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Caro JJ, Möller J, Santhirapala V, Gill H, Johnston J, El-Boghdadly K, Santhirapala R, Kelly P, McGuire A. Predicting Hospital Resource Use During COVID-19 Surges: A Simple but Flexible Discretely Integrated Condition Event Simulation of Individual Patient-Hospital Trajectories. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1570-1577. [PMID: 34711356 PMCID: PMC8339677 DOI: 10.1016/j.jval.2021.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/22/2021] [Accepted: 05/26/2021] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assist with planning hospital resources, including critical care (CC) beds, for managing patients with COVID-19. METHODS An individual simulation was implemented in Microsoft Excel using a discretely integrated condition event simulation. Expected daily cases presented to the emergency department were modeled in terms of transitions to and from ward and CC and to discharge or death. The duration of stay in each location was selected from trajectory-specific distributions. Daily ward and CC bed occupancy and the number of discharges according to care needs were forecast for the period of interest. Face validity was ascertained by local experts and, for the case study, by comparing forecasts with actual data. RESULTS To illustrate the use of the model, a case study was developed for Guy's and St Thomas' Trust. They provided inputs for January 2020 to early April 2020, and local observed case numbers were fit to provide estimates of emergency department arrivals. A peak demand of 467 ward and 135 CC beds was forecast, with diminishing numbers through July. The model tended to predict higher occupancy in Level 1 than what was eventually observed, but the timing of peaks was quite close, especially for CC, where the model predicted at least 120 beds would be occupied from April 9, 2020, to April 17, 2020, compared with April 7, 2020, to April 19, 2020, in reality. The care needs on discharge varied greatly from day to day. CONCLUSIONS The DICE simulation of hospital trajectories of patients with COVID-19 provides forecasts of resources needed with only a few local inputs. This should help planners understand their expected resource needs.
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Affiliation(s)
- J Jaime Caro
- Department of Health Policy, London School of Economics and Political Science, London, England, UK; Evidera, London, England, UK.
| | | | - Vatshalan Santhirapala
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Harpreet Gill
- Department of Health Policy, London School of Economics and Political Science, London, England, UK; Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Jessica Johnston
- Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Kariem El-Boghdadly
- Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Ramai Santhirapala
- Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Paul Kelly
- Department of Theatres, Anaesthesia, and Perioperative Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, England, UK
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5
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Carlin EP, Allen KC, Morgan JJ, Chretien JP, Murray S, Winslow D, Zimmerman D. Behavioral Risk Modeling for Pandemics: Overcoming Challenges and Advancing the Science. Health Secur 2021; 19:447-453. [PMID: 34415788 DOI: 10.1089/hs.2020.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ellen P Carlin
- Ellen P. Carlin, DVM, was a Senior Health and Policy Specialist, EcoHealth Alliance, New York, NY. She is now an Assistant Research Professor, Georgetown University Center for Global Health Science and Security, Washington, DC. Koya C. Allen, PhD, MS, MSPH, was an Infectious Disease Subject Matter Expert, European Command Headquarters, US Department of Defense, Stuttgart, Germany. She is now a Scientific Officer, Barcelona Institute for Global Health, Malaria Eradication Scientific Alliance, Barcelona, Spain. Jeffrey J. Morgan, MS, was a Senior Systems Engineer, Joint Research and Development, Stafford, VA. He is currently a Senior Systems Engineer, iPower, LLC, Reston, VA, and a PhD Student, Biomedical Engineering, Catholic University of America, Washington, DC. Jean-Paul Chretien, MD, PhD, is a Program Manager, Defense Advanced Research Program Agency, Arlington, VA. Suzan Murray, DVM, DACZM, is Program Director and Dawn Zimmerman, DVM, MS, is Director of Wildlife Health and Associate Program Director; both in the Global Health Program, Smithsonian Conservation Biology Institute, Washington, DC. Dawn Zimmerman is also an Adjunct Assistant Professor, Department of Epidemiology and Microbial Disease, Yale School of Public Health, New Haven, CT. Deborah Winslow, PhD, is a Senior Scholar, School for Advanced Research, Santa Fe, NM
| | - Koya C Allen
