Adaptive behaviors and vaccination on curbing COVID-19 transmission: Modeling simulations in eight countries.

Current persistent outbreak of COVID-19 is triggering a series of collective responses to avoid infection. To further clarify the impact mechanism of adaptive protection behavior and vaccination, we developed a new transmission model via a delay differential system, which parameterized the roles of adaptive behaviors and vaccination, and allowed to simulate the dynamic infection process among people. By validating the model with surveillance data during March 2020 and October 2021 in America, India, South Africa, Philippines, Brazil, UK, Spain and Germany, we quantified the protection effect of adaptive behaviors by different forms of activity function. The modeling results indicated that (1) the adaptive activity function can be used as a good indicator for fitting the intervention outcome, which exhibited short-term awareness in these countries, and it could reduce the total human infections by 3.68, 26.16, 15.23, 4.23, 7.26, 1.65, 5.51 and 7.07 times, compared with the reporting; (2) for complete prevention, the average proportions of people with immunity should be larger than 90%, 92%, 86%, 71%, 92%, 84%, 82% and 76% with adaptive protection behaviors, or 91%, 97%, 94%, 77%, 92%, 88%, 85% and 90% without protection behaviors; and (3) the required proportion of humans being vaccinated is a sub-linear decreasing function of vaccine efficiency, with small heterogeneity in different countries. This manuscript was submitted as part of a theme issue on "Modelling COVID-19 and Preparedness for Future Pandemics".

Patch model for border reopening and control to prevent new outbreaks of COVID-19.

In this paper, we propose a two-patch model with border control to investigate the effect of border control measures and local non-pharmacological interventions (NPIs) on the transmission of COVID-19. The basic reproduction number of the model is calculated, and the existence and stability of the boundary equilibria and the existence of the coexistence equilibrium of the model are obtained. Through numerical simulation, when there are no unquarantined virus carriers in the patch-2, it can be concluded that the reopening of the border with strict border control measures to allow people in patch-1 to move into patch-2 will not lead to disease outbreaks. Also, when there are unquarantined virus carriers in patch-2 (or lax border control causes people carrying the virus to flow into patch-2), the border control is more strict, and the slower the growth of number of new infectious in patch-2, but the strength of border control does not affect the final state of the disease, which is still dependent on local NPIs. Finally, when the border reopens during an outbreak of disease in patch-2, then a second outbreak will happen.

School and community reopening during the COVID-19 pandemic: a mathematical modelling study.

Operating schools safely during the COVID-19 pandemic requires a balance between health risks and the need for in-person learning. Using demographic and epidemiological data between 31 July and 23 November 2020 from Toronto, Canada, we developed a compartmental transmission model with age, household and setting structure to study the impact of schools reopening in September 2020. The model simulates transmission in the home, community and schools, accounting for differences in infectiousness between adults and children, and accounting for work-from-home and virtual learning. While we found a slight increase in infections among adults (2.2%) and children (4.5%) within the first eight weeks of school reopening, transmission in schools was not the key driver of the virus resurgence in autumn 2020. Rather, it was community spread that determined the outbreak trajectory, primarily due to increases in contact rates among adults in the community after school reopening. Analyses of cross-infection among households, communities and schools revealed that home transmission is crucial for epidemic progression and safely operating schools, while the degree of in-person attendance has a larger impact than other control measures in schools. This study suggests that safe school reopening requires the strict maintenance of public health measures in the community.

Recursive Zero-COVID model and quantitation of control efforts of the Omicron epidemic in Jilin province.

Since the beginning of March 2022, the epidemic due to the Omicron variant has developed rapidly in Jilin Province. To figure out the key controlling factors and validate the model to show the success of the Zero-COVID policy in the province, we constructed a Recursive Zero-COVID Model quantifying the strength of the control measures, and defined the control reproduction number as an index for describing the intensity of interventions. Parameter estimation and sensitivity analysis were employed to estimate and validate the impact of changes in the strength of different measures on the intensity of public health preventions qualitatively and quantitatively. The recursive Zero-COVID model predicted that the dates of elimination of cases at the community level of Changchun and Jilin Cities to be on April 8 and April 17, respectively, which are consistent with the real situation. Our results showed that the strict implementation of control measures and adherence of the public are crucial for controlling the epidemic. It is also essential to strengthen the control intensity even at the final stage to avoid the rebound of the epidemic. In addition, the control reproduction number we defined in the paper is a novel index to measure the intensity of the prevention and control measures of public health.

