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.     

A data driven agent-based model that recommends non-pharmaceutical interventions to suppress Coronavirus disease 2019 resurgence in megacities

Before herd immunity against Coronavirus disease 2019 (COVID-19) is achieved by mass vaccination, science-based guidelines for non-pharmaceutical interventions are urgently needed to reopen megacities. This study integrated massive mobile phone tracking records, census data and building characteristics into a spatially explicit agent-based model to simulate COVID-19 spread among 11.2 million individuals living in Shenzhen City, China. After validation by local epidemiological observations, the model was used to assess the probability of COVID-19 resurgence if sporadic cases occurred in a fully reopened city. Combined scenarios of three critical non-pharmaceutical interventions (contact tracing, mask wearing and prompt testing) were assessed at various levels of public compliance. Our results show a greater than 50% chance of disease resurgence if the city reopened without contact tracing. However, tracing household contacts, in combination with mandatory mask use and prompt testing, could suppress the probability of resurgence under 5% within four weeks. If household contact tracing could be expanded to work/class group members, the COVID resurgence could be avoided if 80% of the population wear facemasks and 40% comply with prompt testing. Our assessment, including modelling for different scenarios, helps public health practitioners tailor interventions within Shenzhen City and other world megacities under a variety of suppression timelines, risk tolerance, healthcare capacity and public compliance.     

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.     

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.     

Analysis and Forecasting COVID-19 Outbreak in Pakistan Using Decomposition and Ensemble Model

COVID-19 has caused severe health complications and produced a substantial adverse economic impact around the world. Forecasting the trend of COVID-19 infections could help in executing policies to effectively reduce the number of new cases. In this study, we apply the decomposition and ensemble model to forecast COVID-19 confirmed cases, deaths, and recoveries in Pakistan for the upcoming month until the end of July. For the decomposition of data, the Ensemble Empirical Mode Decomposition (EEMD) technique is applied. EEMD decomposes the data into small components, called Intrinsic Mode Functions (IMFs). For individual IMFs modelling, we use the Autoregressive Integrated Moving Average (ARIMA) model. The data used in this study is obtained from the official website of Pakistan that is publicly available and designated for COVID-19 outbreak with daily updates. Our analyses reveal that the number of recoveries, new cases, and deaths are increasing in Pakistan exponentially. Based on the selected EEMD-ARIMA model, the new confirmed cases are expected to rise from 213,470 to 311,454 by 31 July 2020, which is an increase of almost 1.46 times with a 95% prediction interval of 246,529 to 376,379. The 95% prediction interval for recovery is 162,414 to 224,579, with an increase of almost two times in total from 100802 to 193495 by 31 July 2020. On the other hand, the deaths are expected to increase from 4395 to 6751, which is almost 1.54 times, with a 95% prediction interval of 5617 to 7885. Thus, the COVID-19 forecasting results of Pakistan are alarming for the next month until 31 July 2020. They also confirm that the EEMD-ARIMA model is useful for the short-term forecasting of COVID-19, and that it is capable of keeping track of the real COVID-19 data in nearly all scenarios. The decomposition and ensemble strategy can be useful to help decision-makers in developing short-term strategies about the current number of disease occurrences until an appropriate vaccine is developed.     

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.     

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.     

COVID-19 Vaccine Allocation: Modeling Health Outcomes and Equity Implications of Alternative Strategies

Given the scarcity of safe and effective COVID-19 vaccines, a chief policy question is how to allocate them among different sociodemographic groups. This paper evaluates COVID-19 vaccine prioritization strategies proposed to date, focusing on their stated goals; the mechanisms through which the selected allocations affect the course and burden of the pandemic; and the main epidemiological, economic, logistical, and political issues that arise when setting the prioritization strategy. The paper uses a simple, age-stratified susceptible–exposed–infectious–recovered model applied to the United States to quantitatively assess the performance of alternative prioritization strategies with respect to avoided deaths, avoided infections, and life-years gained. We demonstrate that prioritizing essential workers is a viable strategy for reducing the number of cases and years of life lost, while the largest reduction in deaths is achieved by prioritizing older adults in most scenarios, even if the vaccine is effective at blocking viral transmission. Uncertainty regarding this property and potential delays in dose delivery reinforce the call for prioritizing older adults. Additionally, we investigate the strength of the equity motive that would support an allocation strategy attaching absolute priority to essential workers for a vaccine that reduces infection-fatality risk.     

