ABSTRACT
BackgroundThroughout the COVID-19 pandemic, the effectiveness of face masks mandates has been intensely debated. Many methods have been used to demonstrate mask effectiveness, including one that compares the change in reproduction number following implementing and removing face mask mandates1. MethodsUsing data from Utah, we calculated the effect of mask mandates (EFm) in each local health district from before and after three key mandates: the Salt Lake and Summit County (SLSC) mask mandates enacted; the Utah statewide mask mandate enacted; and the Utah statewide mandate was lifted. ResultsWe found that most counties had a reduction in the growth rate of cases following the mandates. There were reductions in EFm in many counties after the introduction of the SLSC mask mandates and a more widespread reduction in EFm across the state following the statewide mandate. Lifting the mandates, many counties across the states saw an increase in EFm. ConclusionOur data show mask mandates were an effective way to reduce transmission both within the jurisdiction they were enacted and in neighboring jurisdictions. We provide evidence to support mask mandates as a way to prevent transmission to be better equipped to respond to future pandemics.
Subject(s)
COVID-19ABSTRACT
Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. In 2020, the COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized hundreds of thousands of specific predictions from more than 50 different academic, industry, and independent research groups. This manuscript systematically evaluates 23 models that regularly submitted forecasts of reported weekly incident COVID-19 mortality counts in the US at the state and national level. One of these models was a multi-model ensemble that combined all available forecasts each week. The performance of individual models showed high variability across time, geospatial units, and forecast horizons. Half of the models evaluated showed better accuracy than a naive baseline model. In combining the forecasts from all teams, the ensemble showed the best overall probabilistic accuracy of any model. Forecast accuracy degraded as models made predictions farther into the future, with probabilistic accuracy at a 20-week horizon more than 5 times worse than when predicting at a 1-week horizon. This project underscores the role that collaboration and active coordination between governmental public health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks. f
Subject(s)
COVID-19ABSTRACT
Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a high risk of transmission in close-contact indoor settings, which may include households. Prior studies have found a wide range of household secondary attack rates and may contain biases due to simplifying assumptions about transmission variability and test accuracy. Methods. We compiled serological SARS-CoV-2 antibody test data and prior PCR test reporting from members of more than 9000 Utah households. We paired these data with a probabilistic model of household importation and transmission. We calculated a maximum likelihood estimate of the importation probability, mean and variability of household transmission probability, and sensitivity and specificity of test data. Given our household transmission estimates, we estimated the threshold of non-household transmission required for epidemic growth in the population. Results. We estimated that individuals in our study households had a 0.38% (95% CI 0.30% - 0.48%) chance of acquiring SARS-CoV-2 infection outside their household. Our household secondary attack rate estimate was 35% (26% - 47%), substantially higher than the crude estimate of 15% unadjusted for imperfect serological test specificity and other factors. We found evidence for high variability in individual transmissibility, with higher probability of no transmissions or many transmissions compared to standard models. With household transmission at our estimates, the average number of non-household transmissions per case must be kept below 0.40 (0.32 - 0.51) to avoid continued growth of the Utah epidemic. Conclusions. Our findings suggest that crude estimates of household secondary attack rate based on serology data without accounting for false positive tests may underestimate the true average transmissibility, even when test specificity is high. Our finding of potential high variability (overdispersion) in transmissibility of infected individuals is consistent with characterizing SARS-CoV-2 transmission being largely driven by superspreading from a minority of infected individuals. Mitigation efforts targeting large households and other locations where many people congregate indoors might curb continued spread of the virus.
Subject(s)
COVID-19 , Severe Acute Respiratory SyndromeABSTRACT
Long-term care facilities (LTCFs) bear disproportionate burden of COVID-19 and are prioritized for vaccine deployment. LTCF outbreaks could continue occurring during vaccine rollout due to incomplete population coverage, and the effect of vaccines on viral transmission are currently unknown. Declining adherence to non-pharmaceutical interventions (NPIs) against within-facility transmission could therefore limit the effectiveness of vaccination. We built a stochastic model to simulate outbreaks in LTCF populations with differing vaccination coverage and NPI adherence to evaluate their interacting effects. Vaccination combined with strong NPI adherence produced the least morbidity and mortality. Healthcare worker vaccination improved outcomes in unvaccinated LTCF residents but was less impactful with declining NPI adherence. To prevent further illness and deaths, there is a continued need for NPIs in LTCFs during vaccine rollout.
Subject(s)
COVID-19ABSTRACT
Prompt identification of cases is critical for slowing the spread of COVID-19. However, many areas have faced diagnostic testing shortages, requiring difficult decisions to be made regarding who receives a test, without knowing the implications of those decisions on population-level transmission dynamics. Clinical prediction rules (CPRs) are commonly used tools to guide clinical decisions. We used data from electronic health records to develop a parsimonious 5-variable CPR to identify those who are most likely to test positive, and found that its application to prioritize testing increases the proportion of those testing positive in settings of limited testing capacity. To consider the implications of these gains in daily case detection on the population level, we incorporated testing using the CPR into a compartmentalized disease transmission model. We found that prioritized testing led to a delayed and lowered infection peak (i.e. 'flattens the curve'), with the greatest impact at lower values of the effective reproductive number (such as with concurrent social distancing measures), and when higher proportions of infectious persons seek testing. Additionally, prioritized testing resulted in reductions in overall infections as well as hospital and intensive care unit (ICU) burden. In conclusion, we present a novel approach to evidence-based allocation of limited diagnostic capacity, to achieve public health goals for COVID-19.
