Testing, tracing and isolation in compartmental models

Optimal social distancing in pandemic preparedness and lessons from COVID-19: Intervention intensity and infective travelers

Our analysis seeks best social distancing strategies optimally balancing the direct costs of a threatening outbreak with its societal-level costs by investigating the effects of different levels of restrictions' intensity and of the continued importation of infective travellers, while controlling for the key dimensions of the response, such as early action, adherence and the relative weight of societal costs. We identify two primary degrees of freedom in epidemic control, namely the maximum intensity of control measures and their duration. In the absence of travellers, a lower (higher) maximum intensity requires a longer (shorter) duration to achieve similar control outcomes. However, uncontrollable external factors, like the importation of undetected infectives, significantly constrain these degrees of freedom so that the optimal strategy results to be one with low/moderate intensity but prolonged in time. These findings underscore the necessity for resilient health systems and coordinated global responses in preparedness plans.

Smart epidemic control: A hybrid model blending ODEs and agent-based simulations for optimal, real-world intervention planning

Optimal intervention planning is a critical part of epidemiological control, which is difficult to attain in real life situations. Ordinary differential equation (ODE) models can be used to optimize control but the results can not be easily translated to interventions in highly complex real life environments. Agent-based methods on the other hand allow detailed modeling of the environment but optimization is precluded by the large number of parameters. Our goal was to combine the advantages of both approaches, i.e., to allow control optimization in complex environments. The epidemic control objectives are expressed as a time-dependent reference for the number of infected people. To track this reference, a model predictive controller (MPC) is designed with a compartmental ODE prediction model to compute the optimal level of stringency of interventions, which are later translated to specific actions such as mobility restriction, quarantine policy, masking rules, school closure. The effects of interventions on the transmission rate of the pathogen, and hence their stringency, are computed using PanSim, an agent-based epidemic simulator that contains a detailed model of the environment. The realism and practical applicability of the method is demonstrated by the wide range of discrete level measures that can be taken into account. Moreover, the change between measures applied during consecutive planning intervals is also minimized. We found that such a combined intervention planning strategy is able to efficiently control a COVID-19-like epidemic process, in terms of incidence, virulence, and infectiousness with surprisingly sparse (e.g. 21 day) intervention regimes. At the same time, the approach proved to be robust even in scenarios with significant model uncertainties, such as unknown transmission rate, uncertain time and probability constants. The high performance of the computation allows a large number of test cases to be run. The proposed computational framework can be reused for epidemic management of unexpected pandemic events and can be customized to the needs of any country.

A mathematical modeling study of the effectiveness of contact tracing in reducing the spread of infectious diseases with incubation period

In this work, we study an epidemic model with demography that incorporates some key aspects of the contact tracing intervention. We derive generic formulae for the effective reproduction number Re when contact tracing is employed to mitigate the spread of infection. The derived expressions are reformulated in terms of the initial reproduction number R0 (in the absence of tracing), the number of traced cases caused by a primary untraced reported index case, and the average number of secondary cases infected by traced infectees during their infectious period. In parallel, under some restrictions, the local stability of the disease-free equilibrium is investigated. The model was fitted to data of Ebola disease collected during the 2014-2016 outbreaks in West Africa. Finally, numerical simulations are provided to investigate the effect of key parameters on Re. By considering ongoing interventions, the simulations indicate whether contact tracing can suppress Re below unity, as well as identify parameter regions where it can effectively contain epidemic outbreaks when applied with a given level of efficiency.

Mathematical Contact Tracing Models for the COVID-19 Pandemic: A Systematic Review of the Literature

Background: Contact tracing (CT) is a primary means of controlling infectious diseases, such as coronavirus disease 2019 (COVID-19), especially in the early months of the pandemic. Objectives: This work is a systematic review of mathematical models used during the COVID-19 pandemic that explicitly parameterise CT as a potential mitigator of the effects of the pandemic. Methods: This review is registered in PROSPERO. A comprehensive literature search was conducted using the PubMed, EMBASE, Cochrane Library, CINAHL, and Scopus databases. Two reviewers independently selected the title/abstract, full text, data extraction, and risk of bias. Disagreements were resolved through discussion. The characteristics of the studies and mathematical models were collected from each study. Results: A total of 53 articles out of 2101 were included. The modelling of the COVID-19 pandemic was the main objective of 23 studies, while the remaining articles evaluated the forecast transmission of COVID-19. Most studies used compartmental models to simulate COVID-19 transmission (26, 49.1%), while others used agent-based (16, 34%), branching processes (5, 9.4%), or other mathematical models (6). Most studies applying compartmental models consider CT in a separate compartment. Quarantine and basic reproduction numbers were also considered in the models. The quality assessment scores ranged from 13 to 26 of 28. Conclusions: Despite the significant heterogeneity in the models and the assumptions on the relevant model parameters, this systematic review provides a comprehensive overview of the models proposed to evaluate the COVID-19 pandemic, including non-pharmaceutical public health interventions such as CT. Prospero Registration: CRD42022359060.

