Effectiveness of non-pharmaceutical interventions to contain COVID-19: a case study of the 2020 spring pandemic wave in New York City

As COVID-19 continues to pose significant public health threats, quantifying the effectiveness of different public health interventions is crucial to inform intervention strategies. Using detailed epidemiological and mobility data available for New York City and comprehensive modelling accounting for under-detection, we reconstruct the COVID-19 transmission dynamics therein during the 2020 spring pandemic wave and estimate the effectiveness of two major non-pharmaceutical interventions—lockdown-like measures that reduce contact rates and universal masking. Lockdown-like measures were associated with greater than 50% transmission reduction for all age groups. Universal masking was associated with an approximately 7% transmission reduction overall and up to 20% reduction for 65+ year olds during the first month of implementation. This result suggests that face covering can substantially reduce transmission when lockdown-like measures are lifted but by itself may be insufficient to control SARS-CoV-2 transmission. Overall, findings support the need to implement multiple interventions simultaneously to effectively mitigate COVID-19 spread before the majority of population can be protected through mass-vaccination.     

Integrated vaccination and non-pharmaceutical interventions based strategies in Ontario,Canada, as a case study: a mathematical modelling study

Recently, two coronavirus disease 2019 (COVID-19) vaccine products have been authorized in Canada. It is of crucial importance to model an integrated/combined package of non-pharmaceutical (physical/social distancing) and pharmaceutical (immunization) public health control measures. A modified epidemiological, compartmental SIR model was used and fit to the cumulative COVID-19 case data for the province of Ontario, Canada, from 8 September 2020 to 8 December 2020. Different vaccine roll-out strategies were simulated until 75% of the population was vaccinated, including a no-vaccination scenario. We compete these vaccination strategies with relaxation of non-pharmaceutical interventions. Non-pharmaceutical interventions were supposed to remain enforced and began to be relaxed on 31 January, 31 March or 1 May 2021. Based on projections from the data and long-term extrapolation of scenarios, relaxing the public health measures implemented by re-opening too early would cause any benefits of vaccination to be lost by increasing case numbers, increasing the effective reproduction number above 1 and thus increasing the risk of localized outbreaks. If relaxation is, instead, delayed and 75% of the Ontarian population gets vaccinated by the end of the year, re-opening can occur with very little risk. Relaxing non-pharmaceutical interventions by re-opening and vaccine deployment is a careful balancing act. Our combination of model projections from data and simulation of different strategies and scenarios, can equip local public health decision- and policy-makers with projections concerning the COVID-19 epidemiological trend, helping them in the decision-making process.     

A simple criterion to design optimal non-pharmaceutical interventions for mitigating epidemic outbreaks

For mitigating the COVID-19 pandemic, much emphasis is made on implementing non-pharmaceutical interventions to keep the reproduction number below one. However, using that objective ignores that some of these interventions, like bans of public events or lockdowns, must be transitory and as short as possible because of their significant economic and societal costs. Here, we derive a simple and mathematically rigorous criterion for designing optimal transitory non-pharmaceutical interventions for mitigating epidemic outbreaks. We find that reducing the reproduction number below one is sufficient but not necessary. Instead, our criterion prescribes the required reduction in the reproduction number according to the desired maximum of disease prevalence and the maximum decrease of disease transmission that the interventions can achieve. We study the implications of our theoretical results for designing non-pharmaceutical interventions in 16 cities and regions during the COVID-19 pandemic. In particular, we estimate the minimal reduction of each region’s contact rate necessary to control the epidemic optimally. Our results contribute to establishing a rigorous methodology to design optimal non-pharmaceutical intervention policies for mitigating epidemic outbreaks.     

