Profile likelihood-based analyses of infectious disease models

On near-redundancy and identifiability of parametric hazard regression models under censoring

We study parametric inference on a rich class of hazard regression models in the presence of right-censoring. Previous literature has reported some inferential challenges, such as multimodal or flat likelihood surfaces, in this class of models for some particular data sets. We formalize the study of these inferential problems by linking them to the concepts of near-redundancy and practical nonidentifiability of parameters. We show that the maximum likelihood estimators of the parameters in this class of models are consistent and asymptotically normal. Thus, the inferential problems in this class of models are related to the finite-sample scenario, where it is difficult to distinguish between the fitted model and a nested nonidentifiable (i.e., parameter-redundant) model. We propose a method for detecting near-redundancy, based on distances between probability distributions. We also employ methods used in other areas for detecting practical nonidentifiability and near-redundancy, including the inspection of the profile likelihood function and the Hessian method. For cases where inferential problems are detected, we discuss alternatives such as using model selection tools to identify simpler models that do not exhibit these inferential problems, increasing the sample size, or extending the follow-up time. We illustrate the performance of the proposed methods through a simulation study. Our simulation study reveals a link between the presence of near-redundancy and practical nonidentifiability. Two illustrative applications using real data, with and without inferential problems, are presented.

Likelihood-ratio test statistic for the finite-sample case in nonlinear ordinary differential equation models

Likelihood ratios are frequently utilized as basis for statistical tests, for model selection criteria and for assessing parameter and prediction uncertainties, e.g. using the profile likelihood. However, translating these likelihood ratios into p-values or confidence intervals requires the exact form of the test statistic's distribution. The lack of knowledge about this distribution for nonlinear ordinary differential equation (ODE) models requires an approximation which assumes the so-called asymptotic setting, i.e. a sufficiently large amount of data. Since the amount of data from quantitative molecular biology is typically limited in applications, this finite-sample case regularly occurs for mechanistic models of dynamical systems, e.g. biochemical reaction networks or infectious disease models. Thus, it is unclear whether the standard approach of using statistical thresholds derived for the asymptotic large-sample setting in realistic applications results in valid conclusions. In this study, empirical likelihood ratios for parameters from 19 published nonlinear ODE benchmark models are investigated using a resampling approach for the original data designs. Their distributions are compared to the asymptotic approximation and statistical thresholds are checked for conservativeness. It turns out, that corrections of the likelihood ratios in such finite-sample applications are required in order to avoid anti-conservative results.

[Forecasting models to guide intensive care COVID-19 capacities in Germany]

BACKGROUND

Time-series forecasting models play a central role in guiding intensive care coronavirus disease 2019 (COVID-19) bed capacity in a pandemic. A key predictor of future intensive care unit (ICU) COVID-19 bed occupancy is the number of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the general population, which in turn is highly associated with week-to-week variability, reporting delays, regional differences, number of unknown cases, time-dependent infection rates, vaccinations, SARS-CoV‑2 virus variants, and nonpharmaceutical containment measures. Furthermore, current and also future COVID ICU occupancy is significantly influenced by ICU discharge and mortality rates.

METHODS

Both the number of new SARS-CoV‑2 infections in the general population and intensive care COVID-19 bed occupancy rates are recorded in Germany. These data are statistically analyzed on a daily basis using epidemic SEIR (susceptible, exposed, infection, recovered) models using ordinary differential equations and multiple regression models.

RESULTS

Forecast results of the immediate trend (20-day forecast) of ICU occupancy by COVID-19 patients are made available to decision makers at various levels throughout the country.

CONCLUSION

The forecasts are compared with the development of available ICU bed capacities in order to identify capacity limitations at an early stage and to enable short-term solutions to be made, such as supraregional transfers.

Data-driven prediction of COVID-19 cases in Germany for decision making

Background

The COVID-19 pandemic has led to a high interest in mathematical models describing and predicting the diverse aspects and implications of the virus outbreak. Model results represent an important part of the information base for the decision process on different administrative levels. The Robert-Koch-Institute (RKI) initiated a project whose main goal is to predict COVID-19-specific occupation of beds in intensive care units: Steuerungs-Prognose von Intensivmedizinischen COVID-19 Kapazitäten (SPoCK). The incidence of COVID-19 cases is a crucial predictor for this occupation.

Methods

We developed a model based on ordinary differential equations for the COVID-19 spread with a time-dependent infection rate described by a spline. Furthermore, the model explicitly accounts for weekday-specific reporting and adjusts for reporting delay. The model is calibrated in a purely data-driven manner by a maximum likelihood approach. Uncertainties are evaluated using the profile likelihood method. The uncertainty about the appropriate modeling assumptions can be accounted for by including and merging results of different modelling approaches. The analysis uses data from Germany describing the COVID-19 spread from early 2020 until March 31st, 2021.

Results

The model is calibrated based on incident cases on a daily basis and provides daily predictions of incident COVID-19 cases for the upcoming three weeks including uncertainty estimates for Germany and its subregions. Derived quantities such as cumulative counts and 7-day incidences with corresponding uncertainties can be computed. The estimation of the time-dependent infection rate leads to an estimated reproduction factor that is oscillating around one. Data-driven estimation of the dark figure purely from incident cases is not feasible.