- Ellen P. Carlin, DVM, was a Senior Health and Policy Specialist, EcoHealth Alliance, New York, NY. She is now an Assistant Research Professor, Georgetown University Center for Global Health Science and Security, Washington, DC. Koya C. Allen, PhD, MS, MSPH, was an Infectious Disease Subject Matter Expert, European Command Headquarters, US Department of Defense, Stuttgart, Germany. She is now a Scientific Officer, Barcelona Institute for Global Health, Malaria Eradication Scientific Alliance, Barcelona, Spain. Jeffrey J. Morgan, MS, was a Senior Systems Engineer, Joint Research and Development, Stafford, VA. He is currently a Senior Systems Engineer, iPower, LLC, Reston, VA, and a PhD Student, Biomedical Engineering, Catholic University of America, Washington, DC. Jean-Paul Chretien, MD, PhD, is a Program Manager, Defense Advanced Research Program Agency, Arlington, VA. Suzan Murray, DVM, DACZM, is Program Director and Dawn Zimmerman, DVM, MS, is Director of Wildlife Health and Associate Program Director; both in the Global Health Program, Smithsonian Conservation Biology Institute, Washington, DC. Dawn Zimmerman is also an Adjunct Assistant Professor, Department of Epidemiology and Microbial Disease, Yale School of Public Health, New Haven, CT. Deborah Winslow, PhD, is a Senior Scholar, School for Advanced Research, Santa Fe, NM
| | - Jeffrey J Morgan
- Ellen P. Carlin, DVM, was a Senior Health and Policy Specialist, EcoHealth Alliance, New York, NY. She is now an Assistant Research Professor, Georgetown University Center for Global Health Science and Security, Washington, DC. Koya C. Allen, PhD, MS, MSPH, was an Infectious Disease Subject Matter Expert, European Command Headquarters, US Department of Defense, Stuttgart, Germany. She is now a Scientific Officer, Barcelona Institute for Global Health, Malaria Eradication Scientific Alliance, Barcelona, Spain. Jeffrey J. Morgan, MS, was a Senior Systems Engineer, Joint Research and Development, Stafford, VA. He is currently a Senior Systems Engineer, iPower, LLC, Reston, VA, and a PhD Student, Biomedical Engineering, Catholic University of America, Washington, DC. Jean-Paul Chretien, MD, PhD, is a Program Manager, Defense Advanced Research Program Agency, Arlington, VA. Suzan Murray, DVM, DACZM, is Program Director and Dawn Zimmerman, DVM, MS, is Director of Wildlife Health and Associate Program Director; both in the Global Health Program, Smithsonian Conservation Biology Institute, Washington, DC. Dawn Zimmerman is also an Adjunct Assistant Professor, Department of Epidemiology and Microbial Disease, Yale School of Public Health, New Haven, CT. Deborah Winslow, PhD, is a Senior Scholar, School for Advanced Research, Santa Fe, NM
| | - Jean-Paul Chretien
- Ellen P. Carlin, DVM, was a Senior Health and Policy Specialist, EcoHealth Alliance, New York, NY. She is now an Assistant Research Professor, Georgetown University Center for Global Health Science and Security, Washington, DC. Koya C. Allen, PhD, MS, MSPH, was an Infectious Disease Subject Matter Expert, European Command Headquarters, US Department of Defense, Stuttgart, Germany. She is now a Scientific Officer, Barcelona Institute for Global Health, Malaria Eradication Scientific Alliance, Barcelona, Spain. Jeffrey J. Morgan, MS, was a Senior Systems Engineer, Joint Research and Development, Stafford, VA. He is currently a Senior Systems Engineer, iPower, LLC, Reston, VA, and a PhD Student, Biomedical Engineering, Catholic University of America, Washington, DC. Jean-Paul Chretien, MD, PhD, is a Program Manager, Defense Advanced Research Program Agency, Arlington, VA. Suzan Murray, DVM, DACZM, is Program Director and Dawn Zimmerman, DVM, MS, is Director of Wildlife Health and Associate Program Director; both in the Global Health Program, Smithsonian Conservation Biology Institute, Washington, DC. Dawn Zimmerman is also an Adjunct Assistant Professor, Department of Epidemiology and Microbial Disease, Yale School of Public Health, New Haven, CT. Deborah Winslow, PhD, is a Senior Scholar, School for Advanced Research, Santa Fe, NM
| | - Suzan Murray
- Ellen P. Carlin, DVM, was a Senior Health and Policy Specialist, EcoHealth Alliance, New York, NY. She is now an Assistant Research Professor, Georgetown University Center for Global Health Science and Security, Washington, DC. Koya C. Allen, PhD, MS, MSPH, was an Infectious Disease Subject Matter Expert, European Command Headquarters, US Department of Defense, Stuttgart, Germany. She is now a Scientific Officer, Barcelona Institute for Global Health, Malaria Eradication Scientific Alliance, Barcelona, Spain. Jeffrey J. Morgan, MS, was a Senior Systems Engineer, Joint Research and Development, Stafford, VA. He is currently a Senior Systems Engineer, iPower, LLC, Reston, VA, and a PhD Student, Biomedical Engineering, Catholic University of America, Washington, DC. Jean-Paul Chretien, MD, PhD, is a Program Manager, Defense Advanced Research Program Agency, Arlington, VA. Suzan Murray, DVM, DACZM, is Program Director and Dawn Zimmerman, DVM, MS, is Director of Wildlife Health and Associate Program Director; both in the Global Health Program, Smithsonian Conservation Biology Institute, Washington, DC. Dawn Zimmerman is also an Adjunct Assistant Professor, Department of Epidemiology and Microbial Disease, Yale School of Public Health, New Haven, CT. Deborah Winslow, PhD, is a Senior Scholar, School for Advanced Research, Santa Fe, NM
