Containment and Mitigation Measures of COVID-19-A Scoping Review

The epidemic of Coronavirus Disease 2019 (Covid-19) in China and a number of countries had led to the Covid-19 pandemic declaration by WHO. The aim of this study is to assess the evidence and to report the effectiveness of Covid-19 containment and mitigation measures among the affected countries. A comprehensive search strategy was performed using the MESH terms of “Novel coronavirus,” “Novel coronavirus 2019”, “2019 nCoV”, “Covid -19”, “Wuhan coronavirus”, “SARS-CoV-2”, “Containment”, “Mitigation” and “Control”. After completion of the initial screening, 922 articles were excluded for the following reasons: the article did not meet the inclusion criteria (N = 862), the article was a duplicate (N = 60). The remaining 72 articles were screened at the full-text level. After full review for relevancy, 41 articles were excluded and a total of 31 articles were selected for scoping review. The two most successful countries that managed to control this pandemic were Hong Kong and South Korea. While, the United States of America (USA) and Brazil are the countries yet unable to significantly reduce the Covid -19 cases. The aggressiveness of government efforts and the compliance among the population are the main factors contributing to the effectiveness of the containment and mitigation measures implemented.


I. Introduction
In December 2019, Wuhan City, Hubei province in China experienced an unprecedented outbreak of pneumonia of unknown aetiology (Chaolin et al., 2020). Most of the infected patients had developed mild symptoms such as dry cough, sore throat, and fever (Eunha et al., 2020). However, some have developed various fatal complications including organ failure, septic shock, pulmonary oedema, severe pneumonia, and acute respiratory distress syndrome that required specialized management at intensive care units (Catlin et al., 2020). The epidemiology of this unknown disease is still being investigated and the virus was later identified from the throat swab samples of the cases (Catlin et al., 2020). This disease was subsequently named Severe Acute Respiratory Syndrome Coronaviru-2 (SARS-CoV-2) (Ren et al., 2020) and later, the World Health Organization (WHO) renamed this viral disease as COVID-19 (WHO, 2020a). As of January 30, 2020, 7734 cases have been confirmed in China and 90 other cases have also been reported from many countries in Asia, Europe and America (Hussin & Siddappa, 2020). Subsequently, the number of cases rose quickly and as of 16 February 2020, WHO reported 51,174 confirmed cases in China and the number of cases out of China has reached 51,857 (Hussin & Siddappa, 2020). This phenomenon has led WHO to declare COVID-19 as pandemic on March 11, 2020(Lancet, 2020. At the time of preparing this manuscript (04 May 2020), WHO reported laboratoryconfirmed COVID-19 cases and deaths worldwide which stood at 3,349,786 and 238,615 respectively (WHO, 2020b).
In view of the above scenario, it is crucial to explore relevant evidence on current COVID-19 pandemic containment and mitigation measures adopted by affected countries other than China. We hope our study findings will provide important reference data to policy makers in containment and mitigation efforts of the emergence of this pandemic. Therefore, the objective of this study is to assess the evidence and to identify the best containment and mitigation measures used among the countries affected by COVID-19 pandemic.

II. Research Method
In our study, a scoping review approach in searching, screening, reviewing and data extraction was applied based on framework by Arksey and O'Malley (Arksey & O'Malley, 2005). The stages of scoping review framework in our study include: identifying the research objectives, identifying relevant studies, study selection, charting the data, summarizing, and reporting the result (Arksey & O'Malley, 2005).
Scoping review methodology was selected over that of systematic review due to limited literature based on our topic of enquiry (The Joanna Briggs Institute, 2015). Selection criteria for the search are articles in English published from January 1, 2020 to 31 March 2020 and related to measures in COVID-19 containment and mitigation control from the countries with confirmed cases of more than fifty. We excluded publications such as articles and reports that did not include containment or mitigation measures.