Modelling with SPEED: a Stochastic Predictor of Early Epidemic Detection

The frequency of emerging infectious disease outbreaks continues to rise, necessitating predictive frameworks for public health decision-making. This study introduces the Stochastic Predictor of Early Epidemic Detection (SPEED) model, an adaptation of the classic Susceptible-Infected-Recovered model, employing a Gillespie-like algorithm to simulate early-stage stochastic disease transmission. SPEED incorporates individual-level detection probabilities based on the infection time and the lag from GP consultation to lab confirmation. The model dynamically adjusts to public health responses by enhancing testing and reducing detection times once a single case has been identified. SPEED serves two key functionalities. First, as a statistical inference tool refining reproduction number estimates following the detection of a small number of cases. SPEED inference uses specified prior distributions for the reproduction number to provide reliable posterior estimates. Second, to simulate epidemic scenarios under specified values of the reproduction number in order to construct a distribution of the time to subsequent detections. The model is used to evaluate how second case timings can rule out higher values of the reproduction number. Comparisons with simulations under heightened surveillance scenarios demonstrate the model's utility in assessing response efficacy on the initial outbreak spread. Our results demonstrate SPEED applied to a single case of influenza A(H1N2)v, detected through routine flu surveillance on the 23rd November 2023.

A Theoretical Analysis of Mass Testing Strategies to Control Epidemics

One of the strategies used in some countries to contain the COVID-19 epidemic has been the test-and-isolate policy, generally coupled with contact tracing. Such strategies have been examined in several simulation models, but a theoretical analysis of their effectiveness in simple epidemic model is, to our knowledge, missing. In this paper, we present four epidemic models of either SIR or SEIR type, in which it is assumed that at fixed times the whole population (or a part of the population) is tested and, if positive, isolated. We find the conditions for an epidemic to go extinct under such a strategy; for these types of models we provide an appropriate definition of R 0 , that can be computed either analytically or numerically. Finally, we show numerically that the final-size relation of SIR models approximately holds for the four models, over a large parameter range.

A novel indicator in epidemic monitoring through a case study of Ebola in West Africa (2014-2016)

The E/S (exposed/susceptible) ratio is analyzed in the SEIR model. The ratio plays a key role in understanding epidemic dynamics during the 2014-2016 Ebola outbreak in Sierra Leone and Guinea. The maximum value of the ratio occurs immediately before or after the time-dependent reproduction number (Rt) equals 1, depending on the initial susceptible population (S(0)). It is demonstrated that transmission rate curves corresponding to various incubation periods intersect at a single point referred to as the Cross Point (CP). At this point, the E/S ratio reaches an extremum, signifying a critical shift in transmission dynamics and aligning with the time when Rt approaches 1. By plotting transmission rate curves, β(t), for any two arbitrary incubation periods and tracking their intersections, we can trace CP over time. CP serves as an indicator of epidemic status, especially when Rt is close to 1. It provides a practical means of monitoring epidemics without prior knowledge of the incubation period. Through a case study, we estimate the transmission rate and reproduction number, identifying CP and Rt = 1 while examining the E/S ratio across various values of S(0).

A mathematical model to assess the effectiveness of test-trace-isolate-and-quarantine under limited capacities

Diagnostic testing followed by isolation of identified cases with subsequent tracing and quarantine of close contacts-often referred to as test-trace-isolate-and-quarantine (TTIQ) strategy-is one of the cornerstone measures of infectious disease control. The COVID-19 pandemic has highlighted that an appropriate response to outbreaks of infectious diseases requires a firm understanding of the effectiveness of such containment strategies. To this end, mathematical models provide a promising tool. In this work, we present a delay differential equation model of TTIQ interventions for infectious disease control. Our model incorporates the assumption of limited TTIQ capacities, providing insights into the reduced effectiveness of testing and tracing in high prevalence scenarios. In addition, we account for potential transmission during the early phase of an infection, including presymptomatic transmission, which may be particularly adverse to a TTIQ based control. Our numerical experiments inspired by the early spread of COVID-19 in Germany demonstrate the effectiveness of TTIQ in a scenario where immunity within the population is low and pharmaceutical interventions are absent, which is representative of a typical situation during the (re-)emergence of infectious diseases for which therapeutic drugs or vaccines are not yet available. Stability and sensitivity analyses reveal both disease-dependent and disease-independent factors that impede or enhance the success of TTIQ. Studying the diminishing impact of TTIQ along simulations of an epidemic wave, we highlight consequences for intervention strategies.