Community structured model for vaccine strategies to control COVID19 spread: A mathematical study.

Initial efforts to mitigate the COVID-19 pandemic have relied heavily on non-pharmaceutical interventions (NPIs), including physical distancing, hand hygiene, and mask-wearing. However, an effective vaccine is essential to containing the spread of the virus. We developed a compartmental model to examine different vaccine strategies for controlling the spread of COVID-19. Our framework accounts for testing rates, test-turnaround times, and vaccination waning immunity. Using reported case data from the city of Toronto, Canada between Mar-Dec, 2020 we defined epidemic phases of infection using contact rates as well as the probability of transmission upon contact. We investigated the impact of vaccine distribution by comparing different permutations of waning immunity, vaccine coverage and efficacy throughout various stages of NPI's relaxation in terms of cases and deaths. The basic reproduction number is also studied. We observed that widespread vaccine coverage substantially reduced the number of cases and deaths. Under phases with high transmission, an early or late reopening will result in new resurgence of the infection, even with the highest coverage. On the other hand, under phases with lower transmission, 60% of coverage is enough to prevent new infections. Our analysis of R0 showed that the basic reproduction number is reduced by decreasing the tests turnaround time and transmission in the household. While we found that household transmission can decrease following the introduction of a vaccine, public health efforts to reduce test turnaround times remain important for virus containment.

Assessing the mechanism of citywide test-trace-isolate Zero-COVID policy and exit strategy of COVID-19 pandemic.

BACKGROUND: Countries that aimed for eliminating the cases of COVID-19 with test-trace-isolate policy are found to have lower infections, deaths, and better economic performance, compared with those that opted for other mitigation strategies. However, the continuous evolution of new strains has raised the question of whether COVID-19 eradication is still possible given the limited public health response capacity and fatigue of the epidemic. We aim to investigate the mechanism of the Zero-COVID policy on outbreak containment, and to explore the possibility of eradication of Omicron transmission using the citywide test-trace-isolate (CTTI) strategy. METHODS: We develop a compartmental model incorporating the CTTI Zero-COVID policy to understand how it contributes to the SARS-CoV-2 elimination. We employ our model to mimic the Delta outbreak in Fujian Province, China, from September 10 to October 9, 2021, and the Omicron outbreak in Jilin Province, China for the period from March 1 to April 1, 2022. Projections and sensitivity analyses were conducted using dynamical system and Latin Hypercube Sampling/ Partial Rank Correlation Coefficient (PRCC). RESULTS: Calibration results of the model estimate the Fujian Delta outbreak can end in 30 (95% confidence interval CI: 28-33) days, after 10 (95% CI: 9-11) rounds of citywide testing. The emerging Jilin Omicron outbreak may achieve zero COVID cases in 50 (95% CI: 41-57) days if supported with sufficient public health resources and population compliance, which shows the effectiveness of the CTTI Zero-COVID policy. CONCLUSIONS: The CTTI policy shows the capacity for the eradication of the Delta outbreaks and also the Omicron outbreaks. Nonetheless, the implementation of radical CTTI is challenging, which requires routine monitoring for early detection, adequate testing capacity, efficient contact tracing, and high isolation compliance, which constrain its benefits in regions with limited resources. Moreover, these challenges become even more acute in the face of more contagious variants with a high proportion of asymptomatic cases. Hence, in regions where CTTI is not possible, personal protection, public health control measures, and vaccination are indispensable for mitigating and exiting the COVID-19 pandemic.

Mathematical modelling of vaccination rollout and NPIs lifting on COVID-19 transmission with VOC: a case study in Toronto, Canada.

