COVID-19 monitoring with sparse sampling of sewered and non-sewered wastewater in urban and rural communities.

Equitable SARS-CoV-2 surveillance in low-resource communities lacking centralized sewers is critical as wastewater-based epidemiology (WBE) progresses. However, large-scale studies on SARS-CoV-2 detection in wastewater from low-and middle-income countries is limited because of economic and technical reasons. In this study, wastewater samples were collected twice a month from 186 urban and rural subdistricts in nine provinces of Thailand mostly having decentralized and non-sewered sanitation infrastructure and analyzed for SARS-CoV-2 RNA variants using allele-specific RT-qPCR. Wastewater SARS-CoV-2 RNA concentration was used to estimate the real-time incidence and time-varying effective reproduction number (Re). Results showed an increase in SARS-CoV-2 RNA concentrations in wastewater from urban and rural areas 14-20 days earlier than infected individuals were officially reported. It also showed that community/food markets were "hot spots" for infected people. This approach offers an opportunity for early detection of transmission surges, allowing preparedness and potentially mitigating significant outbreaks at both spatial and temporal scales.

Individual-based modeling reveals that the COVID-19 isolation period can be shortened by community vaccination.

The isolation of infected individuals and quarantine of their contacts are usually employed to mitigate the transmission of SARS-CoV-2. Although 14-day isolation of infected individuals could effectively reduce the risk of subsequent transmission, it also substantially impacts the patient's psychological and emotional well-being. It is, therefore, vital to investigate how the isolation duration could be shortened when effective vaccines are available. Here, an individual-based modeling approach was employed to estimate the likelihood of secondary infections and the likelihood of an outbreak following the isolation of a primary case for a range of isolation periods. Our individual-based model integrated the viral loads and infectiousness profiles of vaccinated and unvaccinated infected individuals. The effects of waning vaccine-induced immunity against infection were also considered. By simulating the transmission of the SARS-CoV-2 Delta (B.1.617.2) variant in a community, we found that in the baseline scenario in which all individuals were unvaccinated and nonpharmaceutical interventions were not used, there was an approximately 3% chance that an unvaccinated individual would lead to at least one secondary infection after being isolated for 14 days, and a sustained chain of transmission could occur with a less than 1% chance. With the outbreak risk equivalent to that of the 14-day isolation in the baseline scenario, we found that the isolation duration could be shortened to 7.33 days (95% CI 6.68-7.98) if 75% of people in the community were fully vaccinated with the BNT162b2 vaccine within the last three months. In the best-case scenario in which all individuals in the community are fully vaccinated, isolation of Delta variant-infected individuals may no longer be necessary. However, to keep the outbreak risk lower than 1%, a booster vaccination may be necessary three months after full vaccination.

Estimation of Excess All-Cause Mortality Due to COVID-19 in Thailand.

Thailand has experienced the most prominent COVID-19 outbreak in 2021, resulting in a new record for COVID-19 cases and deaths. To assess the influence of the COVID-19 outbreak on mortality, we estimated excess all-cause and pneumonia mortality in Thailand during the COVID-19 outbreak from April to October 2021. We used mortality from the previous 5 years to estimate the baseline number of deaths using generalized linear mixed models. The models were adjusted for seasonality and demographics. We found that, during the outbreak in 2021, there was a significant rise in excess fatalities, especially in the older age groups. The estimated cumulative excess death was 14.3% (95% CI: 8.6-18.8%) higher than the baseline. The results also showed that the excess deaths in males were higher than in females by approximately 26.3%. The excess deaths directly caused by the COVID-19 infections accounted for approximately 75.0% of the all-cause excess deaths. Furthermore, excess pneumonia deaths were also found to be 26.2% (95% CI: 4.8-46.0%) above baseline.

Reconstruction of the transmission dynamics of the first COVID-19 epidemic wave in Thailand.

Thailand was the first country reporting the first Coronavirus disease 2019 (COVID-19) infected individual outside mainland China. Here we delineated the course of the COVID-19 outbreak together with the timeline of the control measures and public health policies employed by the Thai government during the first wave of the COVID-19 outbreak in Thailand. Based on the comprehensive epidemiological data, we reconstructed the dynamics of COVID-19 transmission in Thailand using a stochastic modeling approach. Our stochastic model incorporated the effects of individual heterogeneity in infectiousness on disease transmission, which allows us to capture relevant features of superspreading events. We found that our model could accurately capture the transmission dynamics of the first COVID-19 epidemic wave in Thailand. The model predicted that at the end of the first wave, the number of cumulative confirmed cases was 3091 (95%CI: 2782-3400). We also estimated the time-varying reproduction number (Rt) during the first epidemic wave. We found that after implementing the nationwide interventions, the Rt in Thailand decreased from the peak value of 5.67 to a value below one in less than one month, indicating that the control measures employed by the Thai government during the first COVID-19 epidemic wave were effective. Finally, the effects of transmission heterogeneity and control measures on the likelihood of outbreak extinction were also investigated.

Modelling the effectiveness of intervention strategies to control COVID-19 outbreaks and estimating healthcare demand in Germany.

OBJECTIVES: An outbreak of the novel coronavirus in December 2019 caused a worldwide pandemic. This disease also impacts European countries, including Germany. Without effective medicines or vaccines, non-pharmaceutical interventions are the best strategy to reduce the number of cases. STUDY DESIGN: A deterministic model was simulated to evaluate the number of infectious and healthcare demand. METHOD: Using an age-structured SEIR model for the COVID-19 transmission, we project the COVID-19-associated demand for hospital and ICU beds within Germany. We estimated the effectiveness of different control measures, including active case-finding and quarantining of asymptomatic persons, self-isolation of people who had contact with an infectious person, and physical distancing, as well as a combination of these control measures. RESULTS: We found that contact tracing could reduce the peak of ICU beds as well as mass testing. The time delay between diagnosis and self-isolation influences the control measures. Physical distancing to limit the contact rate would delay the peak of the outbreak, which results in the demand for ICU beds being below the capacity during the early outbreak. CONCLUSIONS: Our study analyzed several scenarios in order to provide policymakers that face the pandemic of COVID-19 with insights into the different measures available. We highlight that the individuals who have had contact with a virus-positive person must be quarantined as soon as possible to reduce contact with possible infectious cases and to reduce transmission. Keeping physical distance and having fewer contacts should be implemented to prevent overwhelming ICU demand.