The Impact of Contact Structure and Mixing on Control Measures and Disease-Induced Herd Immunity in Epidemic Models: A Mean-Field Model Perspective

The impact of household structure on disease-induced herd immunity

The disease-induced herd immunity level [Formula: see text] is the fraction of the population that must be infected by an epidemic to ensure that a new epidemic among the remaining susceptible population is not supercritical. For a homogeneously mixing population [Formula: see text] equals the classical herd immunity level [Formula: see text], which is the fraction of the population that must be vaccinated in advance of an epidemic so that the epidemic is not supercritical. For most forms of heterogeneous mixing [Formula: see text], sometimes dramatically so. For an SEIR (susceptible [Formula: see text] exposed [Formula: see text] infective [Formula: see text] recovered) model of an epidemic among a population that is partitioned into households, in which individuals mix uniformly within households and, in addition, uniformly at a much lower rate in the population at large, we show that [Formula: see text] unless variability in the household size distribution is sufficiently large. Thus, introducing household structure into a model typically has the opposite effect on disease-induced herd immunity than most other forms of population heterogeneity. We reach this conclusion by considering an approximation [Formula: see text] of [Formula: see text], supported by numerical studies using real-world household size distributions. For [Formula: see text], we prove that [Formula: see text] when all households have size n, and conjecture that this inequality holds for any common household size n. We prove results comparing [Formula: see text] and [Formula: see text] for epidemics which are highly infectious within households, and also for epidemics which are weakly infectious within households.

Novel spatial profiles of some diffusive SIS epidemic models

In this paper, we are concerned with two SIS epidemic reaction-diffusion models with mass action infection mechanism of the form SI, and study the spatial profile of population distribution as the movement rate of the infected individuals is restricted to be small. For the model with a constant total population number, our results show that the susceptible population always converges to a positive constant which is indeed the minimum of the associated risk function, and the infected population either concentrates at the isolated highest-risk points or aggregates only on the highest-risk intervals once the highest-risk locations contain at least one interval. In sharp contrast, for the model with a varying total population number which is caused by the recruitment of the susceptible individuals and death of the infected individuals, our results reveal that the susceptible population converges to a positive function which is non-constant unless the associated risk function is constant, and the infected population may concentrate only at some isolated highest-risk points, or aggregate at least in a neighborhood of the highest-risk locations or occupy the whole habitat, depending on the behavior of the associated risk function and even its smoothness at the highest-risk locations. Numerical simulations are performed to support and complement our theoretical findings.

A nonlinear relapse model with disaggregated contact rates: Analysis of a forward-backward bifurcation

Throughout the progress of epidemic scenarios, individuals in different health classes are expected to have different average daily contact behavior. This contact heterogeneity has been studied in recent adaptive models and allows us to capture the inherent differences across health statuses better. Diseases with reinfection bring out more complex scenarios and offer an important application to consider contact disaggregation. Therefore, we developed a nonlinear differential equation model to explore the dynamics of relapse phenomena and contact differences across health statuses. Our incidence rate function is formulated, taking inspiration from recent adaptive algorithms. It incorporates contact behavior for individuals in each health class. We use constant contact rates at each health status for our analytical results and prove conditions for different forward-backward bifurcation scenarios. The relationship between the different contact rates heavily influences these conditions. Numerical examples highlight the effect of temporarily recovered individuals and initial conditions on infected population persistence.

A hospital demand and capacity intervention approach for COVID-19

The mathematical interpretation of interventions for the mitigation of epidemics in the literature often involves finding the optimal time to initiate an intervention and/or the use of the number of infections to manage impact. Whilst these methods may work in theory, in order to implement effectively they may require information which is not likely to be available in the midst of an epidemic, or they may require impeccable data about infection levels in the community. In reality, testing and cases data can only be as good as the policy of implementation and the compliance of the individuals, which implies that accurately estimating the levels of infections becomes difficult or complicated from the data that is provided. In this paper, we demonstrate a different approach to the mathematical modelling of interventions, not based on optimality or cases, but based on demand and capacity of hospitals who have to deal with the epidemic on a day to day basis. In particular, we use data-driven modelling to calibrate a susceptible-exposed-infectious-recovered-died type model to infer parameters that depict the dynamics of the epidemic in several regions of the UK. We use the calibrated parameters for forecasting scenarios and understand, given a maximum capacity of hospital healthcare services, how the timing of interventions, severity of interventions, and conditions for the releasing of interventions affect the overall epidemic-picture. We provide an optimisation method to capture when, in terms of healthcare demand, an intervention should be put into place given a maximum capacity on the service. By using an equivalent agent-based approach, we demonstrate uncertainty quantification on the likelihood that capacity is not breached, by how much if it does, and the limit on demand that almost guarantees capacity is not breached.

Herd immunity under individual variation and reinfection

We study a susceptible-exposed-infected-recovered (SEIR) model considered by Aguas et al. (In: Herd immunity thresholds for SARS-CoV-2 estimated from unfolding epidemics, 2021), Gomes et al. (In: J Theor Biol. 540:111063, 2022) where individuals are assumed to differ in their susceptibility or exposure to infection. Under this heterogeneity assumption, epidemic growth is effectively suppressed when the percentage of the population having acquired immunity surpasses a critical level - the herd immunity threshold - that is lower than in homogeneous populations. We derive explicit formulas to calculate herd immunity thresholds and stable configurations, especially when susceptibility or exposure are gamma distributed, and explore extensions of the model.

The impact of spatial and social structure on an SIR epidemic on a weighted multilayer network

A key factor in the transmission of infectious diseases is the structure of disease transmitting contacts. In the context of the current COVID-19 pandemic and with some data based on the Hungarian population we develop a theoretical epidemic model (susceptible-infected-removed, SIR) on a multilayer network. The layers include the Hungarian household structure, with population divided into children, adults and elderly, as well as schools and workplaces, some spatial embedding and community transmission due to sharing communal spaces, service and public spaces. We investigate the sensitivity of the model (via the time evolution and final size of the epidemic) to the different contact layers and we map out the relation between peak prevalence and final epidemic size. When compared to the classic compartmental model and for the same final epidemic size, we find that epidemics on multilayer network lead to higher peak prevalence meaning that the risk of overwhelming the health care system is higher. Based on our model we found that keeping cliques/bubbles in school as isolated as possible has a major effect while closing workplaces had a mild effect as long as workplaces are of relatively small size.

Covid-19 and Flattening the Curve: A Feedback Control Perspective

Many of the policies that were put into place during the Covid-19 pandemic had a common goal: to flatten the curve of the number of infected people so that its peak remains under a critical threshold. This letter considers the challenge of engineering a strategy that enforces such a goal using control theory. We introduce a simple formulation of the optimal flattening problem, and provide a closed form solution. This is augmented through nonlinear closed loop tracking of the nominal solution, with the aim of ensuring close-to-optimal performance under uncertain conditions. A key contribution of this letter is to provide validation of the method with extensive and realistic simulations in a Covid-19 scenario, with particular focus on the case of Codogno - a small city in Northern Italy that has been among the most harshly hit by the pandemic.