COVID-19 pandemic dynamics in India,the SARS-CoV-2 Delta variant and implications for vaccination

The Delta variant is a major SARS-CoV-2 variant of concern first identified in India. To better understand COVID-19 pandemic dynamics and Delta, we use multiple datasets and model-inference to reconstruct COVID-19 pandemic dynamics in India during March 2020–June 2021. We further use the large discrepancy in one- and two-dose vaccination coverage in India (53% versus 23% by end of October 2021) to examine the impact of vaccination and whether prior non-Delta infection can boost vaccine effectiveness (VE). We estimate that Delta escaped immunity in 34.6% (95% CI: 0–64.2%) of individuals with prior wild-type infection and was 57.0% (95% CI: 37.9–75.6%) more infectious than wild-type SARS-CoV-2. Models assuming higher VE among non-Delta infection recoverees, particularly after the first dose, generated more accurate predictions than those assuming no such increases (best-performing VE setting: 90/95% versus 30/67% baseline for the first/second dose). Counterfactual modelling indicates that high vaccination coverage for first vaccine dose in India combined with the boosting of VE among recoverees averted around 60% of infections during July–mid-October 2021. These findings provide support to prioritizing first-dose vaccination in regions with high underlying infection rates, given continued vaccine shortages and new variant emergence.     

The East–West Divide in Response to COVID-19

Coronavirus disease 2019 (COVID-19) deaths per million population in the countries of the West had often exceeded those in the countries of the East by factor of 100 by May 2021. In this paper, we refer to the West as represented by the United States plus the five most populous countries of Western Europe (France, Germany, Italy, Spain, and the United Kingdom), and the East as the 15 countries in East Asia and Oceania that are members of the Regional Comprehensive Economic Partnership, RCEP (Australia, Brunei, Cambodia, China, Indonesia, Japan, the Republic of Korea, Laos, Malaysia, Myanmar, New Zealand, Philippines, Singapore, Thailand, and Vietnam). This paper argues that currently available information points to the factors most responsible for the East–West divide. Warnings by early January 2020 about an atypical viral pneumonia in Wuhan, China, prompted rapid responses in many jurisdictions in East Asia. Publication of the virus’s genome on 10 January 2020 provided essential information for making diagnostic tests and launching vaccine development. China’s lockdown of Wuhan on 23 January 2020 provided a final, decisive signal of the danger of the new disease. By late March 2020, China had fully controlled its epidemic, and many other RCEP countries had taken early and decisive measures, including restrictions on travel, that aborted serious outcomes. Inaction during the critical month of February 2020 in the United States and most other Western countries allowed the disease to take hold and spread. In both the East and the West, stringent population-wide non-pharmaceutical interventions were widely implemented at great cost to societies, economies, and school systems. Without these measures, the outcomes could have been even worse. Most countries in the East also implemented tightly focused policies to isolate infectious individuals. Even today, most countries in the West allow infectious individuals to mingle with their families, coworkers, and communities. Much of the East–West divide plausibly results from failure in the West to implement the basic public health policies of early action and the isolation of infectious individuals. Widespread immunization in some RCEP and high-income countries will soon attenuate their outbreaks, while the slow rollout of vaccines in lower income countries is replacing the East–West divide in outcomes with a North–South one. The South is thus replacing the West as the breeding ground for more dangerous variants as exemplified by the highly contagious Delta variant, which may undermine hitherto successful control strategies in many countries.     

Empirical Assessment of Bacillus Calmette-Guérin Vaccine to Combat COVID-19

COVID-19 has become one of the critical health issues globally, which surfaced first in latter part of the year 2019. It is the topmost concern for many nations’ governments as the contagious virus started mushrooming over adjacent regions of infected areas. In 1980, a vaccine called Bacillus Calmette-Guérin (BCG) was introduced for preventing tuberculosis and lung cancer. Countries that have made the BCG vaccine mandatory have witnessed a lesser COVID-19 fatality rate than the countries that have not made it compulsory. This paper’s initial research shows that the countries with a long-term compulsory BCG vaccination system are less affected by COVID-19 than those without a BCG vaccination system. This paper discusses analytical data patterns for medical applications regarding COVID-19 impact on countries with mandatory BCG status on fatality rates. The paper has tackled numerous analytical challenges to realize the full potential of heterogeneous data. An analogy is drawn to demonstrate how other factors can affect fatality and infection rates other than BCG vaccination only, such as age groups affected, other diseases, and stringency index. The data of Spain, Portugal, and Germany have been taken for a case study of BCG impact analysis.     

Epidemiological game-theory dynamics of chickenpox vaccination in the USA and Israel

The general consensus from epidemiological game-theory studies is that vaccination coverage driven by self-interest (Nash vaccination) is generally lower than group-optimal coverage (utilitarian vaccination). However, diseases that become more severe with age, such as chickenpox, pose an exception to this general consensus. An individual choice to be vaccinated against chickenpox has the potential to harm those not vaccinated by increasing the average age at infection and thus the severity of infection as well as those already vaccinated by increasing the probability of breakthrough infection. To investigate the effects of these externalities on the relationship between Nash and utilitarian vaccination coverages for chickenpox, we developed a game-theory epidemic model that we apply to the USA and Israel, which has different vaccination programmes, vaccination and treatment costs, as well as vaccination coverage levels. We find that the increase in chickenpox severity with age can reverse the typical relationship between utilitarian and Nash vaccination coverages in both the USA and Israel. Our model suggests that to obtain herd immunity of chickenpox vaccination, subsidies or external regulation should be used if vaccination costs are high. By contrast, for low vaccination costs, improving awareness of the vaccine and the potential cost of chickenpox infection is crucial.     