An adaptive testing strategy for efficient utilization of healthcare resources during an epidemic

Lockdowns are found to be effective against rapidly spreading epidemics like COVID-19. Two downsides to strategies rooted in social distancing and lockdowns are that they adversely affect the economy and prolong the duration of the epidemic. The extended duration observed in these strategies is often due to the under-utilization of medical facilities. Even though an under-utilized health care system is preferred over an overwhelmed one, an alternate strategy could be to maintain medical facilities close to their capacity, with a factor of safety. We explore the practicality of this alternate mitigation strategy and show that it can be achieved by varying the testing rate. We present an algorithm to calculate the number of tests per day to maintain medical facilities close to their capacity. We illustrate the efficacy of our strategy by showing that it reduced the epidemic duration by 40% in comparison to lockdown-based strategies.

Assessing potential insights of an imperfect testing strategy: Parameter estimation and practical identifiability using early COVID-19 data in India

A deterministic model with testing of infected individuals has been proposed to investigate the potential consequences of the impact of testing strategy. The model exhibits global dynamics concerning the disease-free and a unique endemic equilibrium depending on the basic reproduction number when the recruitment of infected individuals is zero; otherwise, the model does not have a disease-free equilibrium, and disease never dies out in the community. Model parameters have been estimated using the maximum likelihood method with respect to the data of early COVID-19 outbreak in India. The practical identifiability analysis shows that the model parameters are estimated uniquely. The consequences of the testing rate for the weekly new cases of early COVID-19 data in India tell that if the testing rate is increased by 20% and 30% from its baseline value, the weekly new cases at the peak are decreased by 37.63% and 52.90%; and it also delayed the peak time by four and fourteen weeks, respectively. Similar findings are obtained for the testing efficacy that if it is increased by 12.67% from its baseline value, the weekly new cases at the peak are decreased by 59.05% and delayed the peak by 15 weeks. Therefore, a higher testing rate and efficacy reduce the disease burden by tumbling the new cases, representing a real scenario. It is also obtained that the testing rate and efficacy reduce the epidemic's severity by increasing the final size of the susceptible population. The testing rate is found more significant if testing efficacy is high. Global sensitivity analysis using partial rank correlation coefficients (PRCCs) and Latin hypercube sampling (LHS) determine the key parameters that must be targeted to worsen/contain the epidemic.

A mathematical model to assess the impact of testing and isolation compliance on the transmission of COVID-19

The COVID-19 pandemic has ravaged global health and national economies worldwide. Testing and isolation are effective control strategies to mitigate the transmission of COVID-19, especially in the early stage of the disease outbreak. In this paper, we develop a deterministic model to investigate the impact of testing and compliance with isolation on the transmission of COVID-19. We derive the control reproduction number R C , which gives the threshold for disease elimination or prevalence. Using data from New York State in the early stage of the disease outbreak, we estimate R C = 7.989 . Both elasticity and sensitivity analyses show that testing and compliance with isolation are significant in reducing R C and disease prevalence. Simulation reveals that only high testing volume combined with a large proportion of individuals complying with isolation have great impact on mitigating the transmission. The testing starting date is also crucial: the earlier testing is implemented, the more impact it has on reducing the infection. The results obtained here would also be helpful in developing guidelines of early control strategies for pandemics similar to COVID-19.

Assessing the transmissibility of epidemics involving epidemic zoning

BACKGROUND

Epidemic zoning is an important option in a series of measures for the prevention and control of infectious diseases. We aim to accurately assess the disease transmission process by considering the epidemic zoning, and we take two epidemics with distinct outbreak sizes as an example, i.e., the Xi'an epidemic in late 2021 and the Shanghai epidemic in early 2022.

METHODS

For the two epidemics, the total cases were clearly distinguished by their reporting zone and the Bernoulli counting process was used to describe whether one infected case in society would be reported in control zones or not. Assuming the imperfect or perfect isolation policy in control zones, the transmission processes are respectively simulated by the adjusted renewal equation with case importation, which can be derived on the basis of the Bellman-Harris branching theory. The likelihood function containing unknown parameters is then constructed by assuming the daily number of new cases reported in control zones follows a Poisson distribution. All the unknown parameters were obtained by the maximum likelihood estimation.