A comprehensive search strategy was performed, which includes published scientific journals, unpublished work, grey literature, such as: i. Electronic databases of Medline/Pubmed, Science Direct, Web of Sciences and Scopus; ii. Relevant research websites such as WHO, Google Scholar; iii. Bibliographic search of reports, summaries, newsletters, and references from selected articles or bulletin from the WHO and Ministry of Health; iv. Other sources included information from experts in the relevant agencies, research fields from countries all over the world.
The search was conducted with medical subject headings (MeSH) terms, including -Novel coronavirus,‖ -Novel coronavirus 2019‖, -2019 nCoV‖, -COVID-19‖, -Wuhan coronavirus‖, -SARS-CoV-2‖, -Containment‖, -Mitigation‖ and -Control‖. All references of retrieved articles were further searched for identification of other potential articles. Two reviewers independently screened all references from the articles search and then reached consensus on which met the eligibility criteria. Non-English language articles were excluded as the translation was not practical.
Data from the articles were extracted and summarized on a standardized form with the data reviewed by both authors (JSMS and NCAR). Data collected included the following: author(s)/ year of publication, country, type of publication, type of containment measures such as self-isolation and screening, type of mitigation measures such as social distance, movement restriction/travel, partial lockdown and prohibition of mass gathering, date of first case occurred, number of cases and fatality at 31 March 2020 and source of data. The characteristics of the selected articles were described based on the types of containment and mitigation of the study in various countries (excluding China).
The study was registered under the National Medical Research Register (NMRR) and the ethical approval was obtained from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysian (NMRR-20-624-54449).

Results
All included studies were published between 2019 and 2020. A total of 996 sources of evidence identified from the literature search and grey literature hand search were included in the review, representing the types of containment and mitigation from four regions; i. Western Pacific and South East Asia (Australia, Singapore, Philippines, and Hong Kong), ii. European (Spain, France, Germany, United Kingdom, Netherland, Norway, and Austria), iii. Eastern Mediterranean (Bahrain), and iv. The Americas (USA, Canada, and Brazil). After the completion of the initial screening, 922 articles were excluded for the following reasons; the article did not meet the inclusion criteria (N = 862); the article was a duplicate (N = 60).
The remaining 72 articles were screened at the full-text level. After full review for relevancy, another 41 articles were excluded and a total of 31 articles were selected for final review (Figure 1). Out of 31 articles, there were 15 articles from journals, seven reports and nine press statements. Of these, eight (26%) articles from Western Pacific and South East Asia Region, 16 (52%) articles from European Region, one (3%) from Eastern Mediterranean Region and six (19%) from Region of The Americas ( Figure.  The Western Pacific and South East Asia Regions such as South Korea, Japan, Australia, Philippines, Singapore, and Hong Kong had adopted the containment in order to control the disease. Containment measures, aimed at preventing the disease from taking hold, encompassing early detection, isolation, and care of infected people already infected, with careful tracing and screening of their contacts. In South Korea and Japan, containment and mitigation measures in COVID-19 transmission control are self-isolation, screening, and movement restriction/travel (Power, 2020;Wikipedia, 2020a).
The European Region such as Spain, France, Germany, Switzerland, United Kingdom, Netherland, Sweden, Norway and Austria had adopted a few strategies to control the disease. The containment and mitigation control measures in Spain were self-isolation, social distance, movement restriction/travel and partial lockdown (Aleta & Moreno, 2020). In France and United Kingdom, containment and mitigation measures in COVID-19 transmission control were only screening and self-isolation (Sibylle et al., 2020;Mohammad et al., 2020;Moss et al., 2020;Flear et al., 2020).
Containment and mitigation measures in Germany, Switzerland and Netherland were social distancing, self-isolation, movement restriction/travel and prohibition of mass gathering (Wikipedia, 2020b;Joachimet al., 2020;The Federal Council of Swiss Governmenmt, 2020;Salathe, 2020;Government of The Netherland, 2020).
In Eastern Mediterranean Region and Region of Americas, containment and mitigation measures in COVID-19 transmission control adopted in Bahrain and USA, were self-isolation, social distance, movement restriction/travel and prohibition of mass gathering ( Gardaworld, 2020;Peak et al., 2020;Berger et al., 2020;Liu, 2020).
