Integrated vaccination and physical distancing interventions to prevent future COVID-19 waves (preprint)

COVID-19 resurgences worldwide have posed significant challenges to the formulation of preventive interventions, especially given that the effects of physical distancing and upcoming vaccines on reducing susceptible social contacts and eventually halting transmission are still unclear. Using anonymized mobile geolocation data in China, we devised a mobility-associated social contact index to quantify the impact of both physical distancing and vaccination measures in a unified way such that the gap between intervention measures and disease transmission can be explicitly bridged. This index explained 90% of the variance in the changing reproduction number of infections across the COVID-19 outbreak in Wuhan, and was validated in six other cities of different population densities. Our simulations showed that vaccination combined with physical distancing can contain resurgences without relying on mobility reduction, whereas a gradual vaccination process alone cannot achieve this. Further, for cities with medium-population density, vaccination can shorten the duration of physical distancing by 36%-78%, whereas for cities with high-population density, infection numbers can well be controlled through moderate physical distancing. These findings provide guidance on tailoring and implementing comprehensive interventions for cities with varying population densities.

Transmission risk of SARS-CoV-2 on airplanes and high-speed trains (preprint)

Modern transportation plays a key role in the long-distance and rapid spread of SARS-CoV-2. However, little is known about the transmission risk of SARS-CoV-2 on confined vehicles, such as airplanes and trains. Based on the itinerary and epidemiological data of COVID-19 cases and close contacts among 9,265 airline passengers on 291 airplanes and 29,335 passengers on 830 high-speed trains in China from December 20, 2019 to March 17, 2020, we estimated that the upper bound of overall attack rate of COVID-19 among passengers was 0.60% (95% confidence interval: 0.43%-0.84%) for airplanes and 0.35% (0.28%-0.44%) for trains departing from Wuhan before its lockdown, respectively. The reproduction number during travel ranged from 0.12 to 0.19 on airplanes and from 0.07 to 0.12 on trains, with the risk varying by seat distance from the index case and joint travel time, but the difference in risk was not significant between the types of aircraft and train. Overall, the risk of SARS-CoV-2 transmission on planes and high-speed trains with high efficiency air filtration devices was relatively low. Our findings improve understanding of COVID-19 spread during travel and may inform response efforts, such as lifting travel restrictions, and resuming transportation in the pandemic.

Trip duration drives shift in travel network structure with implications for the predictability of spatial disease spread (preprint)

Human travel is one of the primary drivers of infectious disease spread. Models of travel are often used that assume the amount of travel to a specific destination decays as cost of travel increases and higher travel volumes to more populated destinations. Trip duration, the length of time spent in a destination, can also impact travel patterns. We investigated the spatial distribution of travel conditioned on trip duration and find distinct differences between short and long duration trips. In short-trip duration travel networks, trips are skewed towards urban destinations, compared with long-trip duration networks where travel is more evenly spread among locations. Using gravity models imbedded in simulations of disease transmission, we show that pathogens with shorter generation times exhibit initial patterns of spatial propagation that are more predictable among urban locations, whereas longer generation time pathogens have more diffusive patterns of spatial spread reflecting more unpredictable disease dynamics.

High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa (preprint)

A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments [1], younger populations [2,3,4]) have yet to be framed within a comprehensive analysis accounting for factors that may offset the effects of climate and demography. Here, we synthesize factors hypothesized to shape the pace of this pandemic and its burden as it moves across SSA, encompassing demographic, comorbidity, climatic, healthcare and intervention capacity, and human mobility dimensions of risk. We find large scale diversity in probable drivers, such that outcomes are likely to be highly variable among SSA countries. While simulation shows that extensive climatic variation among SSA population centers has little effect on early outbreak trajectories, heterogeneity in connectivity is likely to play a large role in shaping the pace of viral spread. The prolonged, asynchronous outbreaks expected in weakly connected settings may result in extended stress to health systems. In addition, the observed variability in comorbidities and access to care will likely modulate the severity of infection: We show that even small shifts in the infection fatality ratio towards younger ages, which are likely in high risk settings, can eliminate the protective effect of younger populations. We highlight countries with elevated risk of slow pace, high burden outbreaks. Empirical data on the spatial extent of outbreaks within SSA countries, their patterns in severity over age, and the relationship between epidemic pace and health system disruptions are urgently needed to guide efforts to mitigate the high burden scenarios explored here.

Assessing the effect of global travel and contact reductions to mitigate the COVID-19 pandemic and resurgence (preprint)

Travel and physical distancing interventions have been implemented across the World to mitigate the COVID-19 pandemic, but studies are needed to quantify the effectiveness of these measures across regions and time. Timely population mobility data were obtained to measure travel and contact reductions in 135 countries or territories. During the 10 weeks of March 22 - May 30, 2020, domestic travel in study regions has dramatically reduced to a median of 59% (interquartile range [IQR] 43% - 73%) of normal levels seen before the outbreak, with international travel down to 26% (IQR 12% - 35%). If these travel and physical distancing interventions had not been deployed across the World, the cumulative number of cases might have shown a 97-fold (IQR 79 - 116) increase, as of May 31, 2020. However, effectiveness differed by the duration and intensity of interventions and relaxation scenarios, with variations in case severity seen across populations, regions, and seasons.

