Chasing up and locking down the virus: Optimal pandemic interventions within a network.

During the COVID-19 pandemic countries invested significant amounts of resources into its containment. In early stages of the pandemic most of the (nonpharmaceutical) interventions can be classified into two groups: (i) testing and identification of infected individuals, (ii) social distancing measures to reduce the transmission probabilities. Furthermore, both groups of measures may, in principle, be targeted at certain subgroups of a networked population. To study such a problem, we propose an extension of the SIR model with additional compartments for quarantine and different courses of the disease across several network nodes. We develop the structure of the optimal allocation and study a numerical example of three symmetric regions that are subject to an asymmetric progression of the disease (starting from an initial hotspot). Key findings include that (i) for our calibrations policies are chosen in a "flattening-the-curve," avoiding hospital congestion; (ii) policies shift from containing spillovers from the hotspot initially to establishing a symmetric pattern of the disease; and (iii) testing that can be effectively targeted allows to reduce substantially the duration of the disease, hospital congestion and the total cost, both in terms of lives lost and economic costs.

The optimal lockdown intensity for COVID-19.

One of the principal ways nations are responding to the COVID-19 pandemic is by locking down portions of their economies to reduce infectious spread. This is expensive in terms of lost jobs, lost economic productivity, and lost freedoms. So it is of interest to ask: What is the optimal intensity with which to lockdown, and how should that intensity vary dynamically over the course of an epidemic? This paper explores such questions with an optimal control model that recognizes the particular risks when infection rates surge beyond the healthcare system's capacity to deliver appropriate care. The analysis shows that four broad strategies emerge, ranging from brief lockdowns that only "smooth the curve" to sustained lockdowns that prevent infections from spiking beyond the healthcare system's capacity. Within this model, it can be optimal to have two separate periods of locking down, so returning to a lockdown after initial restrictions have been lifted is not necessarily a sign of failure. Relatively small changes in judgments about how to balance health and economic harms can alter dramatically which strategy prevails. Indeed, there are constellations of parameters for which two or even three of these distinct strategies can all perform equally well for the same set of initial conditions; these correspond to so-called triple Skiba points. The performance of trajectories can be highly nonlinear in the state variables, such that for various times t , the optimal unemployment rate could be low, medium, or high, but not anywhere in between. These complex dynamics emerge naturally from modeling the COVID-19 epidemic and suggest a degree of humility in policy debates. Even people who share a common understanding of the problem's economics and epidemiology can prefer dramatically different policies. Conversely, favoring very different policies is not evident that there are fundamental disagreements.

How long should the COVID-19 lockdown continue?

Nations struggled to decide when and how to end COVID-19 inspired lockdowns, with sharply divergent views between those arguing for a resumption of economic activity and those arguing for continuing the lockdown in some form. We examine the choice between continuing or ending a full lockdown within a simple optimal control model that encompasses both health and economic outcomes, and pays particular attention to when need for care exceeds hospital capacity. The model shows that very different strategies can perform similarly well and even both be optimal for the same relative valuation on work and life because of the presence of a so-called Skiba threshold. Qualitatively the alternate strategies correspond to trying essentially to eradicate the virus or merely to flatten the curve so fewer people urgently need healthcare when hospitals are already filled to capacity.

Leading bureaucracies to the tipping point: An alternative model of multiple stable equilibrium levels of corruption.

We present a novel model of corruption dynamics in the form of a nonlinear optimal dynamic control problem. It has a tipping point, but one whose origins and character are distinct from that in the classic Schelling (1978) model. The decision maker choosing a level of corruption is the chief or some other kind of authority figure who presides over a bureaucracy whose state of corruption is influenced by the authority figure's actions, and whose state in turn influences the pay-off for the authority figure. The policy interpretation is somewhat more optimistic than in other tipping models, and there are some surprising implications, notably that reforming the bureaucracy may be of limited value if the bureaucracy takes its cues from a corrupt leader.

[Electroconvulsive therapy as a "last resort" in the treatment of depression?]. / Elektrokonvulsionstherapie als Ultima Ratio in der Behandlung der Depression?

OBJECTIVE: The use of electroconvulsive therapy (ECT) in treatment-resistant depressed patients is supported by numerous international guidelines. This study aims to describe what type of patients are actually referred to treatment with ECT. METHODS: We included all patients referred to two main ECT-treatment centers in Switzerland during the period of August 2008 to February 2011. We collected data on the diagnosis, severity of illness, and the history of treatment. RESULTS: Most of the patients (n = 104) were referred after an average of 124 weeks of an index episode of unipolar depression. The patients were severely and chronically ill and had been treated on average for more than a decade. Eighty-three percent of the patients were referred for ECT treatment for the first time. CONCLUSIONS: The surveyed practice of referral does not concur with evidence-based guidelines for the use of ECT in the treatment of depression.

Numerical solution of a conspicuous consumption model with constant control delay.

We derive optimal pricing strategies for conspicuous consumption products in periods of recession. To that end, we formulate and investigate a two-stage economic optimal control problem that takes uncertainty of the recession period length and delay effects of the pricing strategy into account.This non-standard optimal control problem is difficult to solve analytically, and solutions depend on the variable model parameters. Therefore, we use a numerical result-driven approach. We propose a structure-exploiting direct method for optimal control to solve this challenging optimization problem. In particular, we discretize the uncertainties in the model formulation by using scenario trees and target the control delays by introduction of slack control functions.Numerical results illustrate the validity of our approach and show the impact of uncertainties and delay effects on optimal economic strategies. During the recession, delayed optimal prices are higher than the non-delayed ones. In the normal economic period, however, this effect is reversed and optimal prices with a delayed impact are smaller compared to the non-delayed case.