Pre-Emptive Low Cost Social Distancing and Enhanced Hygiene Implemented before Local COVID-19 Transmission Could Decrease the Number and Severity of Cases.

China appears to have constrained transmission of COVID-19 outside of Hubei Provence through rapid and intensive containment and mitigation interventions. Most countries only attempt social distancing and hygiene interventions when widespread transmission is apparent. This gives the virus many weeks to spread with a higher basic reproduction number (R0) than if they were in place before transmission was detected or widespread. Pre-emptive, low cost, hygiene enhancement and social distancing in the context of imminent community transmission of novel coronavirus COVID-19 should be considered. Early interventions to reduce the average frequency and intensity of exposure to the virus might reduce infection risk, reduce the average viral infectious dose of those exposed, and result in less severe cases who are less infectious. A pre-emptive phase would also assist government, workplaces, schools, and businesses to prepare for a more stringent phase. Countries, and subregions of countries, without recognised COVID-19 transmission should assume it is present and consider implementation of low cost enhanced hygiene and social distancing measures.Funding: No funding was required or provided for this research. Declaration of Interest: The authors have no conflict of interests to declare.