BACKGROUND: Since December 2020, public health agencies have implemented a variety of vaccination strategies to curb the spread of SARS-CoV-2, along with pre-existing Nonpharmaceutical Interventions (NPIs). Initial strategies focused on vaccinating the elderly to prevent hospitalizations and deaths, but with vaccines becoming available to the broader population, it became important to determine the optimal strategy to enable the safe lifting of NPIs while avoiding virus resurgence. METHODS: We extended the classic deterministic SIR compartmental disease-transmission model to simulate the lifting of NPIs under different vaccine rollout scenarios. Using case and vaccination data from Toronto, Canada between December 28, 2020, and May 19, 2021, we estimated transmission throughout past stages of NPI escalation/relaxation to compare the impact of lifting NPIs on different dates on cases, hospitalizations, and deaths, given varying degrees of vaccine coverages by 20-year age groups, accounting for waning immunity. RESULTS: We found that, once coverage among the elderly is high enough (80% with at least one dose), the main age groups to target are 20-39 and 40-59 years, wherein first-dose coverage of at least 70% by mid-June 2021 is needed to minimize the possibility of resurgence if NPIs are to be lifted in the summer. While a resurgence was observed for every scenario of NPI lifting, we also found that under an optimistic vaccination coverage (70% coverage by mid-June, along with postponing reopening from August 2021 to September 2021) can reduce case counts and severe outcomes by roughly 57% by December 31, 2021. CONCLUSIONS: Our results suggest that focusing the vaccination strategy on the working-age population can curb the spread of SARS-CoV-2. However, even with high vaccination coverage in adults, increasing contacts and easing protective personal behaviours is not advisable since a resurgence is expected to occur, especially with an earlier reopening.

Efficacy of a "stay-at-home" policy on SARS-CoV-2 transmission in Toronto, Canada: a mathematical modelling study.

BACKGROUND: Globally, nonpharmaceutical interventions for COVID-19, including stay-at-home policies, limitations on gatherings and closure of public spaces, are being lifted. We explored the effect of lifting a stay-at-home policy on virus resurgence under different conditions. METHODS: Using confirmed case data from Toronto, Canada, between Feb. 24 and June 24, 2020, we ran a compartmental model with household structure to simulate the impact of the stay-at-home policy considering different levels of compliance. We estimated threshold values for the maximum number of contacts, probability of transmission and testing rates required for the safe reopening of the community. RESULTS: After the implementation of the stay-at-home policy, the contact rate outside the household fell by 39% (from 11.58 daily contacts to 7.11). The effective reproductive number decreased from 3.56 (95% confidence interval [CI] 3.02-4.14) on Mar. 12 to 0.84 (95% CI 0.79-0.89) on May 6. Strong adherence to stay-at-home policies appeared to prevent SARS-CoV-2 resurgence, but extending the duration of stay-at-home policies beyond 2 months had little added effect on cumulative cases (25 958 for 65 days of a stay-at-home policy and 23 461 for 95 days, by July 2, 2020) and deaths (1404 for 65 days and 1353 for 95 days). To avoid a resurgence, the average number of contacts per person per day should be kept below 9, with strict nonpharmaceutical interventions in place. INTERPRETATION: Our study demonstrates that the stay-at-home policy implemented in Toronto in March 2020 had a substantial impact on mitigating the spread of SARS-CoV-2. In the context of the early pandemic, before the emergence of variants of concern, reopening schools and workplaces was possible only with other nonpharmaceutical interventions in place.

Projections of the transmission of the Omicron variant for Toronto, Ontario, and Canada using surveillance data following recent changes in testing policies.

At the end of 2021, with the rapid escalation of COVID19 cases due to the Omicron variant, testing centers in Canada were overwhelmed. To alleviate the pressure on the PCR testing capacity, many provinces implemented new strategies that promote self testing and adjust the eligibility for PCR tests, making the count of new cases underreported. We designed a novel compartmental model which captures the new testing guidelines, social behaviours, booster vaccines campaign and features of the newest variant Omicron. To better describe the testing eligibility, we considered the population divided into high risk and non-high-risk settings. The model is calibrated using data from January 1 to February 9, 2022, on cases and severe outcomes in Canada, the province of Ontario and City of Toronto. We conduct analyses on the impact of PCR testing capacity, self testing, different levels of reopening and vaccination coverage on cases and severe outcomes. Our results show that the total number of cases in Canada, Ontario and Toronto are 2.34 (95%CI: 1.22-3.38), 2.20 (95%CI: 1.15-3.72), and 1.97(95%CI: 1.13-3.41), times larger than reported cases, respectively. The current testing strategy is efficient if partial restrictions, such as limited capacity in public spaces, are implemented. Allowing more people to have access to PCR reduces the daily cases and severe outcomes; however, if PCR test capacity is insufficient, then it is important to promote self testing. Also, we found that reopening to a pre-pandemic level will lead to a resurgence of the infections, peaking in late March or April 2022. Vaccination and adherence to isolation protocols are important supports to the testing policies to mitigate any possible spread of the virus.

