Cordon sanitaire, a necessary evil? Evaluation of non-pharmacological interventions against COVID-19 in Ovar, Portugal
Keywords:
COVID-19, Portugal, public health, Disease Outbreaks, Delivery of Health CareAbstract
Background and aim: From March 17 to April 17, 2020, the Portuguese municipality of Ovar was submitted to a cordon sanitaire due to a COVID-19 outbreak. During this period a whole Public Health structure had to be built up to respond to the healthcare needs of the population. The aim of this work is to contribute to the evidence on the efficacy of cordon sanitaire as an epidemic control strategy. Methods: All the major institutions in Ovar, both health and socially related, were called from the first day to form a Crisis Cabinet. Case tracking was assured by the creation of an online database. A major telephone network oversaw contact tracing, isolation mandates and surveillance. A massive testing structure was built up, and clinical assistance was assured by the local hospital and the Primary Care units. Patient referral to testing and clinical visits were made through online forms that allowed an efficient response and data for epidemiologic research. Results: A decline in the daily number of cases was seen after an incubation period (14 days), confirming lockdown was effective in blocking transmission chains. Besides, neighbouring municipalities were not significantly affected in relation to others. Lethality was bigger in Ovar than in whole Portugal. Conclusions: The decrease in the incidence, in the reproductive number and the non-affection of neighbouring municipalities appear to prove the cordon sanitaire as an effective Public Health measure to contain epidemics. However, an appropriate mitigation strategy must be adopted to conceal the challenge.
References
Resolução do Conselho de Ministros 10-D/2020, 2020-03-19 [Internet]. Diário da República Eletrónico. Available at: https://dre.pt/web/guest/pesquisa/-/search/130413790/details/normal?q=cerca+sanit%C3%A1ria+ovar
Decreto do Presidente da República 14-A/2020, 2020-03-18 – DRE. Available at: https://dre.pt/pesquisa/-/search/130399862/details/maximized
Salas-Vives P, Pujadas-Mora J-M. Cordons Sanitaires and the Rationalisation Process in Southern Europe (Nineteenth-Century Majorca). Med Hist Jul 2018;62(3):314–32.
Bondy SJ, Russell ML, Laflèche JM, Rea E. Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine. BMC Public Health 24 Dec 2009; 9:488.
Pandey A, Atkins KE, Medlock J, Wenzel N, Townsend JP, Childs JE, et al. Strategies for containing Ebola in West Africa. Science 21 Nov 2014;346(6212):991–5.
Pontes D. O cerco da peste no Porto: Cidade, imprensa e saúde pública na crise sanitária de 1899. [Porto]: Universidade do Porto 2012.
Moore CB. Ebola, quarantine, and the need for a new ethical framework. J Med Ethics Hist Med 2020; 13:9.
Wynia MK. Ethics and public health emergencies: restrictions on liberty. Am J Bioeth Feb 2007;7(2):1–5.
Espinoza B, Castillo-Chavez C, Perrings C. Mobility restrictions for the control of epidemics: When do they work? Bauch CT, editor. PLoS One 6 Jul 2020;15(7):e0235731.
Pellecchia U, Crestani R, Decroo T, Van den Bergh R, Al-Kourdi Y. Social Consequences of Ebola Containment Measures in Liberia. PloS One 2015;10(12):e0143036.
Lai S, Ruktanonchai NW, Zhou L, Prosper O, Luo W, Floyd JR, et al. Effect of non-pharmaceutical interventions to contain COVID-19 in China. Nature Sep 2020;585(7825):410–3.
Wan KH, Huang SS, Ko C-N, Lam DSC. The end of ‘cordon sanitaire’ in Wuhan: the role of non-pharmaceutical interventions against COVID-19. Public Health Aug 2020; 185:6–7.
INE - Plataforma de divulgação dos Censos 2021 – Resultados Preliminares. Available at: https://www.ine.pt/scripts/db_censos_2021.html
Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med 5 May 2020; 172(9):577–82.
Borges V, Isidro J, Cortes-Martins H, Duarte S, Vieira L, Leite R, et al. Massive dissemination of a SARS-CoV-2 Spike Y839 variant in Portugal. Emerg Microbes Infect 1 Jan 2020; 9(1):2488–96.
Direção Geral de Saúde. FASE DE MITIGAÇÃO – Abordagem do Doente com Suspeita ou Infeção por SARS-CoV-2 2020. Available at: https://covid19.min-saude.pt/normas/
Sá R, Pinho-Bandeira T, Queiroz G, Matos J, Ferreira JD, Rodrigues PP. COVID-19 and Its Symptoms’ Panoply: A Case-Control Study of 919 Suspected Cases in Locked-Down Ovar, Portugal. Port J Public Health 2020; 38(3):151–8.
Clara A, Dao ATP, Tran Q, Tran PD, Dang TQ, Nguyen HT, et al. Testing early warning and response systems through a full-scale exercise in Vietnam. BMC Public Health 26
Downloads
Published
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