Effect of manual and digital contact tracing on COVID-19 outbreaks: a study on empirical contact data

Non-pharmaceutical interventions are crucial to mitigate the COVID-19 pandemic and contain re-emergence phenomena. Targeted measures such as case isolation and contact tracing can alleviate the societal cost of lock-downs by containing the spread where and when it occurs. To assess the relative and combined impact of manual contact tracing (MCT) and digital (app-based) contact tracing, we feed a compartmental model for COVID-19 with high-resolution datasets describing contacts between individuals in several contexts. We show that the benefit (epidemic size reduction) is generically linear in the fraction of contacts recalled during MCT and quadratic in the app adoption, with no threshold effect. The cost (number of quarantines) versus benefit curve has a characteristic parabolic shape, independent of the type of tracing, with a potentially high benefit and low cost if app adoption and MCT efficiency are high enough. Benefits are higher and the cost lower if the epidemic reproductive number is lower, showing the importance of combining tracing with additional mitigation measures. The observed phenomenology is qualitatively robust across datasets and parameters. We moreover obtain analytically similar results on simplified models.     

A Scenario-Based Evaluation of COVID-19-Related Essential Clinical Resource Demands in China

The coronavirus disease 2019 (COVID-19) pandemic is a global crisis, and medical systems in many countries are overwhelmed with supply shortages and increasing demands to treat patients due to the surge in cases and severe illnesses. This study aimed to assess COVID-19-related essential clinical resource demands in China, based on different scenarios involving COVID-19 spreads and interventions. We used a susceptible–exposed–infectious–hospitalized/isolated–removed (SEIHR) transmission dynamics model to estimate the number of COVID-19 infections and hospitalizations with corresponding essential healthcare resources needed. We found that, under strict non-pharmaceutical interventions (NPIs) or mass vaccination of the population, China would be able to contain community transmission and local outbreaks rapidly. However, under scenarios involving a low intensity of implemented NPIs and a small proportion of the population vaccinated, the use of a peacetime–wartime transition model would be needed for medical source stockpiles and preparations to ensure a normal functioning healthcare system. The implementation of COVID-19 vaccines and NPIs in different periods can influence the transmission of COVID-19 and subsequently affect the demand for clinical diagnosis and treatment. An increased proportion of asymptomatic infections in simulations will not reduce the demand for medical resources; however, attention must be paid to the increasing difficulty in containing COVID-19 transmission due to asymptomatic cases. This study provides evidence for emergency preparations and the adjustment of prevention and control strategies during the COVID-19 pandemic. It also provides guidance for essential healthcare investment and resource allocation.     

Modelling the impact of household size distribution on the transmission dynamics of COVID-19

Under the implementation of non-pharmaceutical interventions such as social distancing and lockdowns, household transmission has been shown to be significant for COVID-19, posing challenges for reducing incidence in settings where people are asked to self-isolate at home and to spend increasing amounts of time at home due to distancing measures. Accordingly, characteristics of households in a region have been shown to relate to transmission heterogeneity of the virus. We introduce a discrete-time stochastic epidemiological model to examine the impact of the household size distribution in a region on the transmission dynamics. We choose parameters to reflect incidence in two health regions of the Greater Vancouver area in British Columbia and simulate the impact of distancing measures on transmission, with household size distribution the only different parameter between simulations for the two regions. Our result suggests that the dissimilarity in household size distribution alone can cause significant differences in incidence of the two regions, and the distributions drive distinct dynamics that match reported cases. Furthermore, our model suggests that offering individuals a place to isolate outside their household can speed the decline in cases, and does so more effectively where there are more larger households.     

Strategies and Advances in Combating COVID-19 in China

Coronavirus disease 2019 (COVID-19)—the third in a series of coronavirus infections—has caused a global public health event in the 21st century, resulting in substantial global morbidity and mortality. Building on its legacy of managing severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), China has played a key role in the scientific community by revealing the viral transmission routes and clinical characteristics of COVID-19 and developing novel therapeutic interventions and vaccines. Despite these rapid scientific and technological advances, uncertainties remain in tracing the original sources of infection, determining the routes of transmission and pathogenesis, and addressing the lack of targeted clinical management of COVID-19. Here, we summarize the major COVID-19 research advances in China in order to provide useful information for global pandemic control.     