Assessing the impact of coordinated COVID-19 exit strategies across Europe (preprint)

As rates of new COVID-19 cases decline across Europe due to non-pharmaceutical interventions such as social distancing policies and lockdown measures, countries require guidance on how to ease restrictions while minimizing the risk of resurgent outbreaks. Here, we use mobility and case data to quantify how coordinated exit strategies could delay continental resurgence and limit community transmission of COVID-19. We find that a resurgent continental epidemic could occur as many as 5 weeks earlier when well-connected countries with stringent existing interventions end their interventions prematurely. Further, we found that appropriate coordination can greatly improve the likelihood of eliminating community transmission throughout Europe. In particular, synchronizing intermittent lockdowns across Europe meant half as many lockdown periods were required to end community transmission continent-wide.

The COVID-19 pandemic as experienced by the individual (preprint)

The ongoing COVID-19 pandemic has progressed with varying degrees of intensity in individual countries, suggesting it is important to analyse factors that vary between them. We study measures of `population-weighted density', which capture density as perceived by a randomly chosen individual. These measures of population density can significantly explain variation in the initial rate of spread of COVID-19 between countries within Europe. However, such measures do not explain differences on a global scale, particularly when considering countries in East Asia, or looking later into the epidemics. Therefore, to control for country-level differences in response to COVID-19 we consider the cross-cultural measure of individualism proposed by Hofstede. This score can significantly explain variation in the size of epidemics across Europe, North America, and East Asia. Using both our measure of population-weighted density and the Hofstede score we can significantly explain half the variation in the current size of epidemics across Europe and North America. By controlling for country-level responses to the virus and population density, our analysis of the global incidence of COVID-19 can help focus attention on epidemic control measures that are effective for individual countries.

Effect of non-pharmaceutical interventions for containing the COVID-19 outbreak: an observational and modelling study (preprint)

Background: The COVID-19 outbreak containment strategies in China based on non-pharmaceutical interventions (NPIs) appear to be effective. Quantitative research is still needed however to assess the efficacy of different candidate NPIs and their timings to guide ongoing and future responses to epidemics of this emerging disease across the World. Methods: We built a travel network-based susceptible-exposed-infectious-removed (SEIR) model to simulate the outbreak across cities in mainland China. We used epidemiological parameters estimated for the early stage of outbreak in Wuhan to parameterise the transmission before NPIs were implemented. To quantify the relative effect of various NPIs, daily changes of delay from illness onset to the first reported case in each county were used as a proxy for the improvement of case identification and isolation across the outbreak. Historical and near-real time human movement data, obtained from Baidu location-based service, were used to derive the intensity of travel restrictions and contact reductions across China. The model and outputs were validated using daily reported case numbers, with a series of sensitivity analyses conducted. Results: We estimated that there were a total of 114,325 COVID-19 cases (interquartile range [IQR] 76,776 - 164,576) in mainland China as of February 29, 2020, and these were highly correlated (p<0.001, R2=0.86) with reported incidence. Without NPIs, the number of COVID-19 cases would likely have shown a 67-fold increase (IQR: 44 - 94), with the effectiveness of different interventions varying. The early detection and isolation of cases was estimated to prevent more infections than travel restrictions and contact reductions, but integrated NPIs would achieve the strongest and most rapid effect. If NPIs could have been conducted one week, two weeks, or three weeks earlier in China, cases could have been reduced by 66%, 86%, and 95%, respectively, together with significantly reducing the number of affected areas. However, if NPIs were conducted one week, two weeks, or three weeks later, the number of cases could have shown a 3-fold, 7-fold, and 18-fold increase across China, respectively. Results also suggest that the social distancing intervention should be continued for the next few months in China to prevent case numbers increasing again after travel restrictions were lifted on February 17, 2020. Conclusion: The NPIs deployed in China appear to be effectively containing the COVID-19 outbreak, but the efficacy of the different interventions varied, with the early case detection and contact reduction being the most effective. Moreover, deploying the NPIs early is also important to prevent further spread. Early and integrated NPI strategies should be prepared, adopted and adjusted to minimize health, social and economic impacts in affected regions around the World.

Assessing spread risk of Wuhan novel coronavirus within and beyond China, January-April 2020: a travel network-based modelling study (preprint)

Background: A novel coronavirus (2019-nCoV) emerged in Wuhan City, China, at the end of 2019 and has caused an outbreak of human-to-human transmission with a Public Health Emergency of International Concern declared by the World Health Organization on January 30, 2020. Aim: We aimed to estimate the potential risk and geographic range of Wuhan novel coronavirus (2019-nCoV) spread within and beyond China from January through to April, 2020. Methods: A series of domestic and international travel network-based connectivity and risk analyses were performed, by using de-identified and aggregated mobile phone data, air passenger itinerary data, and case reports. Results: The cordon sanitaire of Wuhan is likely to have occurred during the latter stages of peak population numbers leaving the city before Lunar New Year (LNY), with travellers departing into neighbouring cities and other megacities in China. We estimated that 59,912 air passengers, of which 834 (95% UI: 478 - 1349) had 2019-nCoV infection, travelled from Wuhan to 382 cities outside of mainland China during the two weeks prior to the lockdown of Wuhan. The majority of these cities were in Asia, but major hubs in Europe, the US and Australia were also prominent, with strong correlation seen between predicted importation risks and reported cases. Because significant spread has already occurred, a large number of airline travellers (3.3 million under the scenario of 75% travel reduction from normal volumes) may be required to be screened at origin high-risk cities in China and destinations across the globe for the following three months of February to April, 2020 to effectively limit spread beyond its current extent. Conclusion: Further spread of 2019-nCoV within China and international exportation is likely to occur. All countries, especially vulnerable regions, should be prepared for efforts to contain the 2019-nCoV infection.