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      Policy Design for COVID‐19: Worldwide Evidence on the Efficacies of Early Mask Mandates and Other Policy Interventions

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          Abstract

          To understand the extent to which a policy instrument’s early adoption is crucial in crisis management, we leverage unique worldwide data that record the daily evolution of policy mandate adoptions and COVID‐19 infection and mortality rates. The analysis shows that the mask mandate is consistently associated with lower infection rates in the short term, and its early adoption boosts the long‐term efficacy. By contrast, the other five policy instruments—domestic lockdowns, international travel bans, mass gathering bans, and restaurant and school closures—show weaker efficacy. Governments prepared for a public health crisis with stronger resilience or capacity and those with stronger collectivist cultures were quicker to adopt nationwide mask mandates. From a policy design perspective, policymakers must avoid overreacting with less effective instruments and underreacting with more effective ones during uncertain times, especially when interventions differ in efficacy and cost.

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          Most cited references118

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          The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

          Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID-19 and describe its public health implications. Design: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases. Primary Funding Source: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.
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            Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2)

            Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV2, including the fraction of undocumented infections and their contagiousness. We estimate 86% of all infections were undocumented (95% CI: [82%–90%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%–62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.
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              Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe

              Following the detection of the new coronavirus1 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics of coronavirus disease 2019 (COVID-19). In response, many European countries have implemented non-pharmaceutical interventions, such as the closure of schools and national lockdowns. Here we study the effect of major interventions across 11 European countries for the period from the start of the COVID-19 epidemics in February 2020 until 4 May 2020, when lockdowns started to be lifted. Our model calculates backwards from observed deaths to estimate transmission that occurred several weeks previously, allowing for the time lag between infection and death. We use partial pooling of information between countries, with both individual and shared effects on the time-varying reproduction number (Rt). Pooling allows for more information to be used, helps to overcome idiosyncrasies in the data and enables more-timely estimates. Our model relies on fixed estimates of some epidemiological parameters (such as the infection fatality rate), does not include importation or subnational variation and assumes that changes in Rt are an immediate response to interventions rather than gradual changes in behaviour. Amidst the ongoing pandemic, we rely on death data that are incomplete, show systematic biases in reporting and are subject to future consolidation. We estimate that-for all of the countries we consider here-current interventions have been sufficient to drive Rt below 1 (probability Rt < 1.0 is greater than 99%) and achieve control of the epidemic. We estimate that across all 11 countries combined, between 12 and 15 million individuals were infected with SARS-CoV-2 up to 4 May 2020, representing between 3.2% and 4.0% of the population. Our results show that major non-pharmaceutical interventions-and lockdowns in particular-have had a large effect on reducing transmission. Continued intervention should be considered to keep transmission of SARS-CoV-2 under control.
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                Author and article information

                Contributors
                yan74@gatech.edu
                porcher.iae@univ-paris1.fr
                stang@usc.edu
                emily.kim@gatech.edu
                Journal
                Public Adm Rev
                Public Adm Rev
                10.1111/(ISSN)1540-6210
                PUAR
                Public Administration Review
                Wiley Subscription Services, Inc. (Hoboken, USA )
                0033-3352
                1540-6210
                17 October 2021
                Nov-Dec 2021
                17 October 2021
                : 81
                : 6 ( doiID: 10.1111/puar.v81.6 )
                : 1157-1182
                Affiliations
                [ 1 ] Georgia Institute of Technology
                [ 2 ] IAE Paris ‐ Sorbonne Business School
                [ 3 ] University of Southern California
                Article
                PUAR13426 PAR-D-21-00222
                10.1111/puar.13426
                8662156
                34908595
                4b7efa68-42bf-4c36-806a-9ee1db9931e6
                © 2021 by The American Society for Public Administration

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 11 August 2021
                : 21 February 2021
                : 18 August 2021
                Page count
                Figures: 6, Tables: 11, Pages: 26, Words: 17900
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                November/December 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.9 mode:remove_FC converted:10.12.2021

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