| | - Deborah Winslow
- Ellen P. Carlin, DVM, was a Senior Health and Policy Specialist, EcoHealth Alliance, New York, NY. She is now an Assistant Research Professor, Georgetown University Center for Global Health Science and Security, Washington, DC. Koya C. Allen, PhD, MS, MSPH, was an Infectious Disease Subject Matter Expert, European Command Headquarters, US Department of Defense, Stuttgart, Germany. She is now a Scientific Officer, Barcelona Institute for Global Health, Malaria Eradication Scientific Alliance, Barcelona, Spain. Jeffrey J. Morgan, MS, was a Senior Systems Engineer, Joint Research and Development, Stafford, VA. He is currently a Senior Systems Engineer, iPower, LLC, Reston, VA, and a PhD Student, Biomedical Engineering, Catholic University of America, Washington, DC. Jean-Paul Chretien, MD, PhD, is a Program Manager, Defense Advanced Research Program Agency, Arlington, VA. Suzan Murray, DVM, DACZM, is Program Director and Dawn Zimmerman, DVM, MS, is Director of Wildlife Health and Associate Program Director; both in the Global Health Program, Smithsonian Conservation Biology Institute, Washington, DC. Dawn Zimmerman is also an Adjunct Assistant Professor, Department of Epidemiology and Microbial Disease, Yale School of Public Health, New Haven, CT. Deborah Winslow, PhD, is a Senior Scholar, School for Advanced Research, Santa Fe, NM
| | - Dawn Zimmerman
- Ellen P. Carlin, DVM, was a Senior Health and Policy Specialist, EcoHealth Alliance, New York, NY. She is now an Assistant Research Professor, Georgetown University Center for Global Health Science and Security, Washington, DC. Koya C. Allen, PhD, MS, MSPH, was an Infectious Disease Subject Matter Expert, European Command Headquarters, US Department of Defense, Stuttgart, Germany. She is now a Scientific Officer, Barcelona Institute for Global Health, Malaria Eradication Scientific Alliance, Barcelona, Spain. Jeffrey J. Morgan, MS, was a Senior Systems Engineer, Joint Research and Development, Stafford, VA. He is currently a Senior Systems Engineer, iPower, LLC, Reston, VA, and a PhD Student, Biomedical Engineering, Catholic University of America, Washington, DC. Jean-Paul Chretien, MD, PhD, is a Program Manager, Defense Advanced Research Program Agency, Arlington, VA. Suzan Murray, DVM, DACZM, is Program Director and Dawn Zimmerman, DVM, MS, is Director of Wildlife Health and Associate Program Director; both in the Global Health Program, Smithsonian Conservation Biology Institute, Washington, DC. Dawn Zimmerman is also an Adjunct Assistant Professor, Department of Epidemiology and Microbial Disease, Yale School of Public Health, New Haven, CT. Deborah Winslow, PhD, is a Senior Scholar, School for Advanced Research, Santa Fe, NM
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Wurtz N, Lacoste A, Jardot P, Delache A, Fontaine X, Verlande M, Annessi A, Giraud-Gatineau A, Chaudet H, Fournier PE, Augier P, La Scola B. Viral RNA in City Wastewater as a Key Indicator of COVID-19 Recrudescence and Containment Measures Effectiveness. Front Microbiol 2021; 12:664477. [PMID: 34079532 PMCID: PMC8165276 DOI: 10.3389/fmicb.2021.664477] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 12/26/2022] Open
Abstract
In recent years, and more specifically at the beginning of the COVID-19 crisis, wastewater surveillance has been proposed as a tool to monitor the epidemiology of human viral infections. In the present work, from July to December 2020, the number of copies of SARS-CoV-2 RNA in Marseille's wastewater was correlated with the number of new positive cases diagnosed in our Institute of Infectious Disease, which tested about 20% of the city's population. Number of positive cases and number of copies of SARS-CoV-2 RNA in wastewater were significantly correlated (p = 0.013). During the great epidemic peak, from October to December 2020, the curves of virus in the sewers and the curves of positive diagnoses were perfectly superposed. During the summer period, the superposition of curves was less evident as subject to many confounding factors that were discussed. We also tried to correlate the effect of viral circulation in wastewater with containment measures, probably the most unbiased correlation on their potential inflection effect of epidemic curves. Not only is this correlation not obvious, but it also clearly appears that the drop in cases as well as the drop in the viral load in the sewers occur before the containment measures. In fact, this suggests that there are factors that initiate the end of the epidemic peak independently of the containment measure. These factors will therefore need to be explored more deeply in the future.
