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Espenhain L, Ethelberg S, Mortensen LH, Christiansen LE. Automated local lockdowns for SARS-CoV-2 epidemic control-assessment of effect by controlled interrupted time series analysis. IJID REGIONS 2024; 12:100380. [PMID: 38911235 PMCID: PMC11186853 DOI: 10.1016/j.ijregi.2024.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024]
Abstract
Objectives During the COVID-19 pandemic, broad non-pharmaceutical interventions such as national lockdowns were effective but had significant drawbacks, prompting targeted approaches, such as Denmark's localized lockdowns, based on specific epidemiological criteria. This study evaluates the effect of Denmark's automated local lockdown strategy on epidemic control to inform future response. Methods This was a register-based controlled interrupted time series analysis, examining SARS-CoV-2 infection rates in Danish parishes from March to September 2021. The matching of control parishes was based on location, time, and pre-lockdown infection trends, with the lockdown's start defined as the day after a parish exceeded the lockdown criteria. Follow-up included 3-week pre-lockdown and 2-week post-lockdown. Results A total of 30 parishes were mandated to lockdown, approximately 3.5% of the population of Denmark. A total of 94 control parishes were used as 109 controls. The decrease in the incidence during the 2-week follow-up period after the initiation of the lockdown was 13% points higher in case parishes: in case parishes, the incidence was reduced by 78% compared with 65% in control parishes. Conclusions Our findings demonstrate that local lockdowns did have a positive effect in mitigating the spread of the SARS-CoV-2 virus, making them valuable in the fight against the COVID-19 pandemic and an important alternative to national lockdowns.
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Affiliation(s)
- Laura Espenhain
- Department of Infectious Disease epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Steen Ethelberg
- Department of Infectious Disease epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
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2
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Duval D, Evans B, Sanders A, Hill J, Simbo A, Kavoi T, Lyell I, Simmons Z, Qureshi M, Pearce-Smith N, Arevalo CR, Beck CR, Bindra R, Oliver I. Non-pharmaceutical interventions to reduce COVID-19 transmission in the UK: a rapid mapping review and interactive evidence gap map. J Public Health (Oxf) 2024; 46:e279-e293. [PMID: 38426578 PMCID: PMC11141784 DOI: 10.1093/pubmed/fdae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Non-pharmaceutical interventions (NPIs) were crucial in the response to the COVID-19 pandemic, although uncertainties about their effectiveness remain. This work aimed to better understand the evidence generated during the pandemic on the effectiveness of NPIs implemented in the UK. METHODS We conducted a rapid mapping review (search date: 1 March 2023) to identify primary studies reporting on the effectiveness of NPIs to reduce COVID-19 transmission. Included studies were displayed in an interactive evidence gap map. RESULTS After removal of duplicates, 11 752 records were screened. Of these, 151 were included, including 100 modelling studies but only 2 randomized controlled trials and 10 longitudinal observational studies.Most studies reported on NPIs to identify and isolate those who are or may become infectious, and on NPIs to reduce the number of contacts. There was an evidence gap for hand and respiratory hygiene, ventilation and cleaning. CONCLUSIONS Our findings show that despite the large number of studies published, there is still a lack of robust evaluations of the NPIs implemented in the UK. There is a need to build evaluation into the design and implementation of public health interventions and policies from the start of any future pandemic or other public health emergency.
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Affiliation(s)
- D Duval
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - B Evans
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - A Sanders
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - J Hill
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - A Simbo
- Evaluation and Epidemiological Science Division, UKHSA, Colindale NW9 5EQ, UK
| | - T Kavoi
- Cheshire and Merseyside Health Protection Team, UKHSA, Liverpool L3 1DS, UK
| | - I Lyell
- Greater Manchester Health Protection Team, UKHSA, Manchester M1 3BN, UK
| | - Z Simmons
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - M Qureshi
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - N Pearce-Smith
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - C R Arevalo
- Research, Evidence and Knowledge Division, UK Health Security Agency (UKHSA), London E14 5EA, UK
| | - C R Beck
- Evaluation and Epidemiological Science Division, UKHSA, Salisbury SP4 0JG, UK
| | - R Bindra
- Clinical and Public Health Response Division, UKHSA, London E14 5EA, UK
| | - I Oliver
- Director General Science and Research and Chief Scientific Officer, UKHSA, London E14 5EA, UK
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3
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Crocker A, Strömbom D. Susceptible-Infected-Susceptible type COVID-19 spread with collective effects. Sci Rep 2023; 13:22600. [PMID: 38114694 PMCID: PMC10730724 DOI: 10.1038/s41598-023-49949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
Many models developed to forecast and attempt to understand the COVID-19 pandemic are highly complex, and few take collective behavior into account. As the pandemic progressed individual recurrent infection was observed and simpler susceptible-infected type models were introduced. However, these do not include mechanisms to model collective behavior. Here, we introduce an extension of the SIS model that accounts for collective behavior and show that it has four equilibria. Two of the equilibria are the standard SIS model equilibria, a third is always unstable, and a fourth where collective behavior and infection prevalence interact to produce either node-like or oscillatory dynamics. We then parameterized the model using estimates of the transmission and recovery rates for COVID-19 and present phase diagrams for fixed recovery rate and free transmission rate, and both rates fixed. We observe that regions of oscillatory dynamics exist in both cases and that the collective behavior parameter regulates their extent. Finally, we show that the system exhibits hysteresis when the collective behavior parameter varies over time. This model provides a minimal framework for explaining oscillatory phenomena such as recurring waves of infection and hysteresis effects observed in COVID-19, and other SIS-type epidemics, in terms of collective behavior.