Socio-economic determinants of mobility responses during the first wave of COVID-19 in Italy: from provinces to neighbourhoods

After more than 1 year into the COVID-19 pandemic, governments worldwide still face the challenge of adopting non-pharmaceutical interventions to mitigate the risks posed by the emergence of new SARS-CoV-2 variants and the lack of a worldwide equitable vaccine allocation. Thus, it becomes crucial to identify the drivers of mobility responses to mitigation efforts during different restriction regimes, for planning interventions that are both economically and socially sustainable while effective in controlling an outbreak. Here, using anonymous and privacy-enhanced cell phone data from Italy, we investigate the determinants of spatial variations of reductions in mobility and co-location in response to the adoption and the lift of restrictions, considering both provinces and city neighbourhoods. In large urban areas, our analysis uncovers the desertification of historic city centres, which persisted after the end of the lockdown. Such centre-periphery gradient was mainly associated with differences in educational attainment. At the province level, the local structure of the labour market mainly explained the variations in mobility responses, together with other demographic factors, such as the population’s age and sex composition. In the future, targeted interventions should take into account how the ability to comply with restrictions varies across geographical areas and socio-demographic groups.     

Modelling preventive measures and their effect on generation times in emerging epidemics

We present a stochastic epidemic model to study the effect of various preventive measures, such as uniform reduction of contacts and transmission, vaccination, isolation, screening and contact tracing, on a disease outbreak in a homogeneously mixing community. The model is based on an infectivity process, which we define through stochastic contact and infectiousness processes, so that each individual has an independent infectivity profile. In particular, we monitor variations of the reproduction number and of the distribution of generation times. We show that some interventions, i.e. uniform reduction and vaccination, affect the former while leaving the latter unchanged, whereas other interventions, i.e. isolation, screening and contact tracing, affect both quantities. We provide a theoretical analysis of the variation of these quantities, and we show that, in practice, the variation of the generation time distribution can be significant and that it can cause biases in the estimation of reproduction numbers. The framework, because of its general nature, captures the properties of many infectious diseases, but particular emphasis is on COVID-19, for which numerical results are provided.     

Intelligent Decision Support System for COVID-19 Empowered with Deep Learning

The prompt spread of Coronavirus (COVID-19) subsequently adorns a big threat to the people around the globe. The evolving and the perpetually diagnosis of coronavirus has become a critical challenge for the healthcare sector. Drastically increase of COVID-19 has rendered the necessity to detect the people who are more likely to get infected. Lately, the testing kits for COVID-19 are not available to deal it with required proficiency, along with-it countries have been widely hit by the COVID-19 disruption. To keep in view the need of hour asks for an automatic diagnosis system for early detection of COVID-19. It would be a feather in the cap if the early diagnosis of COVID-19 could reveal that how it has been affecting the masses immensely. According to the apparent clinical research, it has unleashed that most of the COVID-19 cases are more likely to fall for a lung infection. The abrupt changes do require a solution so the technology is out there to pace up, Chest X-ray and Computer tomography (CT) scan images could significantly identify the preliminaries of COVID-19 like lungs infection. CT scan and X-ray images could flourish the cause of detecting at an early stage and it has proved to be helpful to radiologists and the medical practitioners. The unbearable circumstances compel us to flatten the curve of the sufferers so a need to develop is obvious, a quick and highly responsive automatic system based on Artificial Intelligence (AI) is always there to aid against the masses to be prone to COVID-19. The proposed Intelligent decision support system for COVID-19 empowered with deep learning (ID2S-COVID19-DL) study suggests Deep learning (DL) based Convolutional neural network (CNN) approaches for effective and accurate detection to the maximum extent it could be, detection of coronavirus is assisted by using X-ray and CT-scan images. The primary experimental results here have depicted the maximum accuracy for training and is around 98.11 percent and for validation it comes out to be approximately 95.5 percent while statistical parameters like sensitivity and specificity for training is 98.03 percent and 98.20 percent respectively, and for validation 94.38 percent and 97.06 percent respectively. The suggested Deep Learning-based CNN model unleashed here opts for a comparable performance with medical experts and it is helpful to enhance the working productivity of radiologists. It could take the curve down with the downright contribution of radiologists, rapid detection of COVID-19, and to overcome this current pandemic with the proven efficacy.     

