Wastewater-based Epidemiology for COVID-19 Surveillance: A Survey (preprint)

The pandemic of COVID-19 has imposed tremendous pressure on public health systems and social economic ecosystems over the past years. To alleviate its social impact, it is important to proactively track the prevalence of COVID-19 within communities. The traditional way to estimate the disease prevalence is to estimate from reported clinical test data or surveys. However, the coverage of clinical tests is often limited and the tests can be labor-intensive, requires reliable and timely results, and consistent diagnostic and reporting criteria. Recent studies revealed that patients who are diagnosed with COVID-19 often undergo fecal shedding of SARS-CoV-2 virus into wastewater, which makes wastewater-based epidemiology (WBE) for COVID-19 surveillance a promising approach to complement traditional clinical testing. In this paper, we survey the existing literature regarding WBE for COVID-19 surveillance and summarize the current advances in the area. Specifically, we have covered the key aspects of wastewater sampling, sample testing, and presented a comprehensive and organized summary of wastewater data analytical methods. Finally, we provide the open challenges on current wastewater-based COVID-19 surveillance studies, aiming to encourage new ideas to advance the development of effective wastewater-based surveillance systems for general infectious diseases.

Potential impact of annual vaccination with reformulated COVID-19 vaccines: lessons from the U.S. COVID-19 Scenario Modeling Hub (preprint)

ImportanceCOVID-19 continues to cause significant hospitalizations and deaths in the United States. Its continued burden and the impact of annually reformulated vaccines remain unclear. ObjectiveTo project COVID-19 hospitalizations and deaths from April 2023-April 2025 under two plausible assumptions about immune escape (20% per year and 50% per year) and three possible CDC recommendations for the use of annually reformulated vaccines (no vaccine recommendation, vaccination for those aged 65+, vaccination for all eligible groups). DesignThe COVID-19 Scenario Modeling Hub solicited projections of COVID-19 hospitalization and deaths between April 15, 2023-April 15, 2025 under six scenarios representing the intersection of considered levels of immune escape and vaccination. State and national projections from eight modeling teams were ensembled to produce projections for each scenario. SettingThe entire United States. ParticipantsNone. ExposureAnnually reformulated vaccines assumed to be 65% effective against strains circulating on June 15 of each year and to become available on September 1. Age and state specific coverage in recommended groups was assumed to match that seen for the first (fall 2021) COVID-19 booster. Main outcomes and measuresEnsemble estimates of weekly and cumulative COVID-19 hospitalizations and deaths. Expected relative and absolute reductions in hospitalizations and deaths due to vaccination over the projection period. ResultsFrom April 15, 2023-April 15, 2025, COVID-19 is projected to cause annual epidemics peaking November-January. In the most pessimistic scenario (high immune escape, no vaccination recommendation), we project 2.1 million (90% PI: 1,438,000-4,270,000) hospitalizations and 209,000 (90% PI: 139,000-461,000) deaths, exceeding pre-pandemic mortality of influenza and pneumonia. In high immune escape scenarios, vaccination of those aged 65+ results in 230,000 (95% CI: 104,000-355,000) fewer hospitalizations and 33,000 (95% CI: 12,000-54,000) fewer deaths, while vaccination of all eligible individuals results in 431,000 (95% CI: 264,000-598,000) fewer hospitalizations and 49,000 (95% CI: 29,000-69,000) fewer deaths. Conclusion and RelevanceCOVID-19 is projected to be a significant public health threat over the coming two years. Broad vaccination has the potential to substantially reduce the burden of this disease. Key pointsO_ST_ABSQuestionC_ST_ABSWhat is the likely impact of COVID-19 from April 2023-April 2025 and to what extent can vaccination reduce hospitalizations and deaths? FindingsUnder plausible assumptions about viral evolution and waning immunity, COVID-19 will likely cause annual epidemics peaking in November-January over the two-year projection period. Though significant, hospitalizations and deaths are unlikely to reach levels seen in previous winters. The projected health impacts of COVID-19 are reduced by 10-20% through moderate use of reformulated vaccines. MeaningCOVID-19 is projected to remain a significant public health threat. Annual vaccination can reduce morbidity, mortality, and strain on health systems.

