Modelling how face masks and symptoms-based quarantine synergistically and cost-effectively reduce SARS-CoV-2 transmission in Bangladesh

Ferguson, E. A. et al. (2022) Modelling how face masks and symptoms-based quarantine synergistically and cost-effectively reduce SARS-CoV-2 transmission in Bangladesh. Epidemics, 40, 100592. (doi: 10.1016/j.epidem.2022.100592) (PMID:35738153) (PMCID:PMC9192122)

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Background: Non-pharmaceutical interventions (NPIs) used to limit SARS-CoV-2 transmission vary in their feasibility, appropriateness and effectiveness in different contexts. In Bangladesh a national lockdown implemented in March 2020 exacerbated poverty and was untenable long-term. A resurgence in 2021 warranted renewed NPIs. We sought to identify NPIs that were feasible in this context and explore potential synergies between interventions. Methods: We developed an SEIR model for Dhaka District, parameterised from literature values and calibrated to data from Bangladesh. We discussed scenarios and parameterisations with policymakers with the aid of an interactive app. These discussions guided modelling of lockdown and two post-lockdown measures considered feasible to deliver; symptoms-based household quarantining and compulsory mask-wearing. We compared NPI scenarios on deaths, hospitalisations relative to capacity, working days lost, and cost-effectiveness. Results: Lockdowns alone were predicted to delay the first epidemic peak but could not prevent overwhelming of the health service and were costly in lost working days. Impacts of post-lockdown interventions depended heavily on compliance. Assuming 80% compliance, symptoms-based household quarantining alone could not prevent hospitalisations exceeding capacity, whilst mask-wearing prevented overwhelming health services and was cost-effective given masks of high filtration efficiency. Combining masks with quarantine increased their impact. Recalibration to surging cases in 2021 suggested potential for a further wave in 2021, dependent on uncertainties in case reporting and immunity. Conclusions: Masks and symptoms-based household quarantining synergistically prevent transmission, and are cost-effective in Bangladesh. Our interactive app was valuable in supporting decision-making, with mask-wearing being mandated early, and community teams being deployed to support quarantining across Dhaka. These measures likely contributed to averting the worst public health impacts, but delivering an effective response with consistent compliance across the population has been challenging. In the event of a further resurgence, concurrent messaging to increase compliance with both mask-wearing and quarantine is recommended.

Item Type:Articles
Additional Information:Funding: The Bill and Melinda Gates Foundation funded work by FAO and UoG (INV-022851), and UoG reports funding from Wellcome (207569/Z/17/Z).
Glasgow Author(s) Enlighten ID:Hampson, Professor Katie and Steenson, Miss Rachel and Ferguson, Dr Elaine
Authors: Ferguson, E. A., Brum, E., Chowdhury, A., Chowdhury, S., Kundegorski, M., Mahmud, A. S., Purno, N., Sania, A., Steenson, R., Tasneem, M., and Hampson, K.
College/School:College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
Journal Name:Epidemics
ISSN (Online):1878-0067
Published Online:13 June 2022
Copyright Holders:Copyright © 2022 The Author(s)
First Published:First published in Epidemics 40: 100592
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
301620The Science of Rabies EliminationKatie HampsonWellcome Trust (WELLCOTR)207569/Z/17/ZInstitute of Biodiversity, Animal Health and Comparative Medicine