Key epidemiological drivers and impact of interventions in the 2020 SARS-CoV-2 epidemic in England.
Knock ES., Whittles LK., Lees JA., Perez-Guzman PN., Verity R., FitzJohn RG., Gaythorpe KAM., Imai N., Hinsley W., Okell LC., Rosello A., Kantas N., Walters CE., Bhatia S., Watson OJ., Whittaker C., Cattarino L., Boonyasiri A., Djaafara BA., Fraser K., Fu H., Wang H., Xi X., Donnelly CA., Jauneikaite E., Laydon DJ., White PJ., Ghani AC., Ferguson NM., Cori A., Baguelin M.
We fitted a model of SARS-CoV-2 transmission in care homes and the community to regional surveillance data for England. Compared with other approaches, our model provides a synthesis of multiple surveillance data streams into a single coherent modelling framework allowing transmission and severity to be disentangled from features of the surveillance system. Of the control measures implemented, only national lockdown brought the reproduction number (Rt eff ) below 1 consistently; if introduced one week earlier it could have reduced deaths in the first wave from an estimated 48,600 to 25,600 (95% credible interval [95%CrI]: 15,900-38,400). The infection fatality ratio decreased from 1.00% (95%CrI: 0.85%-1.21%) to 0.79% (95%CrI: 0.63%-0.99%), suggesting improved clinical care. The infection fatality ratio was higher in the elderly residing in care homes (23.3%, 95%CrI: 14.7%-35.2%) than those residing in the community (7.9%, 95%CrI: 5.9%-10.3%). On 2nd December 2020 England was still far from herd immunity, with regional cumulative infection incidence between 7.6% (95%CrI: 5.4%-10.2%) and 22.3% (95%CrI: 19.4%-25.4%) of the population. Therefore, any vaccination campaign will need to achieve high coverage and a high degree of protection in vaccinated individuals to allow non-pharmaceutical interventions to be lifted without a resurgence of transmission.