Informing pandemic response in the face of uncertainty. An evaluation of the U.S. COVID-19 Scenario Modeling Hub (preprint)

Our ability to forecast epidemics more than a few weeks into the future is constrained by the complexity of disease systems, our limited ability to measure the current state of an epidemic, and uncertainties in how human action will affect transmission. Realistic longer-term projections (spanning more than a few weeks) may, however, be possible under defined scenarios that specify the future state of critical epidemic drivers, with the additional benefit that such scenarios can be used to anticipate the comparative effect of control measures. Since December 2020, the U.S. COVID-19 Scenario Modeling Hub (SMH) has convened multiple modeling teams to make 6-month ahead projections of the number of SARS-CoV-2 cases, hospitalizations and deaths. The SMH released nearly 1.8 million national and state-level projections between February 2021 and November 2022. SMH performance varied widely as a function of both scenario validity and model calibration. Scenario assumptions were periodically invalidated by the arrival of unanticipated SARS-CoV-2 variants, but SMH still provided projections on average 22 weeks before changes in assumptions (such as virus transmissibility) invalidated scenarios and their corresponding projections. During these periods, before emergence of a novel variant, a linear opinion pool ensemble of contributed models was consistently more reliable than any single model, and projection interval coverage was near target levels for the most plausible scenarios (e.g., 79% coverage for 95% projection interval). SMH projections were used operationally to guide planning and policy at different stages of the pandemic, illustrating the value of the hub approach for long-term scenario projections.

Challenges of COVID-19 Case Forecasting in the US, 2020-2021 (preprint)

During the COVID-19 pandemic, forecasting COVID-19 trends to support planning and response was a priority for scientists and decision makers alike. In the United States, COVID-19 forecasting was coordinated by a large group of universities, companies, and government entities led by the Centers for Disease Control and Prevention and the US COVID-19 Forecast Hub (https://covid19forecasthub.org). We evaluated approximately 9.7 million forecasts of weekly state-level COVID-19 cases for predictions 1-4 weeks into the future submitted by 24 teams from August 2020 to December 2021. We assessed coverage of central prediction intervals and weighted interval scores (WIS), adjusting for missing forecasts relative to a baseline forecast, and used a Gaussian generalized estimating equation (GEE) model to evaluate differences in skill across epidemic phases that were defined by the effective reproduction number. Overall, we found high variation in skill across individual models, with ensemble-based forecasts outperforming other approaches. Forecast skill relative to the baseline was generally higher for larger jurisdictions (e.g., states compared to counties). Over time, forecasts generally performed worst in periods of rapid changes in reported cases (either in increasing or decreasing epidemic phases) with 95% prediction interval coverage dropping below 50% during the growth phases of the winter 2020, Delta, and Omicron waves. Ideally, case forecasts could serve as a leading indicator of changes in transmission dynamics. However, while most COVID-19 case forecasts outperformed a naive baseline model, even the most accurate case forecasts were unreliable in key phases. Further research could improve forecasts of leading indicators, like COVID-19 cases, by leveraging additional real-time data, addressing performance across phases, improving the characterization of forecast confidence, and ensuring that forecasts were coherent across spatial scales. In the meantime, it is critical for forecast users to appreciate current limitations and use a broad set of indicators to inform pandemic-related decision making. Author SummaryAs SARS-CoV-2 began to spread throughout the world in early 2020, modelers played a critical role in predicting how the epidemic could take shape. Short-term forecasts of epidemic outcomes (for example, infections, cases, hospitalizations, or deaths) provided useful information to support pandemic planning, resource allocation, and intervention. Yet, infectious disease forecasting is still a nascent science, and the reliability of different types of forecasts is unclear. We retrospectively evaluated COVID-19 case forecasts, which were often unreliable. For example, forecasts did not anticipate the speed of increase in cases in early winter 2020. This analysis provides insights on specific problems that could be addressed in future research to improve forecasts and their use. Identifying the strengths and weaknesses of forecasts is critical to improving forecasting for current and future public health responses.

