How best can finite-time social distancing reduce epidemic final size?

Confinement tonicity on epidemic spreading

Emerging and re-emerging pathogens are latent threats in our society with the risk of killing millions of people worldwide, without forgetting the severe economic and educational backlogs. From COVID-19, we learned that self isolation and quarantine restrictions (confinement) were the main way of protection till availability of vaccines. However, abrupt lifting of social confinement would result in new waves of new infection cases and high death tolls. Here, inspired by how an extracellular solution can make water move into or out of a cell through osmosis, we define confinement tonicity. This can serve as a standalone measurement for the net direction and magnitude of flows between the confined and deconfined susceptible compartments. Numerical results offer insights on the effects of easing quarantine restrictions.

Reframing Optimal Control Problems for Infectious Disease Management in Low-Income Countries

Optimal control theory can be a useful tool to identify the best strategies for the management of infectious diseases. In most of the applications to disease control with ordinary differential equations, the objective functional to be optimized is formulated in monetary terms as the sum of intervention costs and the cost associated with the burden of disease. We present alternate formulations that express epidemiological outcomes via health metrics and reframe the problem to include features such as budget constraints and epidemiological targets. These alternate formulations are illustrated with a compartmental cholera model. The alternate formulations permit us to better explore the sensitivity of the optimal control solutions to changes in available budget or the desired epidemiological target. We also discuss some limitations of comprehensive cost assessment in epidemiology.

Optimal reduced-mixing for an SIS infectious-disease model

Which reduced-mixing strategy maximizes economic output during a disease outbreak? To answer this question, we formulate an optimal-control problem that maximizes the difference between revenue, due to healthy individuals, and medical costs, associated with infective individuals, for SIS disease dynamics. The control variable is the level of mixing in the population, which influences both revenue and the spread of the disease. Using Pontryagin's maximum principle, we find a closed-form solution for our problem. We explore an example of our problem with parameters for the transmission of Staphylococcus aureus in dairy cows, and we perform sensitivity analyses to determine how model parameters affect optimal strategies. We find that less mixing is preferable when the transmission rate is high, the per-capita recovery rate is low, or when the revenue parameter is much smaller than the cost parameter.

Minimizing the epidemic final size while containing the infected peak prevalence in SIR systems

Mathematical models are critical to understand the spread of pathogens in a population and evaluate the effectiveness of non-pharmaceutical interventions (NPIs). A plethora of optimal strategies has been recently developed to minimize either the infected peak prevalence ( I P P ) or the epidemic final size ( E F S ). While most of them optimize a simple cost function along a fixed finite-time horizon, no consensus has been reached about how to simultaneously handle the I P P and the E F S , while minimizing the intervention's side effects. In this work, based on a new characterization of the dynamical behaviour of SIR-type models under control actions (including the stability of equilibrium sets in terms of herd immunity), we study how to minimize the E F S while keeping the I P P controlled at any time. A procedure is proposed to tailor NPIs by separating transient from stationary control objectives: the potential benefits of the strategy are illustrated by a detailed analysis and simulation results related to the COVID-19 pandemic.

Feedback control of social distancing for COVID-19 via elementary formulae

Social distancing has been enacted in order to mitigate the spread of COVID-19. Like many authors, we adopt the classic epidemic SIR model, where the infection rate is the control variable. Its differential flatness property yields elementary closed-form formulae for open-loop social distancing scenarios, where, for instance, the increase of the number of uninfected people may be taken into account. Those formulae might therefore be useful to decision makers. A feedback loop stemming from model-free control leads to a remarkable robustness with respect to severe uncertainties and mismatches. Although an identification procedure is presented, a good knowledge of the recovery rate is not necessary for our control strategy.

COVID-19 epidemic control using short-term lockdowns for collective gain

While many efforts are currently devoted to vaccines development and administration, social distancing measures, including severe restrictions such as lockdowns, remain fundamental tools to contain the spread of COVID-19. A crucial point for any government is to understand, on the basis of the epidemic curve, the right temporal instant to set up a lockdown and then to remove it. Different strategies are being adopted with distinct shades of intensity. USA and Europe tend to introduce restrictions of considerable temporal length. They vary in time: a severe lockdown may be reached and then gradually relaxed. An interesting alternative is the Australian model where short and sharp responses have repeatedly tackled the virus and allowed people a return to near normalcy. After a few positive cases are detected, a lockdown is immediately set. In this paper we show that the Australian model can be generalized and given a rigorous mathematical analysis, casting strategies of the type short-term pain for collective gain in the context of sliding-mode control, an important branch of nonlinear control theory. This allows us to gain important insights regarding how to implement short-term lockdowns, obtaining a better understanding of their merits and possible limitations. Effects of vaccines administration in improving the control law's effectiveness are also illustrated. Our model predicts the duration of the severe lockdown to be set to maintain e.g. the number of people in intensive care under a certain threshold. After tuning our strategy exploiting data collected in Italy, it turns out that COVID-19 epidemic could be e.g. controlled by alternating one or two weeks of complete lockdown with one or two months of freedom, respectively. Control strategies of this kind, where the lockdown's duration is well circumscribed, could be important also to alleviate coronavirus impact on economy.

