Covid-19 and community mitigation strategies in a pandemic

The covid-19 pandemic that was declared on 11 March 2020 has affected countries on all continents.1 Reported case numbers are certainly underestimates given the shortages or unavailability of test kits in many countries, a virus with a basic reproductive value (R) of 2.2, and evidence of viral shedding from asymptomatic infected people.1234 In addition to suspending travel and efforts to reduce crowds, countries are taking unprecedented measures, including wartime strategies to enhance production of medical supplies in the US, the use of the national guard to restrict movement of people, and suspension of exports of medical products from certain countries (Saudi Arabia, India).5678 Our challenge is to make the best use of available tools through systematic implementation by communities and countries to mitigate the exponential spread of covid-19. No specific drugs or vaccines are available, and health systems are overburdened everywhere. We have to rely on targeted, non-coercive, community interventions with sufficient transparency and public engagement and trust, and implement them urgently (box 1).91011 Such measures may help delay the exponential spread of the outbreak until drugs become available. Transparency and trust are …