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Affiliation(s)
- Amanda Crocker
- Department of Biology, Lafayette College, Easton, PA, 18042, USA
| | - Daniel Strömbom
- Department of Biology, Lafayette College, Easton, PA, 18042, USA.
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4
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Roux J, Massonnaud CR, Colizza V, Cauchemez S, Crépey P. Modeling the impact of national and regional lockdowns on the 2020 spring wave of COVID-19 in France. Sci Rep 2023. [PMID: 36725962 DOI: 10.1101/2021.04.21.21255876] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Several countries have implemented lockdowns to control their COVID-19 epidemic. However, questions like "where" and "when" still require answers. We assessed the impact of national and regional lockdowns considering the French first epidemic wave of COVID-19 as a case study. In a regional lockdown scenario aimed at preventing intensive care units (ICU) saturation, almost all French regions would have had to implement a lockdown within 10 days and 96% of ICU capacities would have been used. For slowly growing epidemics, with a lower reproduction number, the expected delays between regional lockdowns increase. However, the public health costs associated with these delays tend to grow with time. In a quickly growing pandemic wave, defining the timing of lockdowns at a regional rather than national level delays by a few days the implementation of a nationwide lockdown but leads to substantially higher morbidity, mortality, and stress on the healthcare system.
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Affiliation(s)
- Jonathan Roux
- RSMS-U 1309, ARENES-UMR 6051, EHESP, CNRS, Inserm, Université de Rennes, 15, Avenue du Professeur Léon-Bernard, CS 74312, 35043, Rennes Cedex, France
| | - Clément R Massonnaud
- RSMS-U 1309, ARENES-UMR 6051, EHESP, CNRS, Inserm, Université de Rennes, 15, Avenue du Professeur Léon-Bernard, CS 74312, 35043, Rennes Cedex, France
- Department of Biomedical Informatics, Rouen University Hospital, 76000, Rouen, France
| | - Vittoria Colizza
- Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Sorbonne Université, Inserm, 75012, Paris, France
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, Paris, France
| | - Pascal Crépey
- RSMS-U 1309, ARENES-UMR 6051, EHESP, CNRS, Inserm, Université de Rennes, 15, Avenue du Professeur Léon-Bernard, CS 74312, 35043, Rennes Cedex, France.
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5
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Roux J, Massonnaud CR, Colizza V, Cauchemez S, Crépey P. Modeling the impact of national and regional lockdowns on the 2020 spring wave of COVID-19 in France. Sci Rep 2023; 13:1834. [PMID: 36725962 PMCID: PMC9890427 DOI: 10.1038/s41598-023-28687-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
Several countries have implemented lockdowns to control their COVID-19 epidemic. However, questions like "where" and "when" still require answers. We assessed the impact of national and regional lockdowns considering the French first epidemic wave of COVID-19 as a case study. In a regional lockdown scenario aimed at preventing intensive care units (ICU) saturation, almost all French regions would have had to implement a lockdown within 10 days and 96% of ICU capacities would have been used. For slowly growing epidemics, with a lower reproduction number, the expected delays between regional lockdowns increase. However, the public health costs associated with these delays tend to grow with time. In a quickly growing pandemic wave, defining the timing of lockdowns at a regional rather than national level delays by a few days the implementation of a nationwide lockdown but leads to substantially higher morbidity, mortality, and stress on the healthcare system.
