Increasing efficacy of contact-tracing applications by user referrals and stricter quarantining

We study the effects of two mechanisms which increase the efficacy of contact-tracing applications (CTAs) such as the mobile phone contact-tracing applications that have been used during the COVID-19 epidemic. The first mechanism is the introduction of user referrals. We compare four scenarios for the uptake of CTAs-(1) the p% of individuals that use the CTA are chosen randomly, (2) a smaller initial set of randomly-chosen users each refer a contact to use the CTA, achieving p% in total, (3) a small initial set of randomly-chosen users each refer around half of their contacts to use the CTA, achieving p% in total, and (4) for comparison, an idealised scenario in which the p% of the population that uses the CTA is the p% with the most contacts. Using agent-based epidemiological models incorporating a geometric space, we find that, even when the uptake percentage p% is small, CTAs are an effective tool for mitigating the spread of the epidemic in all scenarios. Moreover, user referrals significantly improve efficacy. In addition, it turns out that user referrals reduce the quarantine load. The second mechanism for increasing the efficacy of CTAs is tuning the severity of quarantine measures. Our modelling shows that using CTAs with mild quarantine measures is effective in reducing the maximum hospital load and the number of people who become ill, but leads to a relatively high quarantine load, which may cause economic disruption. Fortunately, under stricter quarantine measures, the advantages are maintained but the quarantine load is reduced. Our models incorporate geometric inhomogeneous random graphs to study the effects of the presence of super-spreaders and of the absence of long-distant contacts (e.g., through travel restrictions) on our conclusions.

Not all interventions are equal for the height of the second peak

In this paper we conduct a simulation study of the spread of an epidemic like COVID-19 with temporary immunity on finite spatial and non-spatial network models. In particular, we assume that an epidemic spreads stochastically on a scale-free network and that each infected individual in the network gains a temporary immunity after its infectious period is over. After the temporary immunity period is over, the individual becomes susceptible to the virus again. When the underlying contact network is embedded in Euclidean geometry, we model three different intervention strategies that aim to control the spread of the epidemic: social distancing, restrictions on travel, and restrictions on maximal number of social contacts per node. Our first finding is that on a finite network, a long enough average immunity period leads to extinction of the pandemic after the first peak, analogous to the concept of "herd immunity". For each model, there is a critical average immunity duration L_c above which this happens. Our second finding is that all three interventions manage to flatten the first peak (the travel restrictions most efficiently), as well as decrease the critical immunity duration L_c , but elongate the epidemic. However, when the average immunity duration L is shorter than L_c , the price for the flattened first peak is often a high second peak: for limiting the maximal number of contacts, the second peak can be as high as 1/3 of the first peak, and twice as high as it would be without intervention. Thirdly, interventions introduce oscillations into the system and the time to reach equilibrium is, for almost all scenarios, much longer. We conclude that network-based epidemic models can show a variety of behaviors that are not captured by the continuous compartmental models.

Biliary and urinary excretion of drug conjugates: effect of diuresis and choleresis on excretion of harmol sulphate and harmol glucuronide in the rat

1. Harmol (7-hydroxy-1-methyl-9H-pyrido [3,4b] indole) is converted to harmol sulphate and harmol glucuronide in the rat in vivo. Harmol sulphate is excreted mainly in urine, while harmol glucuronide is excreted about equally in bile and urine, when harmol is given intravenously. 2. In rats with ligated kidneys, only choleresis produced by glycodehydrocholate and dehydrocholate caused enhanced biliary excretion of harmol sulphate; harmol glucuronide was unaffected. Several other bile salts had no effect. 3. Mannitol diuresis markedly increased urinary excretion of harmol sulphate, and decreased its biliary excretion. Harmol glucuronide was much less affected. 4. Nafenopin pretreatment increased liver weight and bile flow, and enhanced biliary excretion of harmol sulphate at the expense of its urinary excretion. 5. For harmol sulphate, urine and bile are compensatory pathways of elimination that can be influenced by urine and bile flow changes through diuresis and choleresis.