title: Comparing nonpharmaceutical interventions for containing emerging epidemics.
abstract: Strategies for containing an emerging infectious disease outbreak must be nonpharmaceutical when drugs or vaccines for the pathogen do not yet exist or are unavailable. The success of these nonpharmaceutical strategies will depend on not only the effectiveness of isolation measures but also the epidemiological characteristics of the infection. However, there is currently no systematic framework to assess the relationship between different containment strategies and the natural history and epidemiological dynamics of the pathogen. Here, we compare the effectiveness of quarantine and symptom monitoring, implemented via contact tracing, in controlling epidemics using an agent-based branching model. We examine the relationship between epidemic containment and the disease dynamics of symptoms and infectiousness for seven case-study diseases with diverse natural histories, including Ebola, influenza A, and severe acute respiratory syndrome (SARS). We show that the comparative effectiveness of symptom monitoring and quarantine depends critically on the natural history of the infectious disease, its inherent transmissibility, and the intervention feasibility in the particular healthcare setting. The benefit of quarantine over symptom monitoring is generally maximized for fast-course diseases, but we show the conditions under which symptom monitoring alone can control certain outbreaks. This quantitative framework can guide policymakers on how best to use nonpharmaceutical interventions and prioritize research during an outbreak of an emerging pathogen.
authors.affiliation: Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115.
authors.forename: Corey M
authors.identifier: 0000-0001-6150-5318
authors.initials: CM
authors.lastname: Peak
authors.affiliation: Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Childs
authors.affiliation: Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115.|Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
authors.forename: Yonatan H
authors.identifier: 0000-0001-5646-1314
authors.initials: YH
authors.lastname: Grad
authors.affiliation: Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115; cbuckee@hsph.harvard.edu.
authors.forename: Caroline O
authors.initials: CO
authors.lastname: Buckee
mesh_terms: D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000517:prevention & control*; D018352:Coronavirus Infections / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control*; D019142:Hemorrhagic Fever, Ebola / Q000517:prevention & control; D006506:Hepatitis A / Q000517:prevention & control; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control; D008962:Models, Theoretical; D011790:Quarantine; D045169:Severe Acute Respiratory Syndrome / Q000517:prevention & control; D012899:Smallpox / Q000517:prevention & control
keywords: active symptom monitoring; contact tracing; epidemiology; infectious disease dynamics; quarantine