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.     

Estimation of measles vaccine efficacy and critical vaccination coverage in a highly vaccinated population

Measles is a highly infectious disease that has been targeted for elimination from four WHO regions. Whether and under which conditions this goal is feasible is, however, uncertain since outbreaks have been documented in populations with high vaccination coverage (more than 90%). Here, we use the example of a large outbreak in a German public school to show how estimates of key epidemiological parameters such as the basic reproduction number (R₀), vaccine efficacy (VE_S) and critical vaccination coverage (p_c) can be obtained from partially observed outbreaks in highly vaccinated populations. Our analyses rely on Bayesian methods of inference based on the final size distribution of outbreak size, and use data which are easily collected. For the German public school the analyses indicate that the basic reproduction number of measles is higher than previously thought (, 95% credible interval: 23.6–40.4), that the vaccine is highly effective in preventing infection (, 95% credible interval: 0.993–0.999), and that a vaccination coverage in excess of 95 per cent may be necessary to achieve herd immunity (, 95% credible interval: 0.961–0.978). We discuss the implications for measles elimination from highly vaccinated populations.     

COVID-19, history,and humility

Amid the current COVID-19 crisis, everyone has been called upon to offer assistance. What can historians contribute? One obvious approach is to draw on our knowledge of the history of epidemics and proclaim the lessons of history. But does history offer clear lessons? To make their expertise relevant, some historians assert that there are enduring patterns in how societies respond to all epidemics that can inform our experiences today. Others argue that there are informative analogies between specific past epidemics and our present crisis, for instance between COVID-19 and prior outbreaks of SARS or influenza. Both strategies can be pursued, but each must be done with care. It is certainly possible to map COVID-19 onto the classic dramatic structure of an epidemic, but we cannot yet know how it will end, a failure of prognostication that constrains the advice we can offer. It is likewise possible to draw on the history of medical therapeutics and public health interventions to identify the risks we face of both underuse and overuse of our remedies, but we cannot yet judge whether our current commitment to heroic social distancing is warranted. While historians can offer insight, we must temper our contributions with humility.     

Modelling the effectiveness and risks of vaccination strategies to control classical swine fever epidemics

In a recent update of the Dutch contingency plan for controlling outbreaks of classical swine fever (CSF), emergency vaccination is preferred to large-scale pre-emptive culling. This policy change raised two questions: can emergency vaccination be as effective as pre-emptive culling, and what are the implications for showing freedom of infection? Here, we integrate quantitative information available on CSF virus transmission and vaccination effects into a stochastic mathematical model that describes the transmission dynamics at the level of animals, farms and livestock areas. This multilevel approach connects individual-level interventions to large-scale effects. Using this model, we compare the performance of five different control strategies applied to hypothetical CSF epidemics in The Netherlands and, for each of these strategies, we study the properties of three different screening scenarios to show freedom of infection. We find that vaccination in a ring of 2 km radius around a detected infection source is as effective as ring culling in a 1 km radius. Feasible screening scenarios, adapted to the use of emergency vaccination, can reduce the enhanced risks of (initially) undetected farm outbreaks by targeting vaccinated farms. Altogether, our results suggest that emergency vaccination against CSF can be equally effective and safe as pre-emptive culling.     

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.     

Cu-bearing high-entropy alloys with excellent antiviral properties

The worldwide outbreak of COVID-19 since December 2019 has caused great challenges to health organizations,and brought tremendous impact on the global economy.There have been over 62.3 million confirmed infection cases and 1.4 million deaths reported until now(December 1 st,2020),and the numbers are still growing[1].Although not as influential as COVID-19,the other two large pandemics,severe acute respiratory syndrome(SARS,outbroke in 2002)and Middle East respiratory syndrome(MERS,outbroke in 2012),were also caused by coronaviruses and resulted in severe public health and economic crises in several countries[2,3].Accompanied by the globalization,the highly connected human society through air travel and conventions offers conve-nience for the rapid spreading of viruses.Moreover,the occurrence of undetected viruses and their high spontaneous mutation rate challenge the cognitive process and the development of antiviral agents.In this view,the development of broad-spectrum antiviral strategies for prevention and control of viral transmission is of great importance for protecting our human society.     

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.