RESULTS

For both epidemics, the internal infections characterized by subcritical transmission within the control zones were verified, and the median control reproduction numbers were estimated as 0.403 (95% confidence interval (CI): 0.352, 0.459) in Xi'an epidemic and 0.727 (95% CI: 0.724, 0.730) in Shanghai epidemic, respectively. In addition, although the detection rate of social cases quickly increased to 100% during the decline period of daily new cases until the end of the epidemic, the detection rate in Xi'an was significantly higher than that in Shanghai in the previous period.

CONCLUSIONS

The comparative analysis of the two epidemics with different consequences highlights the role of the higher detection rate of social cases since the beginning of the epidemic and the reduced transmission risk in control zones throughout the outbreak. Strengthening the detection of social infection and strictly implementing the isolation policy are of great significance to avoid a larger-scale epidemic.

A contact tracing SIR model for randomly mixed populations

Contact tracing is an important intervention measure to control infectious diseases. We present a new approach that borrows the edge dynamics idea from network models to track contacts included in a compartmental SIR model for an epidemic spreading in a randomly mixed population. Unlike network models, our approach does not require statistical information of the contact network, data that are usually not readily available. The model resulting from this new approach allows us to study the effect of contact tracing and isolation of diagnosed patients on the control reproduction number and number of infected individuals. We estimate the effects of tracing coverage and capacity on the effectiveness of contact tracing. Our approach can be extended to more realistic models that incorporate latent and asymptomatic compartments.

Assessing the Impact of Contact Tracing, Quarantine and Red Zone on the Dynamical Evolution of the Covid-19 Pandemic using the Cellular Automata Approach and the Resulting Mean Field System: A Case study in Mauritius

A cellular automaton (CA) depicting the dynamics of the Covid-19 pandemic, is set up. Unlike the classic CA models, the present CA is an enhanced version, embodied with contact tracing, quarantine and red zones to model the spread of the Covid-19 pandemic. The incubation and illness periods are assimilated in the CA system. An algorithm is provided to showcase the rules governing the CA, with and without the enactment of red zones. By means of mean field approximation, a nonlinear system of delay differential equations (DDE) illustrating the dynamics of the CA is emanated. The concept of red zones is incorporated in the resulting DDE system, forming a DDE model with red zone. The stability analysis of both systems are performed and their respective reproduction numbers are derived. The effect of contact tracing and vaccination on both reproduction numbers is also investigated. Numerical simulations of both systems are conducted and real time Covid-19 data in Mauritius for the period ranged from 5 March 2021 to 2 September 2021, is employed to validate the model. Our findings reveal that a combination of both contact tracing and vaccination is indispensable to attenuate the reproductive ratio to less than 1. Effective contact tracing, quarantine and red zones have been the key strategies to contain the Covid-19 virus in Mauritius. The present study furnishes valuable perspectives to assist the health authorities in addressing the unprecedented rise of Covid-19 cases.

Sequential time-window learning with approximate Bayesian computation: an application to epidemic forecasting

The long duration of the COVID-19 pandemic allowed for multiple bursts in the infection and death rates, the so-called epidemic waves. This complex behavior is no longer tractable by simple compartmental model and requires more sophisticated mathematical techniques for analyzing epidemic data and generating reliable forecasts. In this work, we propose a framework for analyzing complex dynamical systems by dividing the data in consecutive time-windows to be separately analyzed. We fit parameters for each time-window through an approximate Bayesian computation (ABC) algorithm, and the posterior distribution of parameters obtained for one window is used as the prior distribution for the next window. This Bayesian learning approach is tested with data on COVID-19 cases in multiple countries and is shown to improve ABC performance and to produce good short-term forecasting.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11071-022-07865-x.

Disease spreading modeling and analysis: a survey

MOTIVATION

The control of the diffusion of diseases is a critical subject of a broad research area, which involves both clinical and political aspects. It makes wide use of computational tools, such as ordinary differential equations, stochastic simulation frameworks and graph theory, and interaction data, from molecular to social granularity levels, to model the ways diseases arise and spread. The coronavirus disease 2019 (COVID-19) is a perfect testbench example to show how these models may help avoid severe lockdown by suggesting, for instance, the best strategies of vaccine prioritization.

RESULTS

Here, we focus on and discuss some graph-based epidemiological models and show how their use may significantly improve the disease spreading control. We offer some examples related to the recent COVID-19 pandemic and discuss how to generalize them to other diseases.