Predictive performance of multi-model ensemble forecasts of COVID-19 across European nations (preprint)

Background: Short-term forecasts of infectious disease burden can contribute to situational awareness and aid capacity planning. Based on best practice in other fields and recent insights in infectious disease epidemiology, one can maximise the predictive performance of such forecasts if multiple models are combined into an ensemble. Here we report on the performance of ensembles in predicting COVID-19 cases and deaths across Europe between 08 March 2021 and 07 March 2022. Methods: We used open-source tools to develop a public European COVID-19 Forecast Hub. We invited groups globally to contribute weekly forecasts for COVID-19 cases and deaths reported from a standardised source over the next one to four weeks. Teams submitted forecasts from March 2021 using standardised quantiles of the predictive distribution. Each week we created an ensemble forecast, where each predictive quantile was calculated as the equally-weighted average (initially the mean and then from 26th July the median) of all individual models predictive quantiles. We measured the performance of each model using the relative Weighted Interval Score (WIS), comparing models forecast accuracy relative to all other models. We retrospectively explored alternative methods for ensemble forecasts, including weighted averages based on models past predictive performance. Results: Over 52 weeks we collected and combined up to 28 forecast models for 32 countries. We found a weekly ensemble had a consistently strong performance across countries over time. Across all horizons and locations, the ensemble performed better on relative WIS than 84% of participating models forecasts of incident cases (with a total N=862), and 92% of participating models forecasts of deaths (N=746). Across a one to four week time horizon, ensemble performance declined with longer forecast periods when forecasting cases, but remained stable over four weeks for incident death forecasts. In every forecast across 32 countries, the ensemble outperformed most contributing models when forecasting either cases or deaths, frequently outperforming all of its individual component models. Among several choices of ensemble methods we found that the most influential and best choice was to use a median average of models instead of using the mean, regardless of methods of weighting component forecast models. Conclusions: Our results support the use of combining forecasts from individual models into an ensemble in order to improve predictive performance across epidemiological targets and populations during infectious disease epidemics. Our findings further suggest that median ensemble methods yield better predictive performance more than ones based on means. Our findings also highlight that forecast consumers should place more weight on incident death forecasts than incident case forecasts at forecast horizons greater than two weeks.

Impact of SARS-CoV-2 vaccination of children ages 5-11 years on COVID-19 disease burden and resilience to new variants in the United States, November 2021-March 2022: a multi-model study (preprint)

Background: SARS-CoV-2 vaccination of persons aged 12 years and older has reduced disease burden in the United States. The COVID-19 Scenario Modeling Hub convened multiple modeling teams in September 2021 to project the impact of expanding vaccine administration to children 5-11 years old on anticipated COVID-19 burden and resilience against variant strains. Methods: Nine modeling teams contributed state- and national-level projections for weekly counts of cases, hospitalizations, and deaths in the United States for the period September 12, 2021 to March 12, 2022. Four scenarios covered all combinations of: 1) presence vs. absence of vaccination of children ages 5-11 years starting on November 1, 2021; and 2) continued dominance of the Delta variant vs. emergence of a hypothetical more transmissible variant on November 15, 2021. Individual team projections were combined using linear pooling. The effect of childhood vaccination on overall and age-specific outcomes was estimated by meta-analysis approaches. Findings: Absent a new variant, COVID-19 cases, hospitalizations, and deaths among all ages were projected to decrease nationally through mid-March 2022. Under a set of specific assumptions, models projected that vaccination of children 5-11 years old was associated with reductions in all-age cumulative cases (7.2%, mean incidence ratio [IR] 0.928, 95% confidence interval [CI] 0.880-0.977), hospitalizations (8.7%, mean IR 0.913, 95% CI 0.834-0.992), and deaths (9.2%, mean IR 0.908, 95% CI 0.797-1.020) compared with scenarios where children were not vaccinated. This projected effect of vaccinating children 5-11 years old increased in the presence of a more transmissible variant, assuming no change in vaccine effectiveness by variant. Larger relative reductions in cumulative cases, hospitalizations, and deaths were observed for children than for the entire U.S. population. Substantial state-level variation was projected in epidemic trajectories, vaccine benefits, and variant impacts. Conclusions: Results from this multi-model aggregation study suggest that, under a specific set of scenario assumptions, expanding vaccination to children 5-11 years old would provide measurable direct benefits to this age group and indirect benefits to the all-age U.S. population, including resilience to more transmissible variants.