Conclusions

We successfully implemented a procedure to forecast near future COVID-19 incidences for diverse subregions in Germany which are made available to various decision makers via an interactive web application. Results of the incidence modeling are also used as a predictor for forecasting the need of intensive care units.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12874-022-01579-9).

Calibration and prediction for the inexact SIR model

A Susceptible Infective Recovered (SIR) model is usually unable to mimic the actual epidemiological system exactly. The reasons for this inaccuracy include observation errors and model discrepancies due to assumptions and simplifications made by the SIR model. Hence, this work proposes calibration and prediction methods for the SIR model with a one-time reported number of infected cases. Given that the observation errors of the reported data are assumed to be heteroscedastic, we propose two predictors to predict the actual epidemiological system by modeling the model discrepancy through a Gaussian Process model. One is the calibrated SIR model, and the other one is the discrepancy-corrected predictor, which integrates the calibrated SIR model with the Gaussian Process predictor to solve the model discrepancy. A wild bootstrap method quantifies the two predictors' uncertainty, while two numerical studies assess the performance of the proposed method. The numerical results show that, the proposed predictors outperform the existing ones and the prediction accuracy of the discrepancy-corrected predictor is improved by at least 49.95%.

Cell-to-cell variability in JAK2/STAT5 pathway components and cytoplasmic volumes defines survival threshold in erythroid progenitor cells

Survival or apoptosis is a binary decision in individual cells. However, at the cell-population level, a graded increase in survival of colony-forming unit-erythroid (CFU-E) cells is observed upon stimulation with erythropoietin (Epo). To identify components of Janus kinase 2/signal transducer and activator of transcription 5 (JAK2/STAT5) signal transduction that contribute to the graded population response, we extended a cell-population-level model calibrated with experimental data to study the behavior in single cells. The single-cell model shows that the high cell-to-cell variability in nuclear phosphorylated STAT5 is caused by variability in the amount of Epo receptor (EpoR):JAK2 complexes and of SHP1, as well as the extent of nuclear import because of the large variance in the cytoplasmic volume of CFU-E cells. 24-118 pSTAT5 molecules in the nucleus for 120 min are sufficient to ensure cell survival. Thus, variability in membrane-associated processes is sufficient to convert a switch-like behavior at the single-cell level to a graded population-level response.

A note on tools for prediction under uncertainty and identifiability of SIR-like dynamical systems for epidemiology

We provide an overview of the methods that can be used for prediction under uncertainty and data fitting of dynamical systems, and of the fundamental challenges that arise in this context. The focus is on SIR-like models, that are being commonly used when attempting to predict the trend of the COVID-19 pandemic. In particular, we raise a warning flag about identifiability of the parameters of SIR-like models; often, it might be hard to infer the correct values of the parameters from data, even for very simple models, making it non-trivial to use these models for meaningful predictions. Most of the points that we touch upon are actually generally valid for inverse problems in more general setups.

Mathematical Modeling and Robustness Analysis to Unravel COVID-19 Transmission Dynamics: The Italy Case

This study started from the request of providing predictions on hospitalization and Intensive Care Unit (ICU) rates that are caused by COVID-19 for the Umbria region in Italy. To this purpose, we propose the application of a computational framework to a SEIR-type (Susceptible, Exposed, Infected, Removed) epidemiological model describing the different stages of COVID-19 infection. The model discriminates between asymptomatic and symptomatic cases and it takes into account possible intervention measures in order to reduce the probability of transmission. As case studies, we analyze not only the epidemic situation in Umbria but also in Italy, in order to capture the evolution of the pandemic at a national level. First of all, we estimate model parameters through a Bayesian calibration method, called Conditional Robust Calibration (CRC), while using the official COVID-19 data of the Italian Civil Protection. Subsequently, Conditional Robustness Analysis (CRA) on the calibrated model is carried out in order to quantify the influence of epidemiological and intervention parameters on the hospitalization rates. The proposed pipeline properly describes the COVID-19 spread during the lock-down phase. It also reveals the underestimation of new positive cases and the need of promptly isolating asymptomatic and presymptomatic cases. The results emphasize the importance of the lock-down timeliness and provide accurate predictions on the current evolution of the pandemic.

Testing structural identifiability by a simple scaling method

Successful mathematical modeling of biological processes relies on the expertise of the modeler to capture the essential mechanisms in the process at hand and on the ability to extract useful information from empirical data. A model is said to be structurally unidentifiable, if different quantitative sets of parameters provide the same observable outcome. This is typical (but not exclusive) of partially observed problems in which only a few variables can be experimentally measured. Most of the available methods to test the structural identifiability of a model are either too complex mathematically for the general practitioner to be applied, or require involved calculations or numerical computation for complex non-linear models. In this work, we present a new analytical method to test structural identifiability of models based on ordinary differential equations, based on the invariance of the equations under the scaling transformation of its parameters. The method is based on rigorous mathematical results but it is easy and quick to apply, even to test the identifiability of sophisticated highly non-linear models. We illustrate our method by example and compare its performance with other existing methods in the literature.