I've been mulling over the @MRC_Outbreak modeling report on #COVID19 mitigation and suppression strategies since it was posted on March 16. Although mitigation through social distancing may not solve things I believe we can bring this epidemic under control. 1/19
But first, the report. @neil_ferguson, @azraghani and colleagues model COVID-19 epidemic outcomes under different intensities of non-pharmaceutical, aka social distancing, interventions. 2/19
Different mitigation scenarios that include things like school closures, isolation of symptomatic individuals and quarantine of exposed household members, result in #flatteningthecurve and reducing mortality, but under the author's assumptions still result in an epidemic. 3/19 
Given assumed severity of COVID-19 infections, this flattened epidemic is still severe, resulting in over 1 million deaths in the US and >250k deaths in GB, mostly concentrated in those over 60 and with underlying health conditions. 4/19
Alternatively, with stronger social distancing, the epidemic could be brought under control and effectively "suppressed". However, stopping this level of social distancing would result in a fairly rapid rebound as the population would still lack immunity to the virus. 5/19
Managing this level of social distancing required for suppression while still having a functional economy and society would be difficult and it's not at all clear that this could be maintained for the ~18 months until we have a vaccine. 6/19
This is the catch-22 as presented by the report. 7/19
However, I'm not quite that pessimistic. Although I agree that basic mitigation efforts won't stop the epidemic, I have hope that we can solve this thing by doing traditional shoe leather epidemiology of case finding and isolation, but at scale, using modern technology. 8/19
There are two main case-based strategies that I see here, both related, as well as a supporting serological strategy. 9/19
The first strategy revolves around a massive rollout of testing capacity. We believe that a significant proportion of epidemic transmission is due to mild and maybe even asymptomatic infections (science.sciencemag.org/content/early/…). 10/19
We also believe that a significant amount of transmission may occur in the window before symptoms develop (evidence from viral load dynamics nejm.org/doi/full/10.10…, evidence from serial intervals ncbi.nlm.nih.gov/pubmed/32145466). 11/19
These transmission routes can be reduced by a huge rollout of testing capacity. If someone can be tested early in their illness before they show symptoms, they could effectively self isolate and reduce onward transmission compared to isolation when symptoms develop. 12/19
This strategy of massive testing has been a cornerstone in South Korea's response (sciencemag.org/news/2020/03/c…) and we're now seeing their epidemic brought under control without the stringent policies put in place elsewhere. Case counts in South Korea via @covid2019app. 13/19
This rollout of testing could be achieved through at home delivery of swabs with centralized lab-based processing combined with drive-through testing facilities. There are logistics involved in getting a result quickly, but it's really just logistics, which can be solved. 14/19
The second, related, strategy is using cell phone location data combined with data on known positive cases to alert possible exposures to self isolate and get tested. Figure from @ChristoPhraser and colleagues who've considered this in detail. 15/19
This strategy targets testing capacity at most likely cases and serves to detect exposure events early, when isolation is most valuable. This cell phone location based approach is outlined carefully here: github.com/BDI-pathogens/…. 16/19
A third, supporting, strategy: as the epidemic proceeds get serological assays run on as many people as possible to systematically identify individuals who have recovered and are highly likely to possess immunity. 17/19
Individuals who have serological evidence of recovery and are no longer shedding virus can fully return to the workforce and keep society functioning (especially important for those at the clinical front lines). 18/19
Together, I believe these (and other case-based) strategies can bring down the epidemic. This is the Apollo program of our times. Let's get to it. 19/19
