overview of the current epidemiology of COVID-19. The second section provides recommendations and sustainable strategies to reduce community transmission of SARS-CoV-2 and related deaths prior to vaccine distribution. The third section provides the initial guidance for fully vaccinated people including recommendations for visiting in private settings, travel, isolation, testing and quarantine. It also describes the science and rationale behind the guidance. The fourth section assesses the impact of the U.S. national vaccination program on the age distribution of COVID-19. The fifth section determines the key factors that inform the need for layered prevention strategies in the context of varying vaccination coverage. The findings suggest that layered prevention strategies, including vaccination, can reduce the overall burden of illness and the strain on the healthcare system, and provide guidance for decision-making and implementation. The central challenge to SARS-CoV-2 control is no longer a limited understanding of a new virus, but public and political support to implement what we know works. Increasing acceptance of these interventions and reducing disparities in access and uptake remain critical to reducing preventable morbidity and mortality and controlling the pandemic

Reduced evolutionary rate in reemerged Ebola virus transmission chains

On 29 June 2015, Liberia’s respite from Ebola virus disease (EVD) was interrupted for the second time by a renewed outbreak (“flare-up”) of seven confirmed cases. We demonstrate that, similar to the March 2015 flare-up associated with sexual transmission, this new flare-up was a reemergence of a Liberian transmission chain originating from a persistently infected source rather than a reintroduction from a reservoir or a neighboring country with active transmission. Although distinct, Ebola virus (EBOV) genomes from both flare-ups exhibit significantly low genetic divergence, indicating a reduced rate of EBOV evolution during persistent infection. Using this rate of change as a signature, we identified two additional EVD clusters that possibly arose from persistently infected sources. These findings highlight the risk of EVD flare-ups even after an outbreak is declared over

COVID-19 Mitigation: Science to Policy to Practice

The United States is currently experiencing a sixth wave of SARS-CoV-2 transmission with the highest daily number of new COVID-19 cases reported since the pandemic began. The steep epidemic trajectory will require immediate public health action to prevent severe impacts on the health of individuals and the healthcare system. This study describes evidence-based prevention strategies and guidance to reduce SARS-CoV-2 transmission in the United States before and after vaccine introduction. The first section provides a brief overview of the current epidemiology of COVID-19. The second section provides recommendations and sustainable strategies to reduce community transmission of SARS-CoV-2 and related deaths prior to vaccine distribution. The third section provides the initial guidance for fully vaccinated people including recommendations for visiting in private settings, travel, isolation, testing and quarantine. It also describes the science and rationale behind the guidance. The fourth section assesses the impact of the U.S. national vaccination program on the age distribution of COVID-19. The fifth section determines the key factors that inform the need for layered prevention strategies in the context of varying vaccination coverage. The findings suggest that layered prevention strategies, including vaccination, can reduce the overall burden of illness and the strain on the healthcare system, and provide guidance for decision-making and implementation. The central challenge to SARS-CoV-2 control is no longer a limited understanding of a new virus, but public and political support to implement what we know works. Increasing acceptance of these interventions and reducing disparities in access and uptake remain critical to reducing preventable morbidity and mortality and controlling the pandemic

Bolstering Community Cooperation in Ebola Resurgence Protocols: Combining Field Blood Draw and Point-of-Care Diagnosis.

Alison Galvani and colleagues describe a community-based protocol to improve cooperation with Ebola testing as well as contact tracing, quarantining, and treatment

Ebola and Its Control in Liberia, 2014–2015

The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June–July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems

Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data

Background: Ebola virus has been detected in semen of Ebola virus disease survivors after recovery. Liberia's Men's Health Screening Program (MHSP) offers Ebola virus disease survivors semen testing for Ebola virus. We present preliminary results and behavioural outcomes from the first national semen testing programme for Ebola virus. Methods: The MHSP operates out of three locations in Liberia: Redemption Hospital in Montserrado County, Phebe Hospital in Bong County, and Tellewoyan Hospital in Lofa County. Men aged 15 years and older who had an Ebola treatment unit discharge certificate are eligible for inclusion. Participants' semen samples were tested for Ebola virus RNA by real-time RT-PCR and participants received counselling on safe sexual practices. Participants graduated after receiving two consecutive negative semen tests. Counsellors collected information on sociodemographics and sexual behaviours using questionnaires administered at enrolment, follow up, and graduation visits. Because the programme is ongoing, data analysis was restricted to data obtained from July 7, 2015, to May 6, 2016. Findings: As of May 6, 2016, 466 Ebola virus disease survivors had enrolled in the programme; real-time RT-PCR results were available from 429 participants. 38 participants (9%) produced at least one semen specimen that tested positive for Ebola virus RNA. Of these, 24 (63%) provided semen specimens that tested positive 12 months or longer after Ebola virus disease recovery. The longest interval between discharge from an Ebola treatment unit and collection of a positive semen sample was 565 days. Among participants who enrolled and provided specimens more than 90 days since their Ebola treatment unit discharge, men older than 40 years were more likely to have a semen sample test positive than were men aged 40 years or younger (p=0·0004). 84 (74%) of 113 participants who reported not using a condom at enrolment reported using condoms at their first follow-up visit (p<0·0001). 176 (46%) of 385 participants who reported being sexually active at enrolment reported abstinence at their follow-up visit (p<0·0001). Interpretation: Duration of detection of Ebola virus RNA by real-time RT-PCR varies by individual and might be associated with age. By combining behavioural counselling and laboratory testing, the Men's Health Screening Program helps male Ebola virus disease survivors understand their individual risk and take appropriate measures to protect their sexual partners. Funding: World Health Organization and the US Centers for Disease Control and Prevention