IMPACT OF WEEKNIGHT AND WEEKEND CURFEWS USING MOBILITY DATA: A CASE STUDY OF BENGALURU URBAN (preprint)

Karnataka imposed weeknight and weekend curfews to mitigate the spread of the Omicron variant of SARS-CoV-2. We attempt to assess the impact of curfew using community mobility reports published by Google. Then, we quantify the impact of such restrictions via a simulation study. The pattern of weeknight and weekend curfew, followed by relaxations during the weekdays, seems, at best, to slow and delay the Omicron spread. The simulation outcomes suggest that Omicron eventually spreads and affects nearly as much of the population as it would have without the restrictions. Further, if Karnataka cases trajectory follows the South African Omicron wave trend and the hospitalisation is similar to that observed in well-vaccinated countries (2% of the confirmed cases), then the healthcare requirement is likely within the capacity of Bengaluru Urban when the caseload peaks, with or without the mobility restrictions. On the other hand, if Karnataka cases trajectory follows both the South African Omicron wave trend and the hospitalisation requirement observed there (6.9%), then the healthcare capacity may be exceeded at peak, with or without the mobility restrictions.

Projected resurgence of COVID-19 in the United States in July-December 2021 resulting from the increased transmissibility of the Delta variant and faltering vaccination (preprint)

What is already known about this topic?The highly transmissible SARS-CoV-2 Delta variant has begun to cause increases in cases, hospitalizations, and deaths in parts of the United States. With slowed vaccination uptake, this novel variant is expected to increase the risk of pandemic resurgence in the US in July--December 2021. What is added by this report?Data from nine mechanistic models project substantial resurgences of COVID-19 across the US resulting from the more transmissible Delta variant. These resurgences, which have now been observed in most states, were projected to occur across most of the US, coinciding with school and business reopening. Reaching higher vaccine coverage in July--December 2021 reduces the size and duration of the projected resurgence substantially. The expected impact of the outbreak is largely concentrated in a subset of states with lower vaccination coverage. What are the implications for public health practice?Renewed efforts to increase vaccination uptake are critical to limiting transmission and disease, particularly in states with lower current vaccination coverage. Reaching higher vaccination goals in the coming months can potentially avert 1.5 million cases and 21,000 deaths and improve the ability to safely resume social contacts, and educational and business activities. Continued or renewed non-pharmaceutical interventions, including masking, can also help limit transmission, particularly as schools and businesses reopen.

Informing University COVID-19 Decisions Using Simple Compartmental Models (preprint)

Tracking the COVID-19 pandemic has been a major challenge for policy makers. Although, several efforts are ongoing for accurate forecasting of cases, deaths, and hospitalization at various resolutions, few have been attempted for college campuses despite their potential to become COVID-19 hot-spots. In this paper, we present a real-time effort towards weekly forecasting of campus-level cases during the fall semester for four universities in Virginia, United States. We discuss the challenges related to data curation. A causal model is employed for forecasting with one free time-varying parameter, calibrated against case data. The model is then run forward in time to obtain multiple forecasts. We retrospectively evaluate the performance and, while forecast quality suffers during the campus reopening phase, the model makes reasonable forecasts as the fall semester progresses. We provide sensitivity analysis for the several model parameters. In addition, the forecasts are provided weekly to various state and local agencies.

