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Brankston G, Fisman DN, Poljak Z, Tuite AR, Greer AL. Examining the effects of voluntary avoidance behaviour and policy-mediated behaviour change on the dynamics of SARS-CoV-2: A mathematical model. Infect Dis Model 2024; 9:701-712. [PMID: 38646062 PMCID: PMC11033101 DOI: 10.1016/j.idm.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024] Open
Abstract
Background Throughout the SARS-CoV-2 pandemic, policymakers have had to navigate between recommending voluntary behaviour change and policy-driven behaviour change to mitigate the impact of the virus. While individuals will voluntarily engage in self-protective behaviour when there is an increasing infectious disease risk, the extent to which this occurs and its impact on an epidemic is not known. Methods This paper describes a deterministic disease transmission model exploring the impact of individual avoidance behaviour and policy-mediated avoidance behaviour on epidemic outcomes during the second wave of SARS-CoV-2 infections in Ontario, Canada (September 1, 2020 to February 28, 2021). The model incorporates an information feedback function based on empirically derived behaviour data describing the degree to which avoidance behaviour changed in response to the number of new daily cases COVID-19. Results Voluntary avoidance behaviour alone was estimated to reduce the final attack rate by 23.1%, the total number of hospitalizations by 26.2%, and cumulative deaths by 27.5% over 6 months compared to a counterfactual scenario in which there were no interventions or avoidance behaviour. A provincial shutdown order issued on December 26, 2020 was estimated to reduce the final attack rate by 66.7%, the total number of hospitalizations by 66.8%, and the total number of deaths by 67.2% compared to the counterfactual scenario. Conclusion Given the dynamics of SARS-CoV-2 in a pre-vaccine era, individual avoidance behaviour in the absence of government action would have resulted in a moderate reduction in disease however, it would not have been sufficient to entirely mitigate transmission and the associated risk to the population in Ontario. Government action during the second wave of the COVID-19 pandemic in Ontario reduced infections, protected hospital capacity, and saved lives.
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Affiliation(s)
| | - David N. Fisman
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Zvonimir Poljak
- Department of Population Medicine, University of Guelph, Canada
| | - Ashleigh R. Tuite
- Dalla Lana School of Public Health, University of Toronto, Canada
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Amy L. Greer
- Department of Population Medicine, University of Guelph, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
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Dos S Ribeiro C, van Roode M, Farag E, Nour M, Moustafa A, Ahmed M, Haringhuizen G, Koopmans M, van de Burgwal L. A framework for measuring timeliness in the outbreak response path: lessons learned from the Middle East respiratory syndrome (MERS) epidemic, September 2012 to January 2019. Euro Surveill 2022; 27:2101064. [PMID: 36695460 PMCID: PMC9716647 DOI: 10.2807/1560-7917.es.2022.27.48.2101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundEpidemics are a constant threat in the 21st century, particularly disease outbreaks following spillover of an animal virus to humans. Timeliness, a key metric in epidemic response, can be examined to identify critical steps and delays in public health action.AimTo examine timeliness, we analysed the response to the Middle East respiratory syndrome (MERS) epidemic, with a focus on the international and One Health response efforts.MethodsWe performed a historical review of the MERS epidemic between September 2012 and January 2019 in three steps: (i) the construction of a timeline identifying critical events in the global response, (ii) the performance of a critical path analysis to define outbreak milestones and (iii) a time gap analysis to measure timeliness in the execution of these milestones.ResultsWe proposed 14 MERS-specific milestones at different phases of the epidemic, assessing timeliness of the public health response as well as at the animal-human interface, where we identified the most significant delays.ConclusionsWhen comparing timeliness across three coronavirus epidemics, i.e. MERS (2012), SARS (2002) and COVID-19 (2019), we identified clear improvements over time for certain milestones including laboratory confirmation and diagnostics development, while this was not as apparent for others, as the identification of zoonotic hosts. To more efficiently respond to emerging threats, the global health community should widely assess and tackle specific delays in implementing response interventions by addressing challenges in the sharing of information, data and resources, as well as efficiency, quality, transparency and reliability of reporting events.