Assessing the Effect of Global Travel and Contact Restrictions on Mitigating the COVID-19 Pandemic

Travel restrictions and physical distancing have been implemented across the world to mitigate the coronavirus disease 2019 (COVID-19) pandemic, but studies are needed to understand their effectiveness across regions and time. Based on the population mobility metrics derived from mobile phone geolocation data across 135 countries or territories during the first wave of the pandemic in 2020, we built a metapopulation epidemiological model to measure the effect of travel and contact restrictions on containing COVID-19 outbreaks across regions. We found that if these interventions had not been deployed, the cumulative number of cases could have shown a 97-fold (interquartile range 79–116) increase, as of May 31, 2020. However, their effectiveness depended upon the timing, duration, and intensity of the interventions, with variations in case severity seen across populations, regions, and seasons. Additionally, before effective vaccines are widely available and herd immunity is achieved, our results emphasize that a certain degree of physical distancing at the relaxation of the intervention stage will likely be needed to avoid rapid resurgences and subsequent lockdowns.     

An Efficient CNN-Based Hybrid Classification and Segmentation Approach for COVID-19 Detection

COVID-19 remains to proliferate precipitously in the world. It has significantly influenced public health, the world economy, and the persons’ lives. Hence, there is a need to speed up the diagnosis and precautions to deal with COVID-19 patients. With this explosion of this pandemic, there is a need for automated diagnosis tools to help specialists based on medical images. This paper presents a hybrid Convolutional Neural Network (CNN)-based classification and segmentation approach for COVID-19 detection from Computed Tomography (CT) images. The proposed approach is employed to classify and segment the COVID-19, pneumonia, and normal CT images. The classification stage is firstly applied to detect and classify the input medical CT images. Then, the segmentation stage is performed to distinguish between pneumonia and COVID-19 CT images. The classification stage is implemented based on a simple and efficient CNN deep learning model. This model comprises four Rectified Linear Units (ReLUs), four batch normalization layers, and four convolutional (Conv) layers. The Conv layer depends on filters with sizes of 64, 32, 16, and 8. A 2 × 2 window and a stride of 2 are employed in the utilized four max-pooling layers. A soft-max activation function and a Fully-Connected (FC) layer are utilized in the classification stage to perform the detection process. For the segmentation process, the Simplified Pulse Coupled Neural Network (SPCNN) is utilized in the proposed hybrid approach. The proposed segmentation approach is based on salient object detection to localize the COVID-19 or pneumonia region, accurately. To summarize the contributions of the paper, we can say that the classification process with a CNN model can be the first stage a highly-effective automated diagnosis system. Once the images are accepted by the system, it is possible to perform further processing through a segmentation process to isolate the regions of interest in the images. The region of interest can be assesses both automatically and through experts. This strategy helps so much in saving the time and efforts of specialists with the explosion of COVID-19 pandemic in the world. The proposed classification approach is applied for different scenarios of 80%, 70%, or 60% of the data for training and 20%, 30, or 40% of the data for testing, respectively. In these scenarios, the proposed approach achieves classification accuracies of 100%, 99.45%, and 98.55%, respectively. Thus, the obtained results demonstrate and prove the efficacy of the proposed approach for assisting the specialists in automated medical diagnosis services.     

Developing a Recognition System for Classifying COVID-19 Using a Convolutional Neural Network Algorithm

The COVID-19 pandemic poses an additional serious public health threat due to little or no pre-existing human immunity, and developing a system to identify COVID-19 in its early stages will save millions of lives. This study applied support vector machine (SVM), k-nearest neighbor (K-NN) and deep learning convolutional neural network (CNN) algorithms to classify and detect COVID-19 using chest X-ray radiographs. To test the proposed system, chest X-ray radiographs and CT images were collected from different standard databases, which contained 95 normal images, 140 COVID-19 images and 10 SARS images. Two scenarios were considered to develop a system for predicting COVID-19. In the first scenario, the Gaussian filter was applied to remove noise from the chest X-ray radiograph images, and then the adaptive region growing technique was used to segment the region of interest from the chest X-ray radiographs. After segmentation, a hybrid feature extraction composed of 2D-DWT and gray level co-occurrence matrix was utilized to extract the features significant for detecting COVID-19. These features were processed using SVM and K-NN. In the second scenario, a CNN transfer model (ResNet 50) was used to detect COVID-19. The system was examined and evaluated through multiclass statistical analysis, and the empirical results of the analysis found significant values of 97.14%, 99.34%, 99.26%, 99.26% and 99.40% for accuracy, specificity, sensitivity, recall and AUC, respectively. Thus, the CNN model showed significant success; it achieved optimal accuracy, effectiveness and robustness for detecting COVID-19.     