Evaluating the utility of high-resolution proximity metrics in predicting the spread of COVID-19 (preprint)

A bstract High resolution mobility datasets have become increasingly available in the past few years and have enabled detailed models for infectious disease spread including those for COVID-19. However, there are open questions on how such a mobility data can be used effectively within epidemic models and for which tasks they are best suited. In this paper, we extract a number of graph-based proximity metrics from high resolution cellphone trace data from X-Mode and use it to study COVID-19 epidemic spread in 50 land grant university counties in the US. We present an approach to estimate the effect of mobility on cases by fitting an ODE based model and performing multivariate linear regression to explain the estimated time varying transmissibility. We find that, while mobility plays a significant role, the contribution is heterogeneous across the counties, as exemplified by a subsequent correlation analysis. We subsequently evaluate the metrics’ utility for case surge prediction defined as a supervised classification problem, and show that the learnt model can predict surges with 95% accuracy and 87% F1-score.

Strategies to Mitigate COVID-19 Resurgence Assuming Immunity Waning: A Study for Karnataka, India (preprint)

COVID-19 vaccination is being rolled out among the general population in India. Spatial heterogeneities exist in seroprevalence and active infections across India. Using a spatially explicit age-stratified model of Karnataka at the district level, we study three spatial vaccination allocation strategies under different vaccination capacities and a variety of non-pharmaceutical intervention (NPI) scenarios. The models are initialised using on-the-ground datasets that capture reported cases, seroprevalence estimates, seroreversion and vaccine rollout plans. The three vaccination strategies we consider are allocation in proportion to the district populations, allocation in inverse proportion to the seroprevalence estimates, and allocation in proportion to the case-incidence rates during a reference period. The results suggest that the effectiveness of these strategies (in terms of cumulative cases at the end of a four-month horizon) are within 2% of each other, with allocation in proportion to population doing marginally better at the state level. The results suggest that the allocation schemes are robust and thus the focus should be on the easy to implement scheme based on population. Our immunity waning model predicts the possibility of a subsequent resurgence even under relatively strong NPIs. Finally, given a per-day vaccination capacity, our results suggest the level of NPIs needed for the healthcare infrastructure to handle a surge.

All Models Are Useful: Bayesian Ensembling for Robust High Resolution COVID-19 Forecasting (preprint)

ABSTRACT Timely, high-resolution forecasts of infectious disease incidence are useful for policy makers in deciding intervention measures and estimating healthcare resource burden. In this paper, we consider the task of forecasting COVID-19 confirmed cases at the county level for the United States. Although multiple methods have been explored for this task, their performance has varied across space and time due to noisy data and the inherent dynamic nature of the pandemic. We present a forecasting pipeline which incorporates probabilistic forecasts from multiple statistical, machine learning and mechanistic methods through a Bayesian ensembling scheme, and has been operational for nearly 6 months serving local, state and federal policymakers in the United States. While showing that the Bayesian ensemble is at least as good as the individual methods, we also show that each individual method contributes significantly for different spatial regions and time points. We compare our model’s performance with other similar models being integrated into CDC-initiated COVID-19 Forecast Hub, and show better performance at longer forecast horizons. Finally, we also describe how such forecasts are used to increase lead time for training mechanistic scenario projections. Our work demonstrates that such a real-time high resolution forecasting pipeline can be developed by integrating multiple methods within a performance-based ensemble to support pandemic response. ACM Reference Format Aniruddha Adiga, Lijing Wang, Benjamin Hurt, Akhil Peddireddy, Przemys-law Porebski,, Srinivasan Venkatramanan, Bryan Lewis, Madhav Marathe. 2021. All Models Are Useful: Bayesian Ensembling for Robust High Resolution COVID-19 Forecasting. In Proceedings of ACM Conference (Conference’17) . ACM, New York, NY, USA, 9 pages. https://doi.org/10.1145/nnnnnnn.nnnnnnn

