Evaluating the Risk of Reopening the Border: A Case Study of Ontario (Canada) to New York (USA) Using Mathematical Modeling

Many countries have adopted border closures and other jurisdictions (provinces, states, cities, etc.) to control the spread of SARS-CoV-2. Such measures have significantly restricted population movement and have thus led to immense economic and social fallouts. We build a Susceptible-Exposed-Asymptomatic- Infectious (prodromal phase)- Infectious (with symptoms) -Recovered (SEAIR) model with a household structure to investigate the potential of a safe reopening of a border, which can control disease spread but also allow for economic growth. We focus on the Ontario-USA border, considering an opening date of September 21, 2020. In addition to the instantaneous reproduction number, we also define a novel risk indicator by calculating daily new infections’ percentile to inform risk levels promptly. Under ideal conditions, assuming extremely efficient border testing and strict traveler adherence to quarantine policy, the Ontario-USA can be reopened for a maximum daily number of 500 travelers entering Canada. A number exceeding 500 will stem an uncontrollable spread of the virus. Additionally, the current quarantine policy may not be sufficient under specific scenarios;hence testing measures at the border must be extremely efficient. Reopening of the Ontario-USA must consider the potential for disease spread (which can overburden healthcare resources) and economic growth. If a reopening plan is implemented, the local government must limit the number of daily entrances to 500 and enforce a mandatory quarantine, which may need to be stricter than current policy practice. © 2022, Springer Nature Switzerland AG.

Higher rates of COVID-19 but less severe infections reported for patients on Dupilumab: a Big Data analysis of the World Health Organization VigiBase.

OBJECTIVE: Dupilumab (Dupixent®) is a monoclonal antibody that inhibits IL-4 and IL-13 signaling used for the treatment of allergic diseases. Whilst biologic therapy is traditionally regarded as immunosuppressive and capable to increase the infectious risk, Dupilumab does not display these characteristics and may be even protective in certain cases. We investigated the link between Dupilumab therapy and SARS-CoV-2 infection. MATERIALS AND METHODS: We carried out a comprehensive data mining and disproportionality analysis of the WHO global pharmacovigilance database. One asymptomatic COVID-19 case, 106 cases of symptomatic COVID-19, and 2 cases of severe COVID-19 pneumonia were found. RESULTS: Dupilumab treated patients were at higher risk of COVID-19 (with an IC0.25 of 3.05), even though infections were less severe (IC0.25 of -1.71). The risk of developing COVID-19 was significant both among males and females (with an IC0.25 of 0.24 and 0.58, respectively). The risk of developing COVID-19 was significant in the age-group of 45-64 years (with an IC0.25 of 0.17). CONCLUSIONS: Dupilumab use seems to reduce COVID-19 related severity. Further studies are needed to better understand the immunological mechanisms and clinical implications of these findings. Remarkably, the heterogenous nature of the reports and the database structure did not allow to establish a cause-effect link, but only an epidemiologically decreased risk in the patients subset treated with dupilumab.

Cost and social distancing dynamics in a mathematical model of COVID-19 with application to Ontario, Canada.

A mathematical model of COVID-19 is presented where the decision to increase or decrease social distancing is modelled dynamically as a function of the measured active and total cases as well as the perceived cost of isolating. Along with the cost of isolation, we define an overburden healthcare cost and a total cost. We explore these costs by adjusting parameters that could change with policy decisions. We observe that two disease prevention practices, namely increasing isolation activity and increasing incentive to isolate do not always lead to optimal health outcomes. We demonstrate that this is due to the fatigue and cost of isolation. We further demonstrate that an increase in the number of lock-downs, each of shorter duration can lead to minimal costs. Our results are compared with case data in Ontario, Canada from March to August 2020 and details of expanding the results to other regions are presented.