Modelling: Understanding pandemics and how to control them

New disease challenges, societal demands and better or novel types of data, drive innovations in the structure, formulation and analysis of epidemic models. Innovations in modelling can lead to new insights into epidemic processes and better use of available data, yielding improved disease control and stimulating collection of better data and new data types. Here we identify key challenges for the structure, formulation, analysis and use of mathematical models of pathogen transmission relevant to current and future pandemics.

A hybrid stochastic model and its Bayesian identification for infectious disease screening in a university campus with application to massive COVID-19 screening at the University of Liège

Amid the COVID-19 pandemic, universities are implementing various prevention and mitigation measures. Identifying and isolating infectious individuals by using screening testing is one such a measure that can contribute to reducing spread. Here, we propose a hybrid stochastic model for infectious disease transmission in a university campus with screening testing and its surrounding community. Based on a compartmental modeling strategy, this hybrid stochastic model represents the evolution of the infectious disease and its transmission using continuous-time stochastic dynamics, and it represents the screening testing as discrete stochastic events. We also develop, in a Bayesian framework, the identification of parameters of this hybrid stochastic model, including transmission rates. These parameters were identified from the screening test data for the university population and observed incidence counts for the surrounding community. We implement the exploration of the Bayesian posterior using a machine-learning simulation-based inference approach. The proposed methodology was applied in a retrospective modeling study of a massive COVID-19 screening conducted at the University of Liège in Fall 2020. The emphasis of the paper is on the development of the hybrid stochastic model to assess the impact of screening testing as a measure to reduce spread. The hybrid stochastic model allows various factors to be represented and examined, such as interplay with the surrounding community, variability of the transmission dynamics, the rate of participation in the screening testing, the test sensitivity, the test frequency, the diagnosis delay, and compliance with isolation. The application in the retrospective modeling study suggests that a high rate of participation and a high test frequency are important factors to reduce spread.

Regional opening strategies with commuter testing and containment of new SARS-CoV-2 variants in Germany

BACKGROUND

Despite the vaccination process in Germany, a large share of the population is still susceptible to SARS-CoV-2. In addition, we face the spread of novel variants. Until we overcome the pandemic, reasonable mitigation and opening strategies are crucial to balance public health and economic interests.

METHODS

We model the spread of SARS-CoV-2 over the German counties by a graph-SIR-type, metapopulation model with particular focus on commuter testing. We account for political interventions by varying contact reduction values in private and public locations such as homes, schools, workplaces, and other. We consider different levels of lockdown strictness, commuter testing strategies, or the delay of intervention implementation. We conduct numerical simulations to assess the effectiveness of the different intervention strategies after one month. The virus dynamics in the regions (German counties) are initialized randomly with incidences between 75 and 150 weekly new cases per 100,000 inhabitants (red zones) or below (green zones) and consider 25 different initial scenarios of randomly distributed red zones (between 2 and 20% of all counties). To account for uncertainty, we consider an ensemble set of 500 Monte Carlo runs for each scenario.

RESULTS

We find that the strength of the lockdown in regions with out of control virus dynamics is most important to avoid the spread into neighboring regions. With very strict lockdowns in red zones, commuter testing rates of twice a week can substantially contribute to the safety of adjacent regions. In contrast, the negative effect of less strict interventions can be overcome by high commuter testing rates. A further key contributor is the potential delay of the intervention implementation. In order to keep the spread of the virus under control, strict regional lockdowns with minimum delay and commuter testing of at least twice a week are advisable. If less strict interventions are in favor, substantially increased testing rates are needed to avoid overall higher infection dynamics.

CONCLUSIONS

Our results indicate that local containment of outbreaks and maintenance of low overall incidence is possible even in densely populated and highly connected regions such as Germany or Western Europe. While we demonstrate this on data from Germany, similar patterns of mobility likely exist in many countries and our results are, hence, generalizable to a certain extent.

A Multi-Agent-Based Simulation Model for the Spreading of Diseases Through Social Interactions During Pandemics

Epidemiological models have a vital and consolidated role in aiding decision-making during crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. However, the influence of social interactions in the spreading of communicable diseases is left aside from the main models in the literature. The main contribution of this work is the introduction of a probabilistic simulation model based on a multi-agent approach that is capable of predicting the spreading of diseases. Our proposal has a simple model for the main source of infections in pandemics of respiratory viruses: social interactions. This simplicity is key for incorporating complex networks topology into the model, which is a more accurate representation for real-world interactions. This flexibility in network structure allows the evaluation of specific phenomena, such as the presence of super-spreaders. We provide the modeling for the dynamical network topology in two different simulation scenarios. Another contribution is the generic microscopic model for infection evolution that enables the evaluation of impact from more specific behaviors and interventions on the overall spreading of the disease. It also enables a more intuitive process for going from data to model parameters. This ease of changing the infection evolution model is key for performing more complete analyses than would be possible in other models from the literature. Further, we give specific parameters for a controlled scenario with quick testing and tracing. We present computational results that illustrate the model utilization for predicting the spreading of COVID-19 in a city. Also, we show the results of applying the model for assessing the risk of resuming on-site activities at a collective use facility.