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Affiliation(s)
- Carolina Dos S Ribeiro
- Vrije Universiteit (VU) Amsterdam, Faculty of Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Amsterdam, the Netherlands
- The Netherlands National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, Bilthoven, the Netherlands
| | - Martine van Roode
- Erasmus Medical Center (EMC), Viroscience Department, Pandemic and Disaster Preparedness Centre, Rotterdam, the Netherlands
| | | | - Mohamed Nour
- Ministry of Public Health, Department of Public health, Doha, Qatar
| | - Aya Moustafa
- Ministry of Public Health, Department of Public health, Doha, Qatar
| | - Minahil Ahmed
- Ministry of Public Health, Department of Public health, Doha, Qatar
| | - George Haringhuizen
- The Netherlands National Institute for Public Health and the Environment (RIVM), Center for Infectious Disease Control, Bilthoven, the Netherlands
| | - Marion Koopmans
- Erasmus Medical Center (EMC), Viroscience Department, Pandemic and Disaster Preparedness Centre, Rotterdam, the Netherlands
| | - Linda van de Burgwal
- Vrije Universiteit (VU) Amsterdam, Faculty of Science, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Amsterdam, the Netherlands
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Sammut-Powell C, Reynard C, Allen J, McDermott J, Braybrook J, Parisi R, Lasserson D, Body R. Examining the effect of evaluation sample size on the sensitivity and specificity of COVID-19 diagnostic tests in practice: a simulation study. Diagn Progn Res 2022; 6:12. [PMID: 35468850 PMCID: PMC9035779 DOI: 10.1186/s41512-021-00116-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In response to the global COVID-19 pandemic, many in vitro diagnostic (IVD) tests for SARS-CoV-2 have been developed. Given the urgent clinical demand, researchers must balance the desire for precise estimates of sensitivity and specificity against the need for rapid implementation. To complement estimates of precision used for sample size calculations, we aimed to estimate the probability that an IVD will fail to perform to expected standards after implementation, following clinical studies with varying sample sizes. METHODS We assumed that clinical validation study estimates met the 'desirable' performance (sensitivity 97%, specificity 99%) in the target product profile (TPP) published by the Medicines and Healthcare products Regulatory Agency (MHRA). To estimate the real-world impact of imprecision imposed by sample size we used Bayesian posterior calculations along with Monte Carlo simulations with 10,000 independent iterations of 5,000 participants. We varied the prevalence between 1 and 15% and the sample size between 30 and 2,000. For each sample size, we estimated the probability that diagnostic accuracy would fail to meet the TPP criteria after implementation. RESULTS For a validation study that demonstrates 'desirable' sensitivity within a sample of 30 participants who test positive for COVID-19 using the reference standard, the probability that real-world performance will fail to meet the 'desirable' criteria is 10.7-13.5%, depending on prevalence. Theoretically, demonstrating the 'desirable' performance in 90 positive participants would reduce that probability to below 5%. A marked reduction in the probability of failure to hit 'desirable' specificity occurred between samples of 100 (19.1-21.5%) and 160 (4.3-4.8%) negative participants. There was little further improvement above sample sizes of 160 negative participants. CONCLUSION Based on imprecision alone, small evaluation studies can lead to the acceptance of diagnostic tests which are likely to fail to meet performance targets when deployed. There is diminished return on uncertainty surrounding an accuracy estimate above a total sample size of 250 (90 positive and 160 negative).
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Affiliation(s)
- Camilla Sammut-Powell
- Division of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UK
| | - Charles Reynard
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.
- Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
| | - Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - John McDermott
- Department of Genetics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Julian Braybrook
- National Measurement Laboratory, LGC, Queens Road, Teddington, Middlesex, TW11 0LY, UK
| | - Rosa Parisi
- Division of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UK
| | - Daniel Lasserson
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Body
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
- Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
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Petherick A, Goldszmidt R, Andrade EB, Furst R, Hale T, Pott A, Wood A. A worldwide assessment of changes in adherence to COVID-19 protective behaviours and hypothesized pandemic fatigue. Nat Hum Behav 2021; 5:1145-1160. [PMID: 34345009 DOI: 10.2139/ssrn.3774252] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/08/2021] [Indexed: 05/28/2023]
Abstract
As the COVID-19 pandemic lingers, the possibility of 'pandemic fatigue' has raised worldwide concerns. Here, we examine whether there was a gradual reduction in adherence to protective behaviours against COVID-19 from March through December 2020, as hypothesized in expectations of fatigue. We considered self-report behaviours from representative samples of the populations of 14 countries (N = 238,797), as well as mobility and policy data for 124 countries. Our results show that changes in adherence were empirically meaningful and geographically widespread. While a low-cost and habituating behaviour (mask wearing) exhibited a linear rise in adherence, high-cost and sensitizing behaviours (physical distancing) declined, but this decline decelerated over time, with small rebounds seen in later months. Reductions in adherence to physical distancing showed little difference across societal groups, but were less intense in countries with high interpersonal trust. Alternative underlying mechanisms and policy implications are discussed.
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Affiliation(s)
- Anna Petherick
- Blavatnik School of Government, University of Oxford, Oxford, UK.
| | - Rafael Goldszmidt
- Brazilian School of Public and Business Administration (EBAPE), Getulio Vargas Foundation (FGV), Rio de Janeiro, Brazil
| | - Eduardo B Andrade
- Brazilian School of Public and Business Administration (EBAPE), Getulio Vargas Foundation (FGV), Rio de Janeiro, Brazil
| | - Rodrigo Furst
- Brazilian School of Public and Business Administration (EBAPE), Getulio Vargas Foundation (FGV), Rio de Janeiro, Brazil
| | - Thomas Hale
- Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Annalena Pott
- Department of Zoology, University of Oxford, Oxford, UK
| | - Andrew Wood
- Department of Zoology, University of Oxford, Oxford, UK
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A worldwide assessment of changes in adherence to COVID-19 protective behaviours and hypothesized pandemic fatigue. Nat Hum Behav 2021; 5:1145-1160. [PMID: 34345009 DOI: 10.1038/s41562-021-01181-x] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/08/2021] [Indexed: 01/31/2023]
Abstract
As the COVID-19 pandemic lingers, the possibility of 'pandemic fatigue' has raised worldwide concerns. Here, we examine whether there was a gradual reduction in adherence to protective behaviours against COVID-19 from March through December 2020, as hypothesized in expectations of fatigue. We considered self-report behaviours from representative samples of the populations of 14 countries (N = 238,797), as well as mobility and policy data for 124 countries. Our results show that changes in adherence were empirically meaningful and geographically widespread. While a low-cost and habituating behaviour (mask wearing) exhibited a linear rise in adherence, high-cost and sensitizing behaviours (physical distancing) declined, but this decline decelerated over time, with small rebounds seen in later months. Reductions in adherence to physical distancing showed little difference across societal groups, but were less intense in countries with high interpersonal trust. Alternative underlying mechanisms and policy implications are discussed.
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