In addition, USA added screening and the partial lockdown as an extra control measure. While, in Canada, containment and mitigation measures in COVID-19 transmission control were self-isolation, social distance, movement restriction/travel, and prohibition of mass gathering (Public Health Agency Canada, 2020a; Public Health Agency Canada, 2020b) . In Brazil, containment and mitigation measures in COVID-19 transmission control were self-isolation, movement restriction/travel, partial lockdown and prohibition of mass gathering (Albuquerque, 2020) (Table 1).
-681- After more than one month of the containment and mitigation control measures taken, most of the countries managed to reduce the COVID-19 cases from spreading in the communities (WHO, 2019a). The five most successful countries that managed to control this pandemic were Hong Kong, followed by South Korea, Australia, Austria and Switzerland. Meanwhile, The USA, Brazil, United Kingdom, Singapore and Philippines are the countries still unable to significantly reduce the cases although the control measures had been implemented in the countries since the detection of first case of COVID-19 in their countries (WHO, 2019a) ( Table 2).

Discussion
This study investigated the effectiveness of different containment and mitigation control measures of COVID-19 from 21 affected countries. To the best of our knowledge, this is the first scoping review reporting types of containment and mitigation measures to control the current pandemic of COVID-19. All the affected countries highlighted in this article have already implemented community containment and mitigation measures. If these measures were executed effectively, it may prevent the transmission of the cases in the communities and hence flattening the pandemic (Anderson et al., 2020). However, this scoping review results revealed that only a few countries managed to significantly reduce the cases whereas other countries could not show a clear impact or even no effect on reducing the confirmed cases (WHO, 2019a). Hong Kong and South Korea have successfully fought COVID-19 by effectively adopting containment and mitigation measures (Power, 2020;Duddu, 2020). While, Brazil and USA are the two countries still struggling to contain the epidemic (Peak, 2020;Berger, 2020;Liu, 2020;Albuquerque, 2020;Modeste et al., 2020).
In Hong Kong, the country's first case was confirmed on 23 January 2020 (WHO, 2019b) leading the government to declare the viral epidemic two days after the first cases was detected (Duddu, 2020). The government quickly implemented the containment and mitigation measures such as partially lockdown of amusement parks, leisure/cultural facilities, schools, and universities (Duddu, 2020;Kin-Wa, 2020). The screening was conducted among the people crossing the border and the surveillance was done within the city. Close contacts of infected people were tracked down, and quarantine centers were identified to ensure self-isolation of suspected cases.
Visitors coming from infected countries were required to undergo a compulsory 14 days of quarantine and wear a tracking band and practicing some degree of social distancing (Duddu, 2020;Sataline, 2020). A current survey found that majority of respondents (85%) avoided crowded places. While, almost all of them (100%) used face masks when leaving home and adhered firmly to the government advisories on social distancing norms (Gupta, 2020). As a result, the social distancing effort, isolating ill people at home, tracking a nd quarantine those exposed to the sick, closing schools, work-at-home measures, closing public meeting places seems to have trimmed the illness' rampage among the population in Hong Kong (Duddu, 2020;Sataline, 2020;Gupta, 2020).
In South Korea, the confirmed cases among the members of the religious organization in Daegu has triggering a drastic escalation of cases in the country (Power, 2020;Wikipedia, 2020c). No cities were under lockdown but several measures were taken by the government to control the spreading the disease such as imposed travel restrictions to and from South Korea, extensive screening with confirmed cases being hospitalized at the COVID-19 special facilities. While, those without symptoms are required to self-quarantined for 14 days (Power, 2020).
The cases phones and credit card data are used to trace their prior movements and find their contacts (Wikipedia, 2020c). Furthermore, populations are encouraged to wear masks, wash their hands, avoid crowds, always work remotely and practice social distancing to prevent further infection (Ahn, 2020). The government focuses on extensive screening for the disease and used technology for promptly tracking and isolation of infected people resulted the cases have dropped sharply in South Korea (Normile, 2020).