How optimal allocation of limited testing capacity changes epidemic dynamics

Insufficient testing capacity has been a critical bottleneck in the worldwide fight against COVID-19. Optimizing the deployment of limited testing resources has therefore emerged as a keystone problem in pandemic response planning. Here, we use a modified SEIR model to optimize testing strategies under a constraint of limited testing capacity. We define pre-symptomatic, asymptomatic, and symptomatic infected classes, and assume that positively tested individuals are immediately moved into quarantine. We further define two types of testing. Clinical testing focuses only on the symptomatic class. Non-clinical testing detects pre- and asymptomatic individuals from the general population, and a concentration parameter governs the degree to which such testing can be focused on high infection risk individuals. We then solve for the optimal mix of clinical and non-clinical testing as a function of both testing capacity and the concentration parameter. We find that purely clinical testing is optimal at very low testing capacities, supporting early guidance to ration tests for the sickest patients. Additionally, we find that a mix of clinical and non-clinical testing becomes optimal as testing capacity increases. At high but empirically observed testing capacities, a mix of clinical testing and non-clinical testing, even if extremely unfocused, becomes optimal. We further highlight the advantages of early implementation of testing programs, and of combining optimized testing with contact reduction interventions such as lockdowns, social distancing, and masking.

Microsimulation based quantitative analysis of COVID-19 management strategies

Pandemic management requires reliable and efficient dynamical simulation to predict and control disease spreading. The COVID-19 (SARS-CoV-2) pandemic is mitigated by several non-pharmaceutical interventions, but it is hard to predict which of these are the most effective for a given population. We developed the computationally effective and scalable, agent-based microsimulation framework PanSim, allowing us to test control measures in multiple infection waves caused by the spread of a new virus variant in a city-sized societal environment using a unified framework fitted to realistic data. We show that vaccination strategies prioritising occupational risk groups minimise the number of infections but allow higher mortality while prioritising vulnerable groups minimises mortality but implies an increased infection rate. We also found that intensive vaccination along with non-pharmaceutical interventions can substantially suppress the spread of the virus, while low levels of vaccination, premature reopening may easily revert the epidemic to an uncontrolled state. Our analysis highlights that while vaccination protects the elderly from COVID-19, a large percentage of children will contract the virus, and we also show the benefits and limitations of various quarantine and testing scenarios. The uniquely detailed spatio-temporal resolution of PanSim allows the design and testing of complex, specifically targeted interventions with a large number of agents under dynamically changing conditions.

Synchronization in epidemic growth and the impossibility of selective containment

Containment, aiming to prevent the epidemic stage of community-spreading altogether, and mitigation, aiming to merely ‘flatten the curve’ of a wide-ranged outbreak, constitute two qualitatively different approaches to combating an epidemic through non-pharmaceutical interventions. Here, we study a simple model of epidemic dynamics separating the population into two groups, namely a low-risk group and a high-risk group, for which different strategies are pursued. Due to synchronization effects, we find that maintaining a slower epidemic growth behaviour for the high-risk group is unstable against any finite coupling between the two groups. More precisely, the density of infected individuals in the two groups qualitatively evolves very similarly, apart from a small time delay and an overall scaling factor quantifying the coupling between the groups. Hence, selective containment of the epidemic in a targeted (high-risk) group is practically impossible whenever the surrounding society implements a mitigated community-spreading. We relate our general findings to the ongoing COVID-19 pandemic.

Aptamer-Functionalized Nanochannels for One-Step Detection of SARS-CoV-2 in Samples from COVID-19 Patients

With the outbreak of COVID-19, which is fast transmitting and highly contagious, the development of rapid, highly specific, and sensitive detection kits has become a research hotspot. The existing assay methods for SARS-CoV-2 are mainly based on enzymatic reactions, which require expensive reagents, hindering popular use, especially in resource-constrained areas. Herein, we propose an aptamer-based method for the assay of SARS-CoV-2 via binding of the spike protein using functionalized biomimetic nanochannels. To get the analogous effect of human ACE2, a receptor for the spike protein, the aptamer to bind to the spike S1 protein has been first screened by a SELEX technique and then immobilized on the previously prepared nanochannels. In the presence of SARS-CoV-2, the changes in steric hindrance and charge density on the surface of the nanochannels will affect the ion transport, along with a rapid electrochemical response. Our method has been successfully applied to detect the viral particles in clinical pharyngeal swab specimens in one step without sample treatment. We expect this rapid, reagent-free, and sensitive assay method to be developed as a useful tool for diagnosing COVID-19.

