ABSTRACT
OBJECTIVES: The drug overdose crisis with shifting patterns from primarily opioid to polysubstance uses and COVID-19 infections are two concurrent public health crises in the United States, affecting the population of sizes in different magnitudes (approximately <10 million for substance use disorder (SUD) and drug overdoses vs. 80 million for COVID-19 within two years of the pandemic). Our objective is to compare the relative scale of disease burden for the two crises within a common framework, which could help inform policymakers with resource allocation and prioritization strategies. METHODS: We calculated disability-adjusted life years (DALYs) for SUD (including opioids and stimulants) and COVID-19 infections, respectively. We collected estimates for SUD prevalence, overdose deaths, COVID-19 cases and deaths, disability weights, and life expectancy from multiple publicly available sources. We then compared age distributions of estimated DALYs. RESULTS: We estimated a total burden of 13.83 million DALYs for SUD and drug overdoses and 15.03 million DALYs for COVID-19 in two years since March 2020. COVID-19 burden was dominated by the fatal burden (>95% of total DALYs), whereas SUD burden was attributed to both fatal (53%) and non-fatal burdens (47%). The highest disease burden was among individuals aged 30-39 for SUD (27%) and 50-64 for COVID-19 (31%). CONCLUSIONS: Despite the smaller size of the affected population, SUD and drug overdoses resulted in comparable disease burden to the COVID-19 pandemic. Additional resources supporting evidence-based interventions in prevention and treatment may be warranted to ameliorate SUD and drug overdoses during both the pandemic and post-pandemic recovery.
ABSTRACT
Many schools and universities have seen a significant increase in the spread of COVID-19. As such, a number of non-pharmaceutical interventions have been proposed including distancing requirements, surveillance testing, and updating ventilation systems. Unfortunately, there is limited guidance for which policy or set of policies are most effective for a specific school system. We develop a novel approach to model the spread of SARS-CoV-2 quanta in a closed classroom environment that extends traditional transmission models that assume uniform mixing through air recirculation by including the local spread of quanta from a contagious source. In addition, the behavior of students with respect to guideline compliance was modeled through an agent-based simulation. Estimated infection rates were on average lower using traditional transmission models compared to our approach. Further, we found that although ventilation changes were effective at reducing mean transmission risk, it had much less impact than distancing practices. Duration of the class was an important factor in determining the transmission risk. For the same total number of semester hours for a class, delivering lectures more frequently for shorter durations was preferable to less frequently with longer durations. Finally, as expected, as the contact tracing level increased, more infectious students were identified and removed from the environment and the spread slowed, though there were diminishing returns. These findings can help provide guidance as to which school-based policies would be most effective at reducing risk and can be used in a cost/comparative effectiveness estimation study given local costs and constraints.