Key epidemiological drivers and impact of interventions in the 2020 SARS-CoV-2 epidemic in England

Edward S. Knock, Lilith K. Whittles, John A. Lees, Pablo N. Perez-Guzman, Robert Verity, Richard G. FitzJohn, Katy A.M. Gaythorpe, Natsuko Imai, Wes Hinsley, Lucy C. Okell, Alicia Rosello, Nikolas Kantas, Caroline E. Walters, Sangeeta Bhatia, Oliver J. Watson, Charlie Whittaker, Lorenzo Cattarino, Adhiratha Boonyasiri, Bimandra A. Djaafara, Keith FraserHan Fu, Haowei Wang, Xiaoyue Xi, Christl A. Donnelly, Elita Jauneikaite, Daniel J. Laydon, Peter J. White, Azra C. Ghani, Neil M. Ferguson, Anne Cori, Marc Baguelin

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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 modeling 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 (Rteff) below 1 consistently; if introduced 1 week earlier, it could have reduced deaths in the first wave from an estimated 48,600 to 25,600 [95% credible interval (CrI): 15,900 to 38,400]. The infection fatality ratio decreased from 1.00% (95% CrI: 0.85 to 1.21%) to 0.79% (95% CrI: 0.63 to 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 to 35.2%) than those residing in the community (7.9%, 95% CrI: 5.9 to 10.3%). On 2 December 2020, England was still far from herd immunity, with regional cumulative infection incidence between 7.6% (95% CrI: 5.4 to 10.2%) and 22.3% (95% CrI: 19.4 to 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 nonpharmaceutical interventions to be lifted without a resurgence of transmission.

Original languageEnglish
Article number4262
Number of pages11
JournalScience Translational Medicine
Issue number602
Publication statusPublished - 14 Jul 2021

Bibliographical note

Funder Information: This work was supported by the NIHR HPRU in Modelling and Health Economics—a partnership between PHE, Imperial College London, and LSHTM (to N.M.F., grant code NIHR200908)—and the NIHR HPRU in Emerging and Zoonotic Infections—a partnership between PHE, University of Liverpool, University of Oxford, and Liverpool School of Tropical Medicine (to C.A.D., grant code NIHR200907). We acknowledge funding from the MRC Centre for Global Infectious Disease Analysis (to N.M.F., reference MR/R015600/1), jointly funded by the U.K. Medical
Research Council (MRC) and the U.K. Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union

Open Access: Distributed under a Creative Commons Attribution License 4.0 (CC BY).

Publisher Copyright: Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

Citation: Knock, Edward S., et al. "Key epidemiological drivers and impact of interventions in the 2020 SARS-CoV-2 epidemic in England." Science Translational Medicine (2021).

DOI: 10.1126/scitranslmed.abg4262


  • COVID-19


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