Internet of Things Based Contact Tracing Systems

The COVID-19 pandemic has significantly threatened the health and well-being of humanity. Contact tracing (CT) as an important non-pharmaceutical intervention is essential to containing the spread of such an infectious disease. However, current CT solutions are fragmented with limited use of sensing and computing technologies in a scalable framework. These issues can be well addressed with the use of the Internet of Things (IoT) technologies. Therefore, we need to overview the principle, motivation, and architecture for a generic IoT-based CT system (IoT-CTS). A novel architecture for IoT-CTS solutions is proposed with the consideration of peer-to-peer and object-to-peer contact events, as well as the discussion on key topics, such as an overview of applicable sensors for CT needs arising from the COVID-19 transmission methods. The proposed IoT-CTS architecture aims to holistically utilize essential sensing mechanisms with the analysis of widely adopted privacy-preserving techniques. With the use of generic peer-to-peer and object-to-peer sensors based on proximity and environment sensing mechanisms, the infectious cases with self-directed strategies can be effectively reduced. Some open research directions are presented in the end.

Low case numbers enable long-term stable pandemic control without lockdowns

The traditional long-term solutions for epidemic control involve eradication or population immunity. Here, we analytically derive the existence of a third viable solution: a stable equilibrium at low case numbers, where test-trace-and-isolate policies partially compensate for local spreading events and only moderate restrictions remain necessary. In this equilibrium, daily cases stabilize around ten or fewer new infections per million people. However, stability is endangered if restrictions are relaxed or case numbers grow too high. The latter destabilization marks a tipping point beyond which the spread self-accelerates. We show that a lockdown can reestablish control and that recurring lockdowns are not necessary given sustained, moderate contact reduction. We illustrate how this strategy profits from vaccination and helps mitigate variants of concern. This strategy reduces cumulative cases (and fatalities) four times more than strategies that only avoid hospital collapse. In the long term, immunization, large-scale testing, and international coordination will further facilitate control.

Digital Contact Tracing Applications during COVID-19: A Scoping Review about Public Acceptance

Digital contact tracing applications (CTAs) have been one of the most widely discussed technical methods of controlling the COVID-19 outbreak. The effectiveness of this technology and its ethical justification depend highly on public acceptance and adoption. This study aims to describe the current knowledge about public acceptance of CTAs and identify individual perspectives, which are essential to consider concerning CTA acceptance and adoption. In this scoping review, 25 studies from four continents across the globe are compiled, and critical topics are identified and discussed. The results show that public acceptance varies across national cultures and sociodemographic strata. Lower acceptance among people who are mistrusting, socially disadvantaged, or those with low technical skills suggest a risk that CTAs may amplify existing inequities. Regarding determinants of acceptance, eight themes emerged, covering both attitudes and behavioral perspectives that can influence acceptance, including trust, privacy concerns, social responsibility, perceived health threat, experience of and access to technologies, performance expectancy and perceived benefits, and understanding. Furthermore, widespread misconceptions about the CTA function are a topic in need of immediate attention to ensure the safe use of CTAs. The intention-action gap is another topic in need of more research.

Covasim: An agent-based model of COVID-19 dynamics and interventions

The COVID-19 pandemic has created an urgent need for models that can project epidemic trends, explore intervention scenarios, and estimate resource needs. Here we describe the methodology of Covasim (COVID-19 Agent-based Simulator), an open-source model developed to help address these questions. Covasim includes country-specific demographic information on age structure and population size; realistic transmission networks in different social layers, including households, schools, workplaces, long-term care facilities, and communities; age-specific disease outcomes; and intrahost viral dynamics, including viral-load-based transmissibility. Covasim also supports an extensive set of interventions, including non-pharmaceutical interventions, such as physical distancing and protective equipment; pharmaceutical interventions, including vaccination; and testing interventions, such as symptomatic and asymptomatic testing, isolation, contact tracing, and quarantine. These interventions can incorporate the effects of delays, loss-to-follow-up, micro-targeting, and other factors. Implemented in pure Python, Covasim has been designed with equal emphasis on performance, ease of use, and flexibility: realistic and highly customized scenarios can be run on a standard laptop in under a minute. In collaboration with local health agencies and policymakers, Covasim has already been applied to examine epidemic dynamics and inform policy decisions in more than a dozen countries in Africa, Asia-Pacific, Europe, and North America.