When and How to Adjust Non-Pharmacological Interventions Concurrent with Booster Vaccinations Against COVID-19 - Guangdong, China, 2022.

Introduction: With the large-scale roll-out of the coronavirus disease 2019 (COVID-19) booster vaccination effort (a vaccine dose given 6 months after completing primary vaccination) in China, we explore when and how China could lift non-pharmacological interventions (NPIs) against COVID-19 in 2022. Methods: Using a modified susceptible-infectious-recovered (SIR) mathematical model, we projected the COVID-19 epidemic situation and required medical resources in Guangdong Province, China. Results: If the number of people entering from overseas recovers to 20% of the number in 2019, the epidemic in 2022 could be controlled at a low level by a containment (215 local cases) or suppression strategy (1,397 local cases). A mitigation strategy would lead to 21,722 local cases. A coexistence strategy would lead to a large epidemic with 6,850,083 local cases that would overwhelm Guangdong's medical system. With 50% or 100% recovery of the 2019 level of travelers from overseas, the epidemic could also be controlled with containment or suppression, but enormous resources, including more hotel rooms for border quarantine, will be required. However, coexistence would lead to an uncontrollable epidemic with 12,922,032 local cases. Discussion: With booster vaccinations, the number of travelers from overseas could increase slightly in 2022, but a suppression strategy would need to be maintained to ensure a controllable epidemic.

The Impact of Quarantine and Medical Resources on the Control of COVID-19 in Wuhan based on a Household Model.

In order to understand how Wuhan curbed the COVID-19 outbreak in 2020, we build a network transmission model of 123 dimensions incorporating the impact of quarantine and medical resources as well as household transmission. Using our new model, the final infection size of Wuhan is predicted to be 50,662 (95%CI: 46,234, 55,493), and the epidemic would last until April 25 (95%CI: April 23, April 29), which are consistent with the actual situation. It is shown that quarantining close contacts greatly reduces the final size and shorten the epidemic duration. The opening of Fangcang shelter hospitals reduces the final size by about 17,000. Had the number of hospital beds been sufficient when the lockdown started, the number of deaths would have been reduced by at least 54.26%. We also investigate the distribution of infectious individuals in unquarantined households of different sizes. The high-risk households are those with size from two to four before the peak time, while the households with only one member have the highest risk after the peak time. Our findings provide a reference for the prevention, mitigation and control of COVID-19 in other cities of the world.

Modeling and Evaluation of the Joint Prevention and Control Mechanism for Curbing COVID-19 in Wuhan.

The spread of COVID-19 in Wuhan was successfully curbed under the strategy of "Joint Prevention and Control Mechanism." To understand how this measure stopped the epidemics in Wuhan, we establish a compartmental model with time-varying parameters over different stages. In the early stage of the epidemic, due to resource limitations, the number of daily reported cases may lower than the actual number. We employ a dynamic-based approach to calibrate the accumulated clinically diagnosed data with a sudden jump on February 12 and 13. The model simulation shows reasonably good match with the adjusted data which allows the prediction of the cumulative confirmed cases. Numerical results reveal that the "Joint Prevention and Control Mechanism" played a significant role on the containment of COVID-19. The spread of COVID-19 cannot be inhibited if any of the measures was not effectively implemented. Our analysis also illustrates that the Fangcang Shelter Hospitals are very helpful when the beds in the designated hospitals are insufficient. Comprised with Fangcang Shelter Hospitals, the designated hospitals can contain the transmission of COVID-19 more effectively. Our findings suggest that the combined multiple measures are essential to curb an ongoing epidemic if the prevention and control measures can be fully implemented.

Models to assess imported cases on the rebound of COVID-19 and design a long-term border control strategy in Heilongjiang Province, China.

