From science to politics: COVID-19 information fatigue on YouTube.

OBJECTIVE: The COVID-19 pandemic is the first pandemic where social media platforms relayed information on a large scale, enabling an "infodemic" of conflicting information which undermined the global response to the pandemic. Understanding how the information circulated and evolved on social media platforms is essential for planning future public health campaigns. This study investigated what types of themes about COVID-19 were most viewed on YouTube during the first 8 months of the pandemic, and how COVID-19 themes progressed over this period. METHODS: We analyzed top-viewed YouTube COVID-19-related videos in English from December 1, 2019 to August 16, 2020 with an open inductive content analysis. We coded 536 videos associated with 1.1 billion views across the study period. East Asian countries were the first to report the virus, while most of the top-viewed videos in English were from the US. Videos from straight news outlets dominated the top-viewed videos throughout the outbreak, and public health authorities contributed the fewest. Although straight news was the dominant COVID-19 video source with various types of themes, its viewership per video was similar to that for entertainment news and YouTubers after March. RESULTS: We found, first, that collective public attention to the COVID-19 pandemic on YouTube peaked around March 2020, before the outbreak peaked, and flattened afterwards despite a spike in worldwide cases. Second, more videos focused on prevention early on, but videos with political themes increased through time. Third, regarding prevention and control measures, masking received much less attention than lockdown and social distancing in the study period. CONCLUSION: Our study suggests that a transition of focus from science to politics on social media intensified the COVID-19 infodemic and may have weakened mitigation measures during the first waves of the COVID-19 pandemic. It is recommended that authorities should consider co-operating with reputable social media influencers to promote health campaigns and improve health literacy. In addition, given high levels of globalization of social platforms and polarization of users, tailoring communication towards different digital communities is likely to be essential.

Testing and Isolation Efficacy: Insights from a Simple Epidemic Model.

Testing individuals for pathogens can affect the spread of epidemics. Understanding how individual-level processes of sampling and reporting test results can affect community- or population-level spread is a dynamical modeling question. The effect of testing processes on epidemic dynamics depends on factors underlying implementation, particularly testing intensity and on whom testing is focused. Here, we use a simple model to explore how the individual-level effects of testing might directly impact population-level spread. Our model development was motivated by the COVID-19 epidemic, but has generic epidemiological and testing structures. To the classic SIR framework we have added a per capita testing intensity, and compartment-specific testing weights, which can be adjusted to reflect different testing emphases-surveillance, diagnosis, or control. We derive an analytic expression for the relative reduction in the basic reproductive number due to testing, test-reporting and related isolation behaviours. Intensive testing and fast test reporting are expected to be beneficial at the community level because they can provide a rapid assessment of the situation, identify hot spots, and may enable rapid contact-tracing. Direct effects of fast testing at the individual level are less clear, and may depend on how individuals' behaviour is affected by testing information. Our simple model shows that under some circumstances both increased testing intensity and faster test reporting can reduce the effectiveness of control, and allows us to explore the conditions under which this occurs. Conversely, we find that focusing testing on infected individuals always acts to increase effectiveness of control.

Face masking and COVID-19: potential effects of variolation on transmission dynamics.

Face masks do not completely prevent transmission of respiratory infections, but masked individuals are likely to inhale fewer infectious particles. If smaller infectious doses tend to yield milder infections, yet ultimately induce similar levels of immunity, then masking could reduce the prevalence of severe disease even if the total number of infections is unaffected. It has been suggested that this effect of masking is analogous to the pre-vaccination practice of variolation for smallpox, whereby susceptible individuals were intentionally infected with small doses of live virus (and often acquired immunity without severe disease). We present a simple epidemiological model in which mask-induced variolation causes milder infections, potentially with lower transmission rate and/or different duration. We derive relationships between the effectiveness of mask-induced variolation and important epidemiological metrics (the basic reproduction number and initial epidemic growth rate, and the peak prevalence, attack rate and equilibrium prevalence of severe infections). We illustrate our results using parameter estimates for the original SARS-CoV-2 wild-type virus, as well as the Alpha, Delta and Omicron variants. Our results suggest that if variolation is a genuine side-effect of masking, then the importance of face masks as a tool for reducing healthcare burdens from COVID-19 may be under-appreciated.

