Containment or mitigation of COVID-19?

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More studies are clearly required before reaching conclusions, but the available evidence does suggest that increasing coverage of influenza vaccination could result in both direct and indirect benefits in terms of reduced morbidity and mortality from both COVID-19 and influenza. In addition to the longterm benefits of expanding influenza vaccine production and uptake, these efforts will be of great value for rolling-out the COVID-19 vaccines, since production, distribution and promotion of uptake for the new vaccines will face similar challenges and will need to prioritize the same vulnerable populations (Jaklevic 2020, Mendelson 2020).

Public health interventions to control an outbreak or an epidemic aim at achieving two separate but linked objectives (Zhang 2020, OECD 2020): • To contain the spread by minimizing the risk of transmission from infected to non-infected individuals, eventually suppressing transmission and ending the outbreak. • To mitigate the impact by slowing the spread of the disease while protecting those at higher risk. While not halting the outbreak, this would

“flatten the epidemic curve”, reduce disease burden and avoid a peak in health care demand. In case of new emerging pathogens, it would also buy time to develop effective treatments or vaccines (Djidjou-Demasse 2020). Containment strategies rely heavily on case detection and contract tracing, isolation, and quarantine. They are usually applied most successfully in the early stages of an outbreak or epidemic, when the number of cases is still manageable by the public health system (Hellewell 2020). When containment measures are insufficient or applied too late, mitigation becomes the only option, usually through the imposition of generalized preventive measures like closing of non-essential activities, social distancing, mandatory mask use, or lockdowns (Parodi 2020, Walker 2020). During the first months of the COVID-19 pandemic, several countries (China, Vietnam, South Korea, Australia, and New Zealand) have shown how the implementation of a well-timed, comprehensive package of aggressive and combined containment and mitigation policies can be effective in suppressing the COVID-19 epidemic, at least in the short-term. Other countries (most countries in Europe) have not been able to suppress transmission but have managed, at least temporarily, to mitigate the impact and bring the spread of SARS-COV-2 down to acceptable levels during the summer months. In others