Since the outbreak of COVID-19 in Wuhan, China in December 2019, it has spread quickly and become a global pandemic. While the epidemic has been contained well in China due to unprecedented public health interventions, it is still raging or not yet been restrained in some neighboring countries. Chinese government adopted a strict policy of immigration diversion in major entry ports, and it makes Suifenhe port in Heilongjiang Province undertook more importing population. It is essential to understand how imported cases and other key factors of screening affect the epidemic rebound and its mitigation in Heilongjiang Province. Thus we proposed a time switching dynamical system to explore and mimic the disease transmission in three time stages considering importation and control. Cross validation of parameter estimations was carried out to improve the credibility of estimations by fitting the model with eight time series of cumulative numbers simultaneous. Simulation of the dynamics shows that illegal imported cases and imperfect protection in hospitals are the main reasons for the second epidemic wave, the actual border control intensities in the province are relatively effective in early stage. However, a long-term border closure may cause a paradox phenomenon such that it is much harder to restrain the epidemic. Hence it is essential to design an effective border reopening strategy for long-term border control by balancing the limited resources on hotel rooms for quarantine and hospital beds. Our results can be helpful for public health to design border control strategies to suppress COVID-19 transmission.

Assessment of regional vulnerability to Africa swine fever in China during 2018/8-2019/7 based on data envelopment analysis method.

In this study, we introduce a vulnerability index to measure the regional ASF epidemic and present the ASF severity ratings of the 31 provinces of mainland China. The index is defined based on the data from the investigation, national statistical yearbook and reports. The data to be used include pig breeding, financial resources, human resources, epidemic information of ASF and price fluctuation from the 31 provinces. Then, we use the data envelopment analysis (DEA) method to define the vulnerability index, the relative severity value for each region, which quantitatively reflects the damage degree caused by the epidemic of ASF. The method allows us to provide a systematic classification for the regional vulnerability level of ASF in China. Using this index, we find that the vulnerability of the whole country is at a high level, and there is no regional aggregation phenomenon. The vulnerability level of the 31 provinces is quite different and the provinces with high vulnerability level are dispersive geographically. For the five major prevention and control zones for ASF in China, the northern region has the highest vulnerability level, while the eastern zoon level is the lowest.

Nonpharmaceutical interventions contribute to the control of COVID-19 in China based on a pairwise model.

Nonpharmaceutical interventions (NPIs), particularly contact tracing isolation and household quarantine, play a vital role in effectively bringing the Coronavirus Disease 2019 (COVID-19) under control in China. The pairwise model, has an inherent advantage in characterizing those two NPIs than the classical well-mixed models. Therefore, in this paper, we devised a pairwise epidemic model with NPIs to analyze COVID-19 outbreak in China by using confirmed cases during February 3rd-22nd, 2020. By explicitly incorporating contact tracing isolation and family clusters caused by household quarantine, our model provided a good fit to the trajectory of COVID-19 infections. We calculated the reproduction number R = 1.345 (95% CI: 1.230 - 1.460) for Hubei province and R = 1.217 (95% CI: 1.207 - 1.227) for China (except Hubei). We also estimated the peak time of infections, the epidemic duration and the final size, which are basically consistent with real observation. We indicated by simulation that the traced high-risk contacts from incubated to susceptible decrease under NPIs, regardless of infected cases. The sensitivity analysis showed that reducing the exposure of the susceptible and increasing the clustering coefficient bolster COVID-19 control. With the enforcement of household quarantine, the reproduction number R and the epidemic prevalence declined effectively. Furthermore, we obtained the resumption time of work and production in China (except Hubei) on 10th March and in Hubei at the end of April 2020, respectively, which is broadly in line with the actual time. Our results may provide some potential lessons from China on the control of COVID-19 for other parts of the world.

Evaluating the impact of the travel ban within mainland China on the epidemic of the COVID-19.

