Moving Beyond a Peak Mentality: Plateaus, Shoulders, Oscillations and Other 'Anomalous' Behavior-Driven Shapes in COVID-19 Outbreaks (preprint)

ABSTRACT

The COVID-19 pandemic has caused more than 300,000 reported deaths globally, of which more than 83,000 have been reported in the United States as of May 16, 2020. Public health interventions have had significant impacts in reducing transmission and in averting even more deaths. Nonetheless, in many jurisdictions (both at national and local levels) the decline of cases and fatalities after apparent epidemic peaks has not been rapid. Instead, the asymmetric decline in cases appears, in some cases, to be consistent with plateau- or shoulder-like phenomena. Here we explore a model of fatality-driven awareness in which individual protective measures increase with death rates. In this model, epidemic dynamics can be characterized by plateaus, shoulders, and lag-driven oscillations after exponential rises at the outset of disease dynamics. We also show that incorporating long-term awareness can avoid peak resurgence and accelerate epidemic decline. We suggest that awareness of epidemic severity is likely to play a critical role in disease dynamics, beyond that imposed by intervention-driven policies.