Subject(s)
COVID-19ABSTRACT
Since its emergence in late 2019, COVID-19 has caused significant global morbidity and mortality, overwhelming health systems. Considerable attention has been paid to the burden COVID-19 has put on acute care hospitals, with numerous models projecting hospitalizations and ICU needs for the duration of the pandemic. However, less attention has been paid to where these patients may go if they require additional care following hospital discharge. As COVID-19 patients recover from severe infections, many of them require additional care. Yet with post-acute care facilities averaging 85\% capacity prior to the pandemic and the significant potential for outbreaks, consideration of the downstream effects of the surge of hospitalized COVID-19 patients is critical. Here, we present a method for projecting COVID-19 post-acute care needs. Our model is designed to take the output from any of the numerous epidemiological models (hospital discharges) and estimate the flow of patients to post-acute care services, thus providing a similar surge planning model for post-acute care services. Using data from the University of Utah Hospital, we find that for those who require specialized post-acute care, the majority require either home health care or skilled nursing facilities. Likewise, we find the expected peak in post-acute care occurs about two weeks after the expected peak for acute care hospitalizations, a result of the duration of hospitalization. This short delay between acute care and post-acute care surges highlights the importance of considering the organization necessary to accommodate the influx of recovering COVID patients and protect non-COVID patients prior to the peak in acute care hospitalizations. We developed this model to guide policymakers in addressing the "aftershocks" of discharged patients requiring further supportive care; while we only show the outcomes for discharges based on preliminary data from the University of Utah Hospital, we suggest alternative uses for our model including adapting it to explore potential alternative strategies for addressing the surge in acute care facilities during future pandemic waves.
Subject(s)
COVID-19ABSTRACT
Coronavirus disease 2019 (COVID-19) has caused strain on health systems worldwide due to its high mortality rate and the large portion of cases requiring critical care and mechanical ventilation. During these uncertain times, public health decision makers, from city health departments to federal agencies, sought the use of epidemiological models for decision support in allocating resources, developing non-pharmaceutical interventions, and characterizing the dynamics of COVID-19 in their jurisdictions. In response, we developed a flexible scenario modeling pipeline that could quickly tailor models for decision makers seeking to compare projections of epidemic trajectories and healthcare impacts from multiple intervention scenarios in different locations. Here, we present the components and configurable features of the COVID Scenario Pipeline, with a vignette detailing its current use. We also present model limitations and active areas of development to meet ever-changing decision maker needs.
Subject(s)
COVID-19ABSTRACT
The United States (US), which is currently the epicenter for the COVID-19 pandemic, is a country whose demographic composition differs from that of other highly-impacted countries. US-based descriptions of SARS-CoV-2 infections have, for the most part, focused on patient populations with severe disease, captured in areas with limited testing capacity. The objective of this study is to compare characteristics of positive and negative SARS-CoV-2 patients, in a population primarily comprised of mild and moderate infections, identified from comprehensive population-level testing. Here, we extracted demographics, comorbidities, and vital signs from 20,088 patients who were tested for SARS-CoV-2 at University of Utah Health clinics, in Salt Lake County, Utah; and for a subset of tested patients, we performed manual chart review to examine symptoms and exposure risks. To determine risk factors for testing positive, we used logistic regression to calculate the odds of testing positive, adjusting for symptoms and prior exposure. Of the 20,088 individuals, 1,229 (6.1%) tested positive for SARS-CoV-2. We found that Non-White persons were more likely to test positive compared to non-Hispanic Whites (adjOR=1.1, 95% CI: 0.8, 1.6), and that this increased risk is more pronounced among Hispanic or Latino persons (adjOR=2.0, 95%CI: 1.3, 3.1). However, we did not find differences in the duration of symptoms nor type of symptom presentation between non-Hispanic White and non-White individuals. We found that risk of hospitalization increases with age (adjOR=6.9 95% CI: 2.1, 22.5 for age 60+ compared to 0-19), and additionally show that younger individuals (aged 0-19), were underrepresented both in overall rates of testing as well as rates of testing positive. We did not find major race/ethnic differences in hospitalization rates. In this analysis of predominantly non-hospitalized individuals tested for SARS-CoV-2, enabled by expansive testing capacity, we found disparities in both testing and SARS-CoV-2 infection status by race/ethnicity and by age. Further work on addressing racial and ethnic disparities, particularly among Hispanic/Latino communities (where SARS-CoV-2 may be spreading more rapidly due to increased exposure and comparatively reduced testing), will be needed to effectively combat COVID-19 in the US.