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Affiliation(s)
- Nathalie Wurtz
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France
| | | | | | | | - Xavier Fontaine
- Bataillon de Marins-Pompiers de Marseille, Marseille, France
| | - Maxime Verlande
- Bataillon de Marins-Pompiers de Marseille, Marseille, France
| | | | - Audrey Giraud-Gatineau
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France
| | - Hervé Chaudet
- Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, VITROME, Marseille, France
| | - Pierre-Edouard Fournier
- Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, VITROME, Marseille, France
| | - Patrick Augier
- Bataillon de Marins-Pompiers de Marseille, Marseille, France
| | - Bernard La Scola
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
- Institut Hospitalo-Universitaire Méditerranée-Infection, Marseille, France
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Richardson ET, Malik MM, Darity WA, Mullen AK, Morse ME, Malik M, Maybank A, Bassett MT, Farmer PE, Worden L, Jones JH. Reparations for Black American descendants of persons enslaved in the U.S. and their potential impact on SARS-CoV-2 transmission. Soc Sci Med 2021; 276:113741. [PMID: 33640157 PMCID: PMC7871902 DOI: 10.1016/j.socscimed.2021.113741] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/17/2020] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
Background In the United States, Black Americans are suffering from a significantly disproportionate incidence of COVID-19. Going beyond mere epidemiological tallying, the potential for racial-justice interventions, including reparations payments, to ameliorate these disparities has not been adequately explored. Methods We compared the COVID-19 time-varying Rt curves of relatively disparate polities in terms of social equity (South Korea vs. Louisiana). Next, we considered a range of reproductive ratios to back-calculate the transmission rates βi→j for 4 cells of the simplified next-generation matrix (from which R0 is calculated for structured models) for the outbreak in Louisiana. Lastly, we considered the potential structural effects monetary payments as reparations for Black American descendants of persons enslaved in the U.S. would have had on pre-intervention βi→j and consequently R0. Results Once their respective epidemics begin to propagate, Louisiana displays Rt values with an absolute difference of 1.3–2.5 compared to South Korea. It also takes Louisiana more than twice as long to bring Rt below 1. Reasoning through the consequences of increased equity via matrix transmission models, we demonstrate how the benefits of a successful reparations program (reflected in the ratio βb→b/βw→w) could reduce R0 by 31–68%. Discussion While there are compelling moral and historical arguments for racial-injustice interventions such as reparations, our study considers potential health benefits in the form of reduced SARS-CoV-2 transmission risk. A restitutive program targeted towards Black individuals would not only decrease COVID-19 risk for recipients of the wealth redistribution; the mitigating effects would also be distributed across racial groups, benefiting the population at large.
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Affiliation(s)
- Eugene T Richardson
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Momin M Malik
- Berkman Klein Center for Internet & Society, Harvard University, Cambridge, MA, USA
| | - William A Darity
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | | | - Michelle E Morse
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maya Malik
- McGill University, School of Social Work, Montreal, Quebec, Canada
| | | | - Mary T Bassett
- François-Xavier Bagnoud (FXB) Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paul E Farmer
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Lee Worden
- Proctor Foundation, University of California, San Francisco, USA
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