Optimizing COVID-19 testing strategies on college campuses: evaluation of the health and economic costs (preprint)

Colleges and universities in the US struggled to provide safe in-person education throughout the COVID-19 pandemic. Testing coupled with isolation is a nimble intervention strategy that can be tailored to mitigate health and economic costs, as the virus and our arsenal of medical countermeasures continue to evolve. We developed a decision-support tool to aid in the design of university-based testing strategies using a mathematical model of SARS-CoV-2 transmission. Applying this framework to a large public university reopening in the fall of 2021 with a 60% student vaccination rate, we find that the optimal strategy, in terms of health and economic costs, is twice weekly antigen testing of all students. This strategy provides a 95% guarantee that, throughout the fall semester, case counts would not exceed the CDCs original high transmission threshold of 100 cases per 100k persons over 7 days. As the virus and our medical armament continue to evolve, testing will remain a flexible tool for managing risks and keeping campuses open. We have implemented this model as an online tool to facilitate the design of testing strategies that adjust for COVID-19 conditions, university-specific parameters, and institutional goals.

Estimating Importation Risk of Covid-19 in Hurricane Evacuations: A Prediction Framework Applied to Hurricane Laura in Texas (preprint)

In August 2020, as Texas was coming down from a large summer COVID-19 surge, forecasts suggested that Hurricane Laura was tracking towards 6M residents along the East Texas coastline, threatening to spread COVID-19 across the state and cause pandemic resurgences. To assist local authorities facing the dual-threat, we integrated survey expectations of coastal residents and observed hurricane evacuation rates in a statistical framework that combined with local pandemic conditions predicts how COVID-19 would spread in response to a hurricane. For Hurricane Laura, we estimate that 499,500 [90% Credible Interval (CI): 347,500, 624,000] people evacuated the Texan counties, that no single county accumulated more than 2.5% of hurricane evacuees, and that there were 2,900 [90% CI: 1,700, 5,800] exportations of Covid-19 across the state. In general, reception estimates were concentrated in regions with higher population densities. Nonetheless, higher importation risk is expected in small Districts, with a maximum number of importations of 10 per 10,000 residents in our case study. Overall, we present a flexible and transferable framework that captures spatial heterogeneity and incorporates geographic components for predicting population movement in the wake of a natural disaster. As hurricanes continue to increase in both frequency and strength, our framework can be deployed in response to anticipated hurricane paths to guide disaster preparedness and planning.

The risk of SARS-CoV-2 Omicron variant emergence in low and middle-income countries (LMICs) (preprint)

We estimated the probability of undetected emergence of the SARS-CoV-2 Omicron variant in 25 low and middle-income countries (LMICs) prior to December 5, 2021. In nine countries, the risk exceeds 50%; in Turkey, Pakistan and the Philippines, it exceeds 99%. Risks are generally lower in the Americas than Europe or Asia.

Detecting in-school transmission of SARS-CoV-2 from case ratios and documented clusters (preprint)

Claims that in-person schooling has not amplified SARS-CoV-2 transmission are based on similar infection rates in schools and their surrounding communities and limited numbers of documented in-school transmission events. Simulations assuming high in-school transmission suggest that these metrics cannot exclude the possibility that transmission in schools exacerbated overall pandemic risks.

Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the US (preprint)

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

The impacts of COVID-19 vaccine timing, number of doses, and risk prioritization on mortality in the US (preprint)

As COVID-19 vaccination begins worldwide, policymakers face critical trade-offs. Using a mathematical model of COVID-19 transmission, we find that timing of the rollout is expected to have a substantially greater impact on mortality than risk-based prioritization and adherence and that prioritizing first doses over second doses may be life saving.

Design of COVID-19 Staged Alert Systems to Ensure Healthcare Capacity with Minimal Closures (preprint)

Community mitigation strategies to combat COVID-19, ranging from healthy hygiene to shelter-in-place orders, exact substantial socioeconomic costs. Judicious implementation and relaxation of restrictions amplify their public health benefits while reducing costs. We derive optimal strategies for toggling between mitigation stages using daily COVID-19 hospital admissions. With public compliance, the policy triggers ensure adequate intensive care unit capacity with high probability while minimizing the duration of strict mitigation measures. In comparison, we show that other sensible COVID-19 staging policies, including Frances ICU-based thresholds and a widely adopted indicator for reopening schools and businesses, require overly restrictive measures or trigger strict stages too late to avert catastrophic surges. As cities worldwide face future pandemic waves, our findings provide a robust strategy for tracking COVID-19 hospital admissions as an early indicator of hospital surges and enacting staged measures to ensure integrity of the health system, safety of the health workforce, and public confidence.

Reinforcement Learning for Optimization of COVID-19 Mitigation policies (preprint)

The year 2020 has seen the COVID-19 virus lead to one of the worst global pandemics in history. As a result, governments around the world are faced with the challenge of protecting public health, while keeping the economy running to the greatest extent possible. Epidemiological models provide insight into the spread of these types of diseases and predict the effects of possible intervention policies. However, to date,the even the most data-driven intervention policies rely on heuristics. In this paper, we study how reinforcement learning (RL) can be used to optimize mitigation policies that minimize the economic impact without overwhelming the hospital capacity. Our main contributions are (1) a novel agent-based pandemic simulator which, unlike traditional models, is able to model fine-grained interactions among people at specific locations in a community; and (2) an RL-based methodology for optimizing fine-grained mitigation policies within this simulator. Our results validate both the overall simulator behavior and the learned policies under realistic conditions.

Cocooning is essential to relaxing social distancing (preprint)

As the first wave of COVID-19 recedes, policymakers are contemplating the relaxation of shelter-in-place orders. Using a model capturing high-risk populations and transmission rates estimated from hospitalization data, we find that postponing relaxation will only delay a second wave and cocooning vulnerable populations is needed to prevent overwhelming medical surges.

Projections for first-wave COVID-19 deaths across the US using social-distancing measures derived from mobile phones (preprint)

We propose a Bayesian model for projecting first-wave COVID-19 deaths in all 50 U.S. states. Our model's projections are based on data derived from mobile-phone GPS traces, which allows us to estimate how social-distancing behavior is "flattening the curve" in each state. In a two-week look-ahead test of out-of-sample forecasting accuracy, our model significantly outperforms the widely used model from the Institute for Health Metrics and Evaluation (IHME), achieving 42% lower prediction error: 13.2 deaths per day average error across all U.S. states, versus 22.8 deaths per day average error for the IHME model. Our model also provides an accurate, if slightly conservative, assessment of forecasting accuracy: in the same look-ahead test, 98% of data points fell within the model's 95% credible intervals. Our model's projections are updated daily at https://covid-19. tacc.utexas.edu/projections/