Cohorting to isolate asymptomatic spreaders: An agent-based simulation study on the Mumbai Suburban Railway (preprint)

The Mumbai Suburban Railways, \emph{locals}, are a key transit infrastructure of the city and is crucial for resuming normal economic activity. To reduce disease transmission, policymakers can enforce reduced crowding and mandate wearing of masks. \emph{Cohorting} -- forming groups of travelers that always travel together, is an additional policy to reduce disease transmission on \textit{locals} without severe restrictions. Cohorting allows us to: ($i$) form traveler bubbles, thereby decreasing the number of distinct interactions over time; ($ii$) potentially quarantine an entire cohort if a single case is detected, making contact tracing more efficient, and ($iii$) target cohorts for testing and early detection of symptomatic as well as asymptomatic cases. Studying impact of cohorts using compartmental models is challenging because of the ensuing representational complexity. Agent-based models provide a natural way to represent cohorts along with the representation of the cohort members with the larger social network. This paper describes a novel multi-scale agent-based model to study the impact of cohorting strategies on COVID-19 dynamics in Mumbai. We achieve this by modeling the Mumbai urban region using a detailed agent-based model comprising of 12.4 million agents. Individual cohorts and their inter-cohort interactions as they travel on locals are modeled using local mean field approximations. The resulting multi-scale model in conjunction with a detailed disease transmission and intervention simulator is used to assess various cohorting strategies. The results provide a quantitative trade-off between cohort size and its impact on disease dynamics and well being. The results show that cohorts can provide significant benefit in terms of reduced transmission without significantly impacting ridership and or economic \& social activity.

Using Mobility Data to Understand and Forecast COVID19 Dynamics (preprint)

Disease dynamics, human mobility, and public policies co-evolve during a pandemic such as COVID-19. Understanding dynamic human mobility changes and spatial interaction patterns are crucial for understanding and forecasting COVID-19 dynamics. We introduce a novel graph-based neural network(GNN) to incorporate global aggregated mobility flows for a better understanding of the impact of human mobility on COVID-19 dynamics as well as better forecasting of disease dynamics. We propose a recurrent message passing graph neural network that embeds spatio-temporal disease dynamics and human mobility dynamics for daily state-level new confirmed cases forecasting. This work represents one of the early papers on the use of GNNs to forecast COVID-19 incidence dynamics and our methods are competitive to existing methods. We show that the spatial and temporal dynamic mobility graph leveraged by the graph neural network enables better long-term forecasting performance compared to baselines.

Examining Deep Learning Models with Multiple Data Sources for COVID-19 Forecasting (preprint)

The COVID-19 pandemic represents the most significant public health disaster since the 1918 influenza pandemic. During pandemics such as COVID-19, timely and reliable spatio-temporal forecasting of epidemic dynamics is crucial. Deep learning-based time series models for forecasting have recently gained popularity and have been successfully used for epidemic forecasting. Here we focus on the design and analysis of deep learning-based models for COVID-19 forecasting. We implement multiple recurrent neural network-based deep learning models and combine them using the stacking ensemble technique. In order to incorporate the effects of multiple factors in COVID-19 spread, we consider multiple sources such as COVID-19 confirmed and death case count data and testing data for better predictions. To overcome the sparsity of training data and to address the dynamic correlation of the disease, we propose clustering-based training for high-resolution forecasting. The methods help us to identify the similar trends of certain groups of regions due to various spatio-temporal effects. We examine the proposed method for forecasting weekly COVID-19 new confirmed cases at county-, state-, and country-level. A comprehensive comparison between different time series models in COVID-19 context is conducted and analyzed. The results show that simple deep learning models can achieve comparable or better performance when compared with more complicated models. We are currently integrating our methods as a part of our weekly forecasts that we provide state and federal authorities.