Covasim: An agent-based model of COVID-19 dynamics and interventions

The COVID-19 pandemic has created an urgent need for models that can project epidemic trends, explore intervention scenarios, and estimate resource needs. Here we describe the methodology of Covasim (COVID-19 Agent-based Simulator), an open-source model developed to help address these questions. Covasim includes country-specific demographic information on age structure and population size; realistic transmission networks in different social layers, including households, schools, workplaces, long-term care facilities, and communities; age-specific disease outcomes; and intrahost viral dynamics, including viral-load-based transmissibility. Covasim also supports an extensive set of interventions, including non-pharmaceutical interventions, such as physical distancing and protective equipment; pharmaceutical interventions, including vaccination; and testing interventions, such as symptomatic and asymptomatic testing, isolation, contact tracing, and quarantine. These interventions can incorporate the effects of delays, loss-to-follow-up, micro-targeting, and other factors. Implemented in pure Python, Covasim has been designed with equal emphasis on performance, ease of use, and flexibility: realistic and highly customized scenarios can be run on a standard laptop in under a minute. In collaboration with local health agencies and policymakers, Covasim has already been applied to examine epidemic dynamics and inform policy decisions in more than a dozen countries in Africa, Asia-Pacific, Europe, and North America.

Determining the level of social distancing necessary to avoid future COVID-19 epidemic waves: a modelling study for North East London

Determining the level of social distancing, quantified here as the reduction in daily number of social contacts per person, i.e. the daily contact rate, needed to maintain control of the COVID-19 epidemic and not exceed acute bed capacity in case of future epidemic waves, is important for future planning of relaxing of strict social distancing measures. This work uses mathematical modelling to simulate the levels of COVID-19 in North East London (NEL) and inform the level of social distancing necessary to protect the public and the healthcare demand from future COVID-19 waves. We used a Susceptible-Exposed-Infected-Removed (SEIR) model describing the transmission of SARS-CoV-2 in NEL, calibrated to data on hospitalised patients with confirmed COVID-19, hospital discharges and in-hospital deaths in NEL during the first epidemic wave. To account for the uncertainty in both the infectiousness period and the proportion of symptomatic infection, we simulated nine scenarios for different combinations of infectiousness period (1, 3 and 5 days) and proportion of symptomatic infection (70%, 50% and 25% of all infections). Across all scenarios, the calibrated model was used to assess the risk of occurrence and predict the strength and timing of a second COVID-19 wave under varying levels of daily contact rate from July 04, 2020. Specifically, the daily contact rate required to suppress the epidemic and prevent a resurgence of COVID-19 cases, and the daily contact rate required to stay within the acute bed capacity of the NEL system without any additional intervention measures after July 2020, were determined across the nine different scenarios. Our results caution against a full relaxing of the lockdown later in 2020, predicting that a return to pre-COVID-19 levels of social contact from July 04, 2020, would induce a second wave up to eight times the original wave. With different levels of ongoing social distancing, future resurgence can be avoided, or the strength of the resurgence can be mitigated. Keeping the daily contact rate lower than 5 or 6, depending on scenarios, can prevent an increase in the number of COVID-19 cases, could keep the effective reproduction number Re below 1 and a secondary COVID-19 wave may be avoided in NEL. A daily contact rate between 6 and 7, across scenarios, is likely to increase Re above 1 and result in a secondary COVID-19 wave with significantly increased COVID-19 cases and associated deaths, but with demand for hospital-based care remaining within the bed capacity of the NEL health and care system. In contrast, an increase in daily contact rate above 8 to 9, depending on scenarios, will likely exceed the acute bed capacity in NEL and may potentially require additional lockdowns. This scenario is associated with significantly increased COVID-19 cases and deaths, and acute COVID-19 care demand is likely to require significant scaling down of the usual operation of the health and care system and should be avoided. Our findings suggest that to avoid future COVID-19 waves and to stay within the acute bed capacity of the NEL health and care system, maintaining social distancing in NEL is advised with a view to limiting the average number of social interactions in the population. Increasing the level of social interaction beyond the limits described in this work could result in future COVID-19 waves that will likely exceed the acute bed capacity in the system, and depending on the strength of the resurgence may require additional lockdown measures.