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Affiliation(s)
- Jonathan Roux
- RSMS-U 1309, ARENES-UMR 6051, EHESP, CNRS, Inserm, Université de Rennes, 15, Avenue du Professeur Léon-Bernard, CS 74312, 35043, Rennes Cedex, France
| | - Clément R Massonnaud
- RSMS-U 1309, ARENES-UMR 6051, EHESP, CNRS, Inserm, Université de Rennes, 15, Avenue du Professeur Léon-Bernard, CS 74312, 35043, Rennes Cedex, France.,Department of Biomedical Informatics, Rouen University Hospital, 76000, Rouen, France
| | - Vittoria Colizza
- Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Sorbonne Université, Inserm, 75012, Paris, France
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR2000, Paris, France
| | - Pascal Crépey
- RSMS-U 1309, ARENES-UMR 6051, EHESP, CNRS, Inserm, Université de Rennes, 15, Avenue du Professeur Léon-Bernard, CS 74312, 35043, Rennes Cedex, France.
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T-Cell Responses Induced by an Intradermal BNT162b2 mRNA Vaccine Booster Following Primary Vaccination with Inactivated SARS-CoV-2 Vaccine. Vaccines (Basel) 2022; 10:vaccines10091494. [PMID: 36146571 PMCID: PMC9501140 DOI: 10.3390/vaccines10091494] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
A practical booster vaccine is urgently needed to control the coronavirus disease (COVID-19) pandemic. We have previously reported the safety and immunogenicity of a fractional intradermal booster, using the BNT162b2 mRNA vaccine in healthy volunteers who had completed two doses of inactivated SARS-CoV-2 vaccine. In this study, an intramuscular booster at full dosage was used as a control, and a half-dose vaccination was included for reciprocal comparison. Detailed T-cell studies are essential to understand cellular responses to vaccination. T-cell immunity was examined using S1 peptide restimulation and flow cytometry. The fractional dose (1:5) of the BNT162b2 mRNA vaccine enhanced antigen-specific effector T-cells, but the responses were less remarkable compared to the intramuscular booster at full dosage. However, the intradermal regimen was not inferior to the intramuscular booster a month after boosting. An intradermal booster using only one-fifth of the standard dosage could provide comparable T-cell responses with the fractional intramuscular booster. This work confirms the efficacy of intradermal and fractional vaccination in terms of T-cell immunogenicity in previously immunised populations.
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7
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Schwarzendahl FJ, Grauer J, Liebchen B, Löwen H. Mutation induced infection waves in diseases like COVID-19. Sci Rep 2022; 12:9641. [PMID: 35688998 PMCID: PMC9186490 DOI: 10.1038/s41598-022-13137-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/20/2022] [Indexed: 12/16/2022] Open
Abstract
After more than 6 million deaths worldwide, the ongoing vaccination to conquer the COVID-19 disease is now competing with the emergence of increasingly contagious mutations, repeatedly supplanting earlier strains. Following the near-absence of historical examples of the long-time evolution of infectious diseases under similar circumstances, models are crucial to exemplify possible scenarios. Accordingly, in the present work we systematically generalize the popular susceptible-infected-recovered model to account for mutations leading to repeatedly occurring new strains, which we coarse grain based on tools from statistical mechanics to derive a model predicting the most likely outcomes. The model predicts that mutations can induce a super-exponential growth of infection numbers at early times, which self-amplify to giant infection waves which are caused by a positive feedback loop between infection numbers and mutations and lead to a simultaneous infection of the majority of the population. At later stages-if vaccination progresses too slowly-mutations can interrupt an ongoing decrease of infection numbers and can cause infection revivals which occur as single waves or even as whole wave trains featuring alternative periods of decreasing and increasing infection numbers. This panorama of possible mutation-induced scenarios should be tested in more detailed models to explore their concrete significance for specific infectious diseases. Further, our results might be useful for discussions regarding the importance of a release of vaccine-patents to reduce the risk of mutation-induced infection revivals but also to coordinate the release of measures following a downwards trend of infection numbers.
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Affiliation(s)
- Fabian Jan Schwarzendahl
- Institut für Theoretische Physik II: Weiche Materie, Heinrich-Heine-Universität Düsseldorf, 40225, Düsseldorf, Germany.
| | - Jens Grauer
- Institut für Theoretische Physik II: Weiche Materie, Heinrich-Heine-Universität Düsseldorf, 40225, Düsseldorf, Germany
| | - Benno Liebchen
- Institute of Condensed Matter Physics, Technische Universität Darmstadt, Darmstadt, Germany
| | - Hartmut Löwen
- Institut für Theoretische Physik II: Weiche Materie, Heinrich-Heine-Universität Düsseldorf, 40225, Düsseldorf, Germany
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8
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Kühn MJ, Abele D, Binder S, Rack K, Klitz M, Kleinert J, Gilg J, Spataro L, Koslow W, Siggel M, Meyer-Hermann M, Basermann A. Regional opening strategies with commuter testing and containment of new SARS-CoV-2 variants in Germany. BMC Infect Dis 2022; 22:333. [PMID: 35379190 PMCID: PMC8978163 DOI: 10.1186/s12879-022-07302-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 03/21/2022] [Indexed: 12/23/2022] Open
Abstract
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.
