Effectiveness of interventions as part of the One Health approach to control coronavirus disease 2019 and stratified case features in Anhui Province, China: A real-world population-based cohort study

• Main Authors: Lei Huang, Xinyue Zhang, Aman Xu
• Format: Article
• Language: English
• Published: Elsevier 2021-06-01
• Series: One Health
• Subjects: COVID-19; SARS-CoV-2; Case importation; Outbreak; Contact tracing; Control
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352771421000148

Background: Coronavirus-Disease-2019 (COVID-19) caused by Severe-Acute-Respiratory-Syndrome-Coronavirus-2 (SARS-CoV-2) is rapidly spreading worldwide causing a pandemic. To control the pandemic, the One Health approach (https://www.who.int/news-room/q-a-detail/one-health) is very important. We herein provide a real-world example of efficient COVID-19 control in Anhui Province, China with outbreak originating from imported cases through implementation of a series of measures as part of the One Health approach and describe the stratified cases features. Methods: Since the identification of the first imported COVID-19 case on Jan 22, 2020, Anhui immediately initiated a sequence of systematic and forceful interventions. We detailed the control measures and analyzed the effects as demonstrated by the corresponding temporal changes of overall epidemiology data on confirmed, cured, and hospitalized cases and contacts. An accumulated number of 991 cases were confirmed, with a total number of 29,399 contacts traced. We further retrieved individual-level data of confirmed cases and compared them across stratifications by sex, age group, linkage to Wuhan, and period of diagnosis. Results: With a series of interventions including active field investigation, case tracing, quarantine, centralization, education, closed management, and boundary control implemented, number of hospitalized COVID-19 cases peaked, new case disappeared, and all cases were discharged 21, 36, and 46 days after the identification of the initial case, respectively. Male patients were younger, more often had linkage to Wuhan, and received timelier care, but less often had infected cohabitants. Patients aged 25–44 years most often had linkage to Wuhan, while such frequency was lowest in those ≥65 years. Cases <25 years most often had a known contact with COVID-19 patients and any infected family member and cohabitant and were beforehand quarantined, and received fastest management. Patients with linkage to Wuhan were younger, less often had infected family member, had longer incubation period, and received earlier quarantine and timelier care. With more recent periods, the proportion of cases with linkage to Wuhan markedly decreased while the proportion of cases with known contact with COVID-19 cases dramatically increased; the proportions of patients with any infected family member or cohabitant, those beforehand quarantined, and those taking drugs before admission increased; incubation period lengthened, and patients received timelier professional care. Nonspecific systemic symptoms were most common, whose proportion decreased in more recent periods. Conclusions: Timely and powerful measures as part of the One Health approach (https://www.who.int/news-room/q-a-detail/one-health) effectively and efficiently controlled the COVID-19 outbreak in Anhui, which can be a good real-world example strongly demonstrating the usefulness of such measures in places with outbreaks originating from imported cases. Precise and dynamic prevention and control measures should be implemented and based on features including sex, age group, exposure history, and phase of outbreak.