Corona: Which measures work? CSH has the ranking

A combination of soft measures can be highly effective without being as intrusive as a lockdown

This is one of the major findings of a detailed analysis of the CCCSL database with more than 4,500 governmental measures against coronavirus spread.

Which governmental measures work—and how well do they work—to curb COVID-19? This is one of the most pressing questions since the early days of the pandemic. An international team of scientists related to the Hub disentangled the packages of measures taken in countries worldwide and now came up with a detailed effectiveness ranking. In their study, which was submitted as a preprint to medrXiv, they quantify the contribution of each measure to reduce the famous “reproduction number” R(t).

R(t) shows how many people get infected by one sick person on average. To contain further spreading of any disease, R(t) must be below one.

“Social distancing clearly works best,” says CSH Faculty member and principal investigator Peter Klimek. “Us parents may like it or not, but the by far most effective measure according to our study is the closure of educational institutions.”

Also highly effective are small gathering cancellations—a measure type that includes closing of shops and restaurants or working from home—, travel restrictions such as the closing of borders, active risk communication with stakeholders, for example by promoting safety protocols in firms or at events, and improving the capacity of health care systems to cope with the pandemic, such as providing special education on COVID-19 and protective equipment for health care workers, or separating COVID-19 from Non-COVID-19 patients in hospitals.

Not one, but many: To bend the curve, a clever combination of measures is needed

“Yet, no single measure alone is good enough to bring R(t) below one,” first author Nils Haug points out. “The most effective intervention, the closure of kindergartens, schools and universities impacts the reproduction number by –0.34 at the max.” It is currently believed that without any interventions, R(t) is around 3. Just closing schools and doing nothing else translates into each infected person infecting 2.7 people on average instead of 3.

To bend the curve, countries therefore must use a clever mix of measures—and do so “the earlier, the better,” according to the CSH study. “Timing really is half of the battle. Face masks for instance showed to be most efficient in countries that promoted a voluntary use early on, compared to countries that implemented a mandatory use at later stages,” says complexity scientist Nils Haug. “We indeed observe a pattern: Early and voluntary interventions outperform similar measures that are taken late and as mandatory guidelines. Besides face masks, this was also true for the isolation of individuals with symptoms or for safety measures taken at workplaces.” This means that an active risk communication with the public as well as the education and information of all relevant stakeholders are key to curb the epidemic.

WHICH MEASURES BEND THE COVID-19 CURVE?

The earlier, the better

To bend the curve, countries therefore must use a clever mix of measures—and do so “the earlier, the better,” according to the CSH study. “Timing really is half of the battle. Face masks for instance showed to be most efficient in countries that promoted a voluntary use early on, compared to countries that implemented a mandatory use at later stages,” says complexity scientist Nils Haug. “We indeed observe a pattern: Early and voluntary interventions outperform similar measures that are taken late and as mandatory guidelines. Besides face masks, this was also true for the isolation of individuals with symptoms or for safety measures taken at workplaces.” This means that an active risk communication with the public as well as the education and information of all relevant stakeholders are key to curb the epidemic.

Lockdowns too were most effective when imposed early on—but they also had tremendous impacts on social and cultural life, wellbeing and the economy as a whole. “Our study is good news in that respect. We see that we do not necessarily need the most intrusive measures to successfully bend the curve. With the right combination of less severe interventions, the reproduction number can considerably be reduced,” Nils Haug points out.

Making use of the CCCSL

The to date most comprehensive analysis of governmental measures is based on a curated version of our CSH COVID-19 Control Strategies List (CCCSL). The CCCSL, which eventually became part of the WHO’s “Public health and social measures (PHSMs)” initiative, is described in more detail in another preprint that was submitted in May.

Almost 4,600 individual measures in 76 different territories worldwide, including more than twenty US States, European countries, and Asian regions like Japan and Hong Kong, were included in the analyses.

Our scientists used four very different methods to analyze the dataset. “The vastly different approaches come to remarkably similar conclusions,” says Peter. “This makes us confident about the significance of our ranking. We therefore believe that our findings could be of great help for decision-makers to combat the currently starting second wave of the pandemic.”

Lit.:

[1] N. Haug, L. Geyrhofer, A. Londei, E. Dervic, A. Desvars-Larrive, V. Loreto, B. Pinior, S. Thurner, P. Klimek, Ranking the effectiveness of worldwide COVID-19 government interventions, medRxiv (2020)

[2] A. Desvars-Larrive, E. Dervic, N. Haug, et al., A structured open dataset of government interventions in response to COVID-19, medRxiv (2020)

This text is based on a CSH press release, published on AlphaGalileo, July 14, 2020.