Model predictive control for optimal social distancing in a type SIR-switched model

Social distancing strategies have been adopted by governments to manage the COVID-19 pandemic, since the first outbreak began. However, further epidemic waves keep out the return of economic and social activities to their standard levels of intensity. Social distancing interventions based on control theory are needed to consider a formal dynamic characterization of the implemented SIR-type model to avoid unrealistic objectives and prevent further outbreaks. The objective of this work is twofold: to fully understand some dynamical aspects of SIR-type models under control actions (associated with second waves) and, based on it, to propose a switching non-linear model predictive control that optimize the non-pharmaceutical measures strategy. Opposite to other strategies, the objective here is not just to minimize the number of infected individuals at any time, but to minimize the final size of the epidemic while minimizing the time of social restrictions and avoiding the infected prevalence peak to overpass a maximum established by the healthcare system capacity. Simulations illustrate the benefits of the aforementioned proposal.

Optimization in the Context of COVID-19 Prediction and Control: A Literature Review

This paper presents an overview of some key results from a body of optimization studies that are specifically related to COVID-19, as reported in the literature during 2020-2021. As shown in this paper, optimization studies in the context of COVID-19 have been used for many aspects of the pandemic. From these studies, it is observed that since COVID-19 is a multifaceted problem, it cannot be studied from a single perspective or framework, and neither can the related optimization models. Four new and different frameworks are proposed that capture the essence of analyzing COVID-19 (or any pandemic for that matter) and the relevant optimization models. These are: (i) microscale vs. macroscale perspective; (ii) early stages vs. later stages perspective; (iii) aspects with direct vs. indirect relationship to COVID-19; and (iv) compartmentalized perspective. To limit the scope of the review, only optimization studies related to the prediction and control of COVID-19 are considered (public health focused), and which utilize formal optimization techniques or machine learning approaches. In this context and to the best of our knowledge, this survey paper is the first in the literature with a focus on the prediction and control related optimization studies. These studies include optimization of screening testing strategies, prediction, prevention and control, resource management, vaccination prioritization, and decision support tools. Upon reviewing the literature, this paper identifies current gaps and major challenges that hinder the closure of these gaps and provides some insights into future research directions.

A simple criterion to design optimal non-pharmaceutical interventions for mitigating epidemic outbreaks

For mitigating the COVID-19 pandemic, much emphasis is made on implementing non-pharmaceutical interventions to keep the reproduction number below one. However, using that objective ignores that some of these interventions, like bans of public events or lockdowns, must be transitory and as short as possible because of their significant economic and societal costs. Here, we derive a simple and mathematically rigorous criterion for designing optimal transitory non-pharmaceutical interventions for mitigating epidemic outbreaks. We find that reducing the reproduction number below one is sufficient but not necessary. Instead, our criterion prescribes the required reduction in the reproduction number according to the desired maximum of disease prevalence and the maximum decrease of disease transmission that the interventions can achieve. We study the implications of our theoretical results for designing non-pharmaceutical interventions in 16 cities and regions during the COVID-19 pandemic. In particular, we estimate the minimal reduction of each region's contact rate necessary to control the epidemic optimally. Our results contribute to establishing a rigorous methodology to design optimal non-pharmaceutical intervention policies for mitigating epidemic outbreaks.

Optimal Immunity Control and Final Size Minimization by Social Distancing for the SIR Epidemic Model

The aim of this article is to understand how to apply partial or total containment to SIR epidemic model during a given finite time interval in order to minimize the epidemic final size, that is the cumulative number of cases infected during the complete course of an epidemic. The existence and uniqueness of an optimal strategy are proved for this infinite-horizon problem, and a full characterization of the solution is provided. The best policy consists in applying the maximal allowed social distancing effort until the end of the interval, starting at a date that is not always the closest date and may be found by a simple algorithm. Both theoretical results and numerical simulations demonstrate that it leads to a significant decrease in the epidemic final size. We show that in any case the optimal intervention has to begin before the number of susceptible cases has crossed the herd immunity level, and that its limit is always smaller than this threshold. This problem is also shown to be equivalent to the minimum containment time necessary to stop at a given distance after this threshold value.