In Brazil, the government has implemented containment and mitigation strategies to slow the transmission of COVID-19 by restricting social contacts, self-isolation, partial lockdown of non-essential facilities, movement restriction and prohibition of gathering in several municipalities 52 . Although the government has launched the control measures aggressively. The numbers of COVID-19 cases still increase exponentially and it is believed that the actual numbers of confirmed cases are far higher than government official figure as the government is only screening people who end up in the hospital (WHO, 2019b).
A larger reduction of the confirmed cases can be achieved if the federal government, states, municipalities, and the population strictly followed the instructions of interventions related to social contacts, behavioral changes, improvement on public health and health care system (Requia et al., 2020). In addition, the impact of the spread of the COVID-19 can be further reduced if the country's started intensive screening capacity on its population (Watson, 2020).
The first COVID-19 case in the USA was confirmed on 20 January 2020 and the government declared a public health emergency on 31 January 2020 (Liu, 2020). In response to the global outbreak, the Federal government and public health partners were implementing aggressive measures to slow and contain transmission of COVID-19 in the USA such as travel restrictions, closing of businesses/schools/universities, complete suspension of sports leagues, imposed "stay at home" quarantines on their population to stem the spread and expanding the screening (but the number of available test kits were still limited) (Wikipedia, 2020c). In addition, The Centers for Disease Control and Prevention (CDC) staff members were working with state, local, tribal, and territorial health departments and other public health authorities to assist with case identification, contact tracing, and medical management of cases (Jernigan, 2020). However, the initial government response to the pandemic was otherwise slow causing the disease to increase exponentially and by the end of March, COVID-19 cases had spread to all 50 states and became the leading country in the number of cases worldwide (Peak, 2020). Lastly, the lack of available screening has been a major setback for the USA and has prevented the country from getting ahead of the pandemic (Jernigan, 2020).
According to WHO, the issue of affected countries is no longer about epidemic prevention but about virus containment and mitigation. Slowing down the spread to manageable levels will help medical staff to provide adequate care to infected patients and maintain social order (Ren et al., 2020). Appropriate action in individual communities and countries can benefit the entire world. These approaches are used to minimize the infection rate and deaths caused by COVID-19. Everyone plays an important role for the success of the containment and mitigation strategies. The failure to take this matter seriously will result in the countries unable to successfully flattening the curve of COVID-19 (Gupta, 2020;Normile, 2020). Until a cure or vaccine is found, everyone should play their part in reducing the spread of COVID-19. The delayed in implementation control measures represents a missed opportunity to diminish further the transmission of the COVID-19 and lower compliance increases the opportunity for personto-person transmission .
The limitations of this scoping review should be noted. First, studies written in languages other than English were excluded. Thus, we are unable to claim to have captured the full breadth of the field as the intent of scoping reviews. Second, we did not systematically assess the scientific rigor of our literature sample especially the weaknesses of the press release and report articles. Therefore, further research and systematic investigation are warranted. However, the significance of this scoping review is its potential to highlight the importance of various containment and mitigation measures used in the affected countries to control or reduce the COVID-19 cases. This scoping review has provided a broad overview of containment and mitigation measures used in COVID-19 transmission control from the affected countries which can be adopted by other countries in the management of COVID-19.

IV. Conclusion
This review revealed all countries affected by the COVID-19 had implemented multiple containment and mitigation measures to reduce the impact of the disease. Thus, making it difficult to measure the effectiveness of each individual method. A combination of multiple control measures is necessary, since this could increase the success in reducing the transmission of the COVID-19 disease. In addition, the aggressiveness of government efforts and the compliance among the population are the main factors for the effectiveness of the containment and mitigation measures implemented. Even the best prepared government may not be able to overcome this crisis without the participation of their populations. Thus, efforts should be directed at the creation of standard guidelines to improve the containment and mitigation efforts, considering the characteristics of the virus and community acceptance.