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In this blog post, Jennifer Sargent, Handling Editor for at Nature Medicine shares why this paper was important.

Before the development and authorisation of COVID vaccines, the only available weapons against the spread of SARS-CoV-2 in the public health armory were non-pharmaceutical inventions (NPIs). These included wearing face masks, social distancing and closures of schools and workplaces for non-essential professionals who could work from home. Globally, implementation of NPIs required strong governance and their broad application in many countries was generally accepted by the public. But in some societies their usefulness and blanket application was (and continues to be) questioned, and in some cases, protested. We, as an editorial team, felt that recruiting and publishing studies demonstrating the potential of NPIs to help to curb the spread of COVID was therefore a high priority for the journal.

The study by the Institute for Health Metrics and Evaluation (IHME) COVID-19 Forecasting Team was published by Nature Medicine in October 2020. The study used COVID-19 mortality and case data from the first 8 months of the pandemic combined with a mathematical modelling approach to simulate a range of future scenarios with different levels of implementation of NPIs at the state-level across the US.

Scenario modelling

To demonstrate the effectiveness of NPIs, the authors felt that it was important to show how many lives could potentially be saved in the US with the use of NPIs and what might happen if the pandemic were to be left unchecked to spread through the nation. The different models included a business-as-usual scenario, in which projections of case numbers and mortality were based on the current levels of NPI implementation by state were retained. This baseline scenario was then compared with scenarios modelling increasing stringency of mask usage, testing for SARS-CoV-2 infections and social distancing mandates and mobility.

A mandate-easing scenario (a doomsday scenario) was also modelled to demonstrate the effects of lifting NPI-based restrictions, as was occurring in many states at the time of analysis and publication. The outcomes assessed were number of SARS-CoV-2 infections, deaths and hospital demands (specifically intensive care units) forecast out to February 2021. The authors reported that as many as 511,373 COVID-related deaths across the USA might occur by the end of winter if mandates were eased as of September 2020; however, if mask usage was increased to 95% (the highest level of compliance observed globally) then up to an additional 134,925 lives could be saved through the end of February 2021.

Timely editorial action

The editorial team at Nature Medicine felt that these data were important to have reviewed and disseminated quickly, particularly as NPI mandates—notably mask usage policies—became a central issue through the pandemic and into the lead up to the US Presidential elections in November 2020. The urgency of the policy implications of the findings prompted the authors to make their preliminary projections publicly available on the IHME website. Director of the IHME, Professor Chris Murray, and his team reached out to both the Trump and Biden campaigns to help each develop their COVID-19 policies and election commitments. The paper was published prior to the elections and formed the basis of US President-elect Joe Biden’s December request to the American public to don masks for the first 100 days of his presidency.

Commitment to expedite research

Throughout the pandemic, Nature Medicine has fulfilled our commitment as a part of Pվ��Ƶ’s compliance with the , requiring authors to post a preprint of their work when it is submitted and to share drafts of articles under peer review with the World Health Organisation (WHO). We also committed to our authors working on pandemic research to expedite the peer review and publication process of relevant papers. From the time of submission to publication, I worked closely with the authors from IHME to ensure that reviewer and editorial feedback was sufficiently addressed, as well as help the authors relay their findings to a broad readership that extends beyond the scientific and medical communities. In the course of the authors’ revision and our in-house edit, we paid special attention to nuancing the language and terminology in the paper, replacing terms such as “mandate” or “impose” with “apply” and “implement,” recognising the need for the data to be more readily accessible to the general public and in particular to communities in which there may have been resistance to accepting NPI guidelines. Due to the rapid pace of pandemic research and the speed at which SARS-CoV-2 was transmitted globally, we also had the authors update the data in the paper to the most recent available immediately prior to publication. The findings from this study continue to inform the US pandemic response at national and state levels as the authors provide live updates to the model on their , which continue to suggest that masks and other NPIs will continue to play an important role in curbing SARS-CoV-2 transmission, even on a background of national COVID-19 vaccination rollouts.

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