The origins and potential future of SARS-CoV-2 variants of concern in the evolving COVID-19 pandemic.

One year into the global COVID-19 pandemic, the focus of attention has shifted to the emergence and spread of SARS-CoV-2 variants of concern (VOCs). After nearly a year of the pandemic with little evolutionary change affecting human health, several variants have now been shown to have substantial detrimental effects on transmission and severity of the virus. Public health officials, medical practitioners, scientists, and the broader community have since been scrambling to understand what these variants mean for diagnosis, treatment, and the control of the pandemic through nonpharmaceutical interventions and vaccines. Here we explore the evolutionary processes that are involved in the emergence of new variants, what we can expect in terms of the future emergence of VOCs, and what we can do to minimise their impact.

Forward-looking serial intervals correctly link epidemic growth to reproduction numbers.

The reproduction number R and the growth rate r are critical epidemiological quantities. They are linked by generation intervals, the time between infection and onward transmission. Because generation intervals are difficult to observe, epidemiologists often substitute serial intervals, the time between symptom onset in successive links in a transmission chain. Recent studies suggest that such substitution biases estimates of R based on r. Here we explore how these intervals vary over the course of an epidemic, and the implications for R estimation. Forward-looking serial intervals, measuring time forward from symptom onset of an infector, correctly describe the renewal process of symptomatic cases and therefore reliably link R with r. In contrast, backward-looking intervals, which measure time backward, and intrinsic intervals, which neglect population-level dynamics, give incorrect R estimates. Forward-looking intervals are affected both by epidemic dynamics and by censoring, changing in complex ways over the course of an epidemic. We present a heuristic method for addressing biases that arise from neglecting changes in serial intervals. We apply the method to early (21 January to February 8, 2020) serial interval-based estimates of R for the COVID-19 outbreak in China outside Hubei province; using improperly defined serial intervals in this context biases estimates of initial R by up to a factor of 2.6. This study demonstrates the importance of early contact tracing efforts and provides a framework for reassessing generation intervals, serial intervals, and R estimates for COVID-19.

Acceleration of plague outbreaks in the second pandemic.

Historical records reveal the temporal patterns of a sequence of plague epidemics in London, United Kingdom, from the 14th to 17th centuries. Analysis of these records shows that later epidemics spread significantly faster ("accelerated"). Between the Black Death of 1348 and the later epidemics that culminated with the Great Plague of 1665, we estimate that the epidemic growth rate increased fourfold. Currently available data do not provide enough information to infer the mode of plague transmission in any given epidemic; nevertheless, order-of-magnitude estimates of epidemic parameters suggest that the observed slow growth rates in the 14th century are inconsistent with direct (pneumonic) transmission. We discuss the potential roles of demographic and ecological factors, such as climate change or human or rat population density, in driving the observed acceleration.

Reconciling early-outbreak estimates of the basic reproductive number and its uncertainty: framework and applications to the novel coronavirus (SARS-CoV-2) outbreak.

A novel coronavirus (SARS-CoV-2) emerged as a global threat in December 2019. As the epidemic progresses, disease modellers continue to focus on estimating the basic reproductive number [Formula: see text]-the average number of secondary cases caused by a primary case in an otherwise susceptible population. The modelling approaches and resulting estimates of [Formula: see text] during the beginning of the outbreak vary widely, despite relying on similar data sources. Here, we present a statistical framework for comparing and combining different estimates of [Formula: see text] across a wide range of models by decomposing the basic reproductive number into three key quantities: the exponential growth rate, the mean generation interval and the generation-interval dispersion. We apply our framework to early estimates of [Formula: see text] for the SARS-CoV-2 outbreak, showing that many [Formula: see text] estimates are overly confident. Our results emphasize the importance of propagating uncertainties in all components of [Formula: see text], including the shape of the generation-interval distribution, in efforts to estimate [Formula: see text] at the outset of an epidemic.