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Affiliation(s)
- Martin J Kühn
- Institute for Software Technology, German Aerospace Center, Cologne, Germany.
| | - Daniel Abele
- Institute for Software Technology, German Aerospace Center, Cologne, Germany
| | - Sebastian Binder
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology (BRICS), Helmholtz Centre for Infection Research, Braunschweig, Germany.
| | - Kathrin Rack
- Institute for Software Technology, German Aerospace Center, Cologne, Germany
| | - Margrit Klitz
- Institute for Software Technology, German Aerospace Center, Cologne, Germany
| | - Jan Kleinert
- Institute for Software Technology, German Aerospace Center, Cologne, Germany
| | - Jonas Gilg
- Institute for Software Technology, German Aerospace Center, Cologne, Germany
| | - Luca Spataro
- Institute for Software Technology, German Aerospace Center, Cologne, Germany
| | - Wadim Koslow
- Institute for Software Technology, German Aerospace Center, Cologne, Germany
| | - Martin Siggel
- Institute for Software Technology, German Aerospace Center, Cologne, Germany
| | - Michael Meyer-Hermann
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology (BRICS), Helmholtz Centre for Infection Research, Braunschweig, Germany.
| | - Achim Basermann
- Institute for Software Technology, German Aerospace Center, Cologne, Germany.
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9
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Chu A, Huber G, McGeever A, Veytsman B, Yllanes D. A random-walk-based epidemiological model. Sci Rep 2021; 11:19308. [PMID: 34588487 PMCID: PMC8481482 DOI: 10.1038/s41598-021-98211-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/30/2021] [Indexed: 12/23/2022] Open
Abstract
Random walkers on a two-dimensional square lattice are used to explore the spatio-temporal growth of an epidemic. We have found that a simple random-walk system generates non-trivial dynamics compared with traditional well-mixed models. Phase diagrams characterizing the long-term behaviors of the epidemics are calculated numerically. The functional dependence of the basic reproductive number [Formula: see text] on the model's defining parameters reveals the role of spatial fluctuations and leads to a novel expression for [Formula: see text]. Special attention is given to simulations of inter-regional transmission of the contagion. The scaling of the epidemic with respect to space and time scales is studied in detail in the critical region, which is shown to be compatible with the directed-percolation universality class.
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Affiliation(s)
- Andrew Chu
- Chan Zuckerberg Biohub, 499 Illinois Street, San Francisco, CA, 94158, USA
| | - Greg Huber
- Chan Zuckerberg Biohub, 499 Illinois Street, San Francisco, CA, 94158, USA
| | - Aaron McGeever
- Chan Zuckerberg Biohub, 499 Illinois Street, San Francisco, CA, 94158, USA
| | - Boris Veytsman
- Chan Zuckerberg Initiative, 601 Marshall Street, Redwood City, CA, 94063, USA
- School of Systems Biology, George Mason University, Fairfax, VA, USA
| | - David Yllanes
- Chan Zuckerberg Biohub, 499 Illinois Street, San Francisco, CA, 94158, USA.
- Instituto de Biocomputación y Física de Sistemas Complejos (BIFI), 50018, Zaragoza, Spain.
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Bittihn P, Golestanian R. Stochastic effects on the dynamics of an epidemic due to population subdivision. CHAOS (WOODBURY, N.Y.) 2020; 30:101102. [PMID: 33138468 PMCID: PMC7758998 DOI: 10.1063/5.0028972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Using a stochastic susceptible-infected-removed meta-population model of disease transmission, we present analytical calculations and numerical simulations dissecting the interplay between stochasticity and the division of a population into mutually independent sub-populations. We show that subdivision activates two stochastic effects-extinction and desynchronization-diminishing the overall impact of the outbreak even when the total population has already left the stochastic regime and the basic reproduction number is not altered by the subdivision. Both effects are quantitatively captured by our theoretical estimates, allowing us to determine their individual contributions to the observed reduction of the peak of the epidemic.
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Affiliation(s)
- Philip Bittihn
- Max Planck Institute for Dynamics and Self-Organization (MPIDS), 37077 Göttingen, Germany
- Authors to whom correspondence should be addressed: and
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