Automated contact tracing: a game of big numbers in the time of COVID-19

One of the more widely advocated solutions for slowing down the spread of COVID-19 has been automated contact tracing. Since proximity data can be collected by personal mobile devices, the natural proposal has been to use this for automated contact tracing providing a major gain over a manual implementation. In this work, we study the characteristics of voluntary and automated contact tracing and its effectiveness for mapping the spread of a pandemic due to the spread of SARS-CoV-2. We highlight the infrastructure and social structures required for automated contact tracing to work. We display the vulnerabilities of the strategy to inadequate sampling of the population, which results in the inability to sufficiently determine significant contact with infected individuals. Of crucial importance will be the participation of a significant fraction of the population for which we derive a minimum threshold. We conclude that relying largely on automated contact tracing without population-wide participation to contain the spread of the SARS-CoV-2 pandemic can be counterproductive and allow the pandemic to spread unchecked. The simultaneous implementation of various mitigation methods along with automated contact tracing is necessary for reaching an optimal solution to contain the pandemic.     

Deciphering early-warning signals of SARS-CoV-2 elimination and resurgence from limited data at multiple scales

Inferring the transmission potential of an infectious disease during low-incidence periods following epidemic waves is crucial for preparedness. In such periods, scarce data may hinder existing inference methods, blurring early-warning signals essential for discriminating between the likelihoods of resurgence versus elimination. Advanced insight into whether elevating caseloads (requiring swift community-wide interventions) or local elimination (allowing controls to be relaxed or refocussed on case-importation) might occur can separate decisive from ineffective policy. By generalizing and fusing recent approaches, we propose a novel early-warning framework that maximizes the information extracted from low-incidence data to robustly infer the chances of sustained local transmission or elimination in real time, at any scale of investigation (assuming sufficiently good surveillance). Applying this framework, we decipher hidden disease-transmission signals in prolonged low-incidence COVID-19 data from New Zealand, Hong Kong and Victoria, Australia. We uncover how timely interventions associate with averting resurgent waves, support official elimination declarations and evidence the effectiveness of the rapid, adaptive COVID-19 responses employed in these regions.     

Modelling and predicting the effect of social distancing and travel restrictions on COVID-19 spreading

To date, the only effective means to respond to the spreading of the COVID-19 pandemic are non-pharmaceutical interventions (NPIs), which entail policies to reduce social activity and mobility restrictions. Quantifying their effect is difficult, but it is key to reducing their social and economic consequences. Here, we introduce a meta-population model based on temporal networks, calibrated on the COVID-19 outbreak data in Italy and applied to evaluate the outcomes of these two types of NPIs. Our approach combines the advantages of granular spatial modelling of meta-population models with the ability to realistically describe social contacts via activity-driven networks. We focus on disentangling the impact of these two different types of NPIs: those aiming at reducing individuals’ social activity, for instance through lockdowns, and those that enforce mobility restrictions. We provide a valuable framework to assess the effectiveness of different NPIs, varying with respect to their timing and severity. Results suggest that the effects of mobility restrictions largely depend on the possibility of implementing timely NPIs in the early phases of the outbreak, whereas activity reduction policies should be prioritized afterwards.     

