Adaptive Control of COVID-19 Outbreaks in India: Local, Gradual, and Trigger-based Exit Paths from Lockdown

Managing the outbreak of COVID-19 in India constitutes an unprecedented health emergency in one of the largest and most diverse nations in the world. On May 4, 2020, India started the process of releasing its population from a national lockdown during which extreme social distancing was implemented. We describe and simulate an adaptive control approach to exit this situation, while maintaining the epidemic under control. Adaptive control is a flexible counter-cyclical policy approach, whereby different areas release from lockdown in potentially different gradual ways, dependent on the local progression of the dis- ease. Because of these features, adaptive control requires the ability to decrease or increase social distancing in response to observed and projected dynamics of the disease outbreak. We show via simulation of a stochastic Susceptible-Infected-Recovered (SIR) model and of a synthetic intervention (SI) model that adaptive control performs at least as well as immediate and full release from lockdown starting May 4 and as full release from lockdown after a month (i.e., after May 31). The key insight is that adaptive response provides the option to increase or decrease socioeconomic activity depending on how it affects disease progression and this freedom allows it to do at least as well as most other policy alternatives. We also discuss the central challenge to any nuanced release policy, including adaptive control, specifically learning how specific policies translate into changes in contact rates and thus COVID-19's reproductive rate in real time.

Impact of wearing personal protective equipment on the performance and decision making of surgeons during the COVID-19 pandemic: An observational cross-sectional study.

ABSTRACT: During the coronavirus disease 2019 (COVID-19) pandemic, the mandatory use of personal protective equipment (PPE) has resulted in a significant reduction in the infection rate among health care workers (HCWs). However, there are some ongoing concerns about the negative impact of using PPE for prolonged periods.This study examined the impact of wearing PPE on surgeons' performance and decision making during the COVID-19 pandemic.In this cross-sectional study, an anonymous online questionnaire was created and disseminated to surgeons all over the Eastern Province of Saudi Arabia. The questionnaire included the demographic data, the local hospital policies, the non-technical skills (e.g., communication, vision, and comfort) and the technical skills, and the process of decision making.From June 2020 to August 2020, 162 surgeons participated in this questionnaire. Of them, 80.2% were aged from 26 to 45 years, 70.4% have received a special training for PPE, and 59.3% of participants have operated on COVID-19 confirmed cases. A negative impact of wearing PPE was reported on their overall comfort, vision, and communication skills (92.6%, 95.1%, and 82.8%, respectively). The technical skills and decision making were not significantly affected (60.5% and 72.8%, respectively). More preference for conservative approach, damage control procedures, and/or open approach was reported.Despite its benefits, PPE is associated with a significant negative impact on the non-technical skills (including vision, communication, and comfort) as well as a non-significant negative impact on technical skills and decision making of surgeons. Extra efforts should be directed to improve PPE, especially during lengthy pandemics.