Data-driven modeling for different stages of pandemic response (preprint)

Some of the key questions of interest during the COVID-19 pandemic (and all outbreaks) include: where did the disease start, how is it spreading, who is at risk, and how to control the spread. There are a large number of complex factors driving the spread of pandemics, and, as a result, multiple modeling techniques play an increasingly important role in shaping public policy and decision making. As different countries and regions go through phases of the pandemic, the questions and data availability also changes. Especially of interest is aligning model development and data collection to support response efforts at each stage of the pandemic. The COVID-19 pandemic has been unprecedented in terms of real-time collection and dissemination of a number of diverse datasets, ranging from disease outcomes, to mobility, behaviors, and socio-economic factors. The data sets have been critical from the perspective of disease modeling and analytics to support policymakers in real-time. In this overview article, we survey the data landscape around COVID-19, with a focus on how such datasets have aided modeling and response through different stages so far in the pandemic. We also discuss some of the current challenges and the needs that will arise as we plan our way out of the pandemic.

Models for COVID-19 Pandemic: A Comparative Analysis (preprint)

COVID-19 pandemic represents an unprecedented global health crisis in the last 100 years. Its economic, social and health impact continues to grow and is likely to end up as one of the worst global disasters since the 1918 pandemic and the World Wars. Mathematical models have played an important role in the ongoing crisis; they have been used to inform public policies and have been instrumental in many of the social distancing measures that were instituted worldwide. In this article we review some of the important mathematical models used to support the ongoing planning and response efforts. These models differ in their use, their mathematical form and their scope.

Interplay of global multi-scale human mobility, social distancing, government interventions, and COVID-19 dynamics (preprint)

This work quantifies the impact of interventions to curtail mobility and social interactions in order to control the COVID-19 pandemic. We analyze the change in world-wide mobility at multiple spatio-temporal resolutions -- county, state, country -- using an anonymized aggregate mobility map that captures population flows between geographic cells of size 5 km2. We show that human mobility underwent an abrupt and significant change, partly in response to the interventions, resulting in 87% reduction of international travel and up to 75% reduction of domestic travel. Taking two very different countries sampled from the global spectrum, we observe a maximum reduction of 42% in mobility across different states of the United States (US), and a 68% reduction across the states of India between late March and late April. Since then, there has been an uptick in flows, with the US seeing 53% increase and India up to 38% increase with respect to flows seen during the lockdown. As we overlay this global map with epidemic incidence curves and dates of government interventions, we observe that as case counts rose, mobility fell -- often before stay-at-home orders were issued. Further, in order to understand mixing within a region, we propose a new metric to quantify the effect of social distancing on the basis of mobility. We find that population mixing has decreased considerably as the pandemic has progressed and are able to measure this effect across the world. Finally, we carry out a counterfactual analysis of delaying the lockdown and show that a one week delay would have doubled the reported number of cases in the US and India. To our knowledge, this work is the first to model in near real-time, the interplay of human mobility, epidemic dynamics and public policies across multiple spatial resolutions and at a global scale.

Evaluating the impact of international airline suspensions on COVID-19 direct importation risk (preprint)

Global airline networks play a key role in the global importation of emerging infectious diseases. Detailed information on air traffic between international airports has been demonstrated to be useful in retrospectively validating and prospectively predicting case emergence in other countries. In this paper, we use a well-established metric known as effective distance on the global air traffic data from IATA to quantify risk of emergence for different countries as a consequence of direct importation from China, and compare it against arrival times for the first 24 countries. Using this model trained on official first reports from WHO, we estimate time of arrival (ToA) for all other countries. We then incorporate data on airline suspensions to recompute the effective distance and assess the effect of such cancellations in delaying the estimated arrival time for all other countries. Finally we use the infectious disease vulnerability indices to explain some of the estimated reporting delays.