Buying Time for an Effective Epidemic Response: The Impact of a Public Holiday for Outbreak Control on COVID-19 Epidemic Spread

Rapid responses in the early stage of a new epidemic are crucial in outbreak control. Public holidays for outbreak control could provide a critical time window for a rapid rollout of social distancing and other control measures at a large population scale. The objective of our study was to explore the impact of the timing and duration of outbreak-control holidays on the coronavirus disease 2019 (COVID-19) epidemic spread during the early stage in China. We developed a compartment model to simulate the dynamic transmission of COVID-19 in China starting from January 2020. We projected and compared epidemic trajectories with and without an outbreak-control holiday that started during the Chinese Lunar New Year. We considered multiple scenarios of the outbreak-control holiday with different durations and starting times, and under different assumptions about viral transmission rates. We estimated the delays in days to reach certain thresholds of infections under different scenarios. Our results show that the outbreak-control holiday in China likely stalled the spread of COVID-19 for several days. The base case outbreak-control holiday (21 d for Hubei Province and 10 d for all other provinces) delayed the time to reach 100 000 confirmed infections by 7.54 d. A longer outbreak-control holiday would have had stronger effects. A nationwide outbreak-control holiday of 21 d would have delayed the time to 100 000 confirmed infections by nearly 10 d. Furthermore, we find that outbreak-control holidays that start earlier in the course of a new epidemic are more effective in stalling epidemic spread than later holidays and that additional control measures during the holidays can boost the holiday effect. In conclusion, an outbreak-control holiday can likely effectively delay the transmission of epidemics that spread through social contacts. The temporary delay in the epidemic trajectory buys time, which scientists can use to discover transmission routes and identify effective public health interventions and which governments can use to build physical infrastructure, organize medical supplies, and deploy human resources for long-term epidemic mitigation and control efforts.     

Can Masks Be Reused After Hot Water Decontamination During the COVID-19 Pandemic?

Masks have become one of the most indispensable pieces of personal protective equipment and are important strategic products during the coronavirus disease 2019 (COVID-19) pandemic. Due to the huge mask demand–supply gap all over the world, the development of user-friendly technologies and methods is urgently needed to effectively extend the service time of masks. In this article, we report a very simple approach for the decontamination of masks for multiple reuse during the COVID-19 pandemic. Used masks were soaked in hot water at a temperature greater than 56 °C for 30 min, based on a recommended method to kill COVID-19 virus by the National Health Commission of the People’s Republic of China. The masks were then dried using an ordinary household hair dryer to recharge the masks with electrostatic charge to recover their filtration function (the so-called “hot water decontamination + charge regeneration” method). Three kinds of typical masks (disposable medical masks, surgical masks, and KN95-grade masks) were treated and tested. The filtration efficiencies of the regenerated masks were almost maintained and met the requirements of the respective standards. These findings should have important implications for the reuse of polypropylene masks during the COVID-19 pandemic. The performance evolution of masks during human wear was further studied, and a company (Zhejiang Runtu Co., Ltd.) applied this method to enable their workers to extend the use of masks. Mask use at the company was reduced from one mask per day per person to one mask every three days per person, and 122 500 masks were saved during the period from 20 February to 30 March 2020. Furthermore, a new method for detection of faulty masks based on the penetrant inspection of fluorescent nanoparticles was established, which may provide scientific guidance and technical methods for the future development of reusable masks, structural optimization, and the formulation of comprehensive performance evaluation standards.     

A multi-layer model for the early detection of COVID-19

Current COVID-19 screening efforts mainly rely on reported symptoms and the potential exposure to infected individuals. Here, we developed a machine-learning model for COVID-19 detection that uses four layers of information: (i) sociodemographic characteristics of the individual, (ii) spatio-temporal patterns of the disease, (iii) medical condition and general health consumption of the individual and (iv) information reported by the individual during the testing episode. We evaluated our model on 140 682 members of Maccabi Health Services who were tested for COVID-19 at least once between February and October 2020. These individuals underwent, in total, 264 516 COVID-19 PCR tests, out of which 16 512 were positive. Our multi-layer model obtained an area under the curve (AUC) of 81.6% when evaluated over all the individuals in the dataset, and an AUC of 72.8% when only individuals who did not report any symptom were included. Furthermore, considering only information collected before the testing episode—i.e. before the individual had the chance to report on any symptom—our model could reach a considerably high AUC of 79.5%. Our ability to predict early on the outcomes of COVID-19 tests is pivotal for breaking transmission chains, and can be used for a more efficient testing policy.