OBJECTIVES: The ongoing COVID-19 pandemic expanded its geographic distribution through the movement of humans and caused subsequent local outbreaks. Hence, it is essential to investigate how human mobility and travel ban affect the transmission and spatial spread while minimizing the impact on social activities and national economics. METHODS: We developed a mobility network model for spatial epidemics, explicitly taking into account time-varying inter-province and inner-province population flows, spatial heterogeneity in terms of disease transmission, as well as the impact of media reports. The model is applied to study the epidemic of the dynamic network of 30 provinces of mainland China. The model was calibrated using the publicly available incidence and movement data. RESULTS: We estimated that the second outbreak occurred approximately on February 24, 2020, and the cumulative number of cases as of March 15, 2020, increased by 290.1% (95% CI: (255.3%, 324.9%)) without a travel ban in mainland China (excluding Hubei and Tibet). We found that intra-province travel contributes more to the increase of cumulative number of cases than inter-province travel. CONCLUSION: Our quantitative and qualitative research results suggest that the strict travel ban has successfully prevented a severe secondary outbreak in mainland China, which provides solutions for many countries and regions experiencing secondary outbreaks of COVID-19.

Fangcang shelter hospitals during the COVID-19 epidemic, Wuhan, China.

OBJECTIVE: To design models of the spread of coronavirus disease-2019 (COVID-19) in Wuhan and the effect of Fangcang shelter hospitals (rapidly-built temporary hospitals) on the control of the epidemic. METHODS: We used data on daily reported confirmed cases of COVID-19, recovered cases and deaths from the official website of the Wuhan Municipal Health Commission to build compartmental models for three phases of the COVID-19 epidemic. We incorporated the hospital-bed capacity of both designated and Fangcang shelter hospitals. We used the models to assess the success of the strategy adopted in Wuhan to control the COVID-19 epidemic. FINDINGS: Based on the 13 348 Fangcang shelter hospitals beds used in practice, our models show that if the Fangcang shelter hospitals had been opened on 6 February (a day after their actual opening), the total number of COVID-19 cases would have reached 7 413 798 (instead of 50 844) with 1 396 017 deaths (instead of 5003), and the epidemic would have lasted for 179 days (instead of 71). CONCLUSION: While the designated hospitals saved lives of patients with severe COVID-19, it was the increased hospital-bed capacity of the large number of Fangcang shelter hospitals that helped slow and eventually stop the COVID-19 epidemic in Wuhan. Given the current global pandemic of COVID-19, our study suggests that increasing hospital-bed capacity, especially through temporary hospitals such as Fangcang shelter hospitals, to isolate groups of people with mild symptoms within an affected region could help curb and eventually stop COVID-19 outbreaks in communities where effective household isolation is not possible.

Four-tier response system and spatial propagation of COVID-19 in China by a network model.

In order to investigate the effectiveness of lockdown and social distancing restrictions, which have been widely carried out as policy choice to curb the ongoing COVID-19 pandemic around the world, we formulate and discuss a staged and weighted network system based on a classical SEAIR epidemiological model. Five stages have been taken into consideration according to four-tier response to Public Health Crisis, which comes from the National Contingency Plan in China. Staggered basic reproduction number has been derived and we evaluate the effectiveness of lockdown and social distancing policies under different scenarios among 19 cities/regions in mainland China. Further, we estimate the infection risk associated with the sequential release based on population mobility between cities and the intensity of some non-pharmaceutical interventions. Our results reveal that Level I public health emergency response is necessary for high-risk cities, which can flatten the COVID-19 curve effectively and quickly. Moreover, properly designed staggered-release policies are extremely significant for the prevention and control of COVID-19, furthermore, beneficial to economic activities and social stability and development.

A data-driven network model for the emerging COVID-19 epidemics in Wuhan, Toronto and Italy.

The ongoing Coronavirus Disease 2019 (COVID-19) pandemic threatens the health of humans and causes great economic losses. Predictive modeling and forecasting the epidemic trends are essential for developing countermeasures to mitigate this pandemic. We develop a network model, where each node represents an individual and the edges represent contacts between individuals where the infection can spread. The individuals are classified based on the number of contacts they have each day (their node degrees) and their infection status. The transmission network model was respectively fitted to the reported data for the COVID-19 epidemic in Wuhan (China), Toronto (Canada), and the Italian Republic using a Markov Chain Monte Carlo (MCMC) optimization algorithm. Our model fits all three regions well with narrow confidence intervals and could be adapted to simulate other megacities or regions. The model projections on the role of containment strategies can help inform public health authorities to plan control measures.