Systematic biases in disease forecasting - The role of behavior change

Analyzing the use of non-pharmaceutical personal protective measures through self-interest and social optimum for the control of an emerging disease

Non-pharmaceutical personal protective (NPP) measures such as face masks use, and hand and respiratory hygiene can be effective measures for mitigating the spread of aerosol/airborne diseases, such as COVID-19, in the absence of vaccination or treatment. However, the usage of such measures is constrained by their inherent perceived cost and effectiveness for reducing transmission risk. To understand the complex interaction of disease dynamics and individuals decision whether to adopt NPP or not, we incorporate evolutionary game theory into an epidemic model such as COVID-19. To compare how self-interested NPP use differs from social optimum, we also investigated optional control from a central planner's perspective. We use Pontryagin's maximum principle to identify the population-level NPP uptake that minimizes disease incidence by incurring the minimum costs. The evolutionary behavior model shows that NPP uptake increases at lower perceived costs of NPP, higher transmission risk, shorter duration of NPP use, higher effectiveness of NPP, and shorter duration of disease-induced immunity. Though social optimum NPP usage is generally more effective in reducing disease incidence than self-interested usage, our analysis identifies conditions under which both strategies get closer. Our model provides new insights for public health in mitigating a disease outbreak through NPP.

Host behaviour driven by awareness of infection risk amplifies the chance of superspreading events

We demonstrate that heterogeneity in the perceived risks associated with infection within host populations amplifies chances of superspreading during the crucial early stages of epidemics. Under this behavioural model, individuals less concerned about dangers from infection are more likely to be infected and attend larger sized (riskier) events, where we assume event sizes remain unchanged. For directly transmitted diseases such as COVID-19, this leads to infections being introduced at rates above the population prevalence to those events most conducive to superspreading. We develop an interpretable, computational framework for evaluating within-event risks and derive a small-scale reproduction number measuring how the infections generated at an event depend on transmission heterogeneities and numbers of introductions. This generalizes previous frameworks and quantifies how event-scale patterns and population-level characteristics relate. As event duration and size grow, our reproduction number converges to the basic reproduction number. We illustrate that even moderate levels of heterogeneity in the perceived risks of infection substantially increase the likelihood of disproportionately large clusters of infections occurring at larger events, despite fixed overall disease prevalence. We show why collecting data linking host behaviour and event attendance is essential for accurately assessing the risks posed by invading pathogens in emerging stages of outbreaks.

Inferring COVID-19 testing and vaccination behavior from New Jersey testing data

Characterizing the relationship between disease testing behaviors and infectious disease dynamics is of great importance for public health. Tests for both current and past infection can influence disease-related behaviors at the individual level, while population-level knowledge of an epidemic's course may feed back to affect one's likelihood of taking a test. The COVID-19 pandemic has generated testing data on an unprecedented scale for tests detecting both current infection (PCR, antigen) and past infection (serology); this opens the way to characterizing the complex relationship between testing behavior and infection dynamics. Leveraging a rich database of individualized COVID-19 testing histories in New Jersey, we analyze the behavioral relationships between PCR and serology tests, infection, and vaccination. We quantify interactions between individuals' test-taking tendencies and their past testing and infection histories, finding that PCR tests were disproportionately taken by people currently infected, and serology tests were disproportionately taken by people with past infection or vaccination. The effects of previous positive test results on testing behavior are less consistent, as individuals with past PCR positives were more likely to take subsequent PCR and serology tests at some periods of the epidemic time course and less likely at others. Lastly, we fit a model to the titer values collected from serology tests to infer vaccination trends, finding a marked decrease in vaccination rates among individuals who had previously received a positive PCR test. These results exemplify the utility of individualized testing histories in uncovering hidden behavioral variables affecting testing and vaccination.

Modelling the impact of human behavior using a two-layer Watts-Strogatz network for transmission and control of Mpox

PURPOSE

This study aims to evaluate the effectiveness of mitigation strategies and analyze the impact of human behavior on the transmission of Mpox. The results can provide guidance to public health authorities on comprehensive prevention and control for the new Mpox virus strain in the Democratic Republic of Congo as of December 2023.

METHODS

We develop a two-layer Watts-Strogatz network model. The basic reproduction number is calculated using the next-generation matrix approach. Markov chain Monte Carlo (MCMC) optimization algorithm is used to fit Mpox cases in Canada into the network model. Numerical simulations are used to assess the impact of mitigation strategies and human behavior on the final epidemic size.

RESULTS

Our results show that the contact transmission rate of low-risk groups and susceptible humans increases when the contact transmission rate of high-risk groups and susceptible humans is controlled as the Mpox epidemic spreads. The contact transmission rate of high-risk groups after May 18, 2022, is approximately 20% lower than that before May 18, 2022. Our findings indicate a positive correlation between the basic reproduction number and the level of heterogeneity in human contacts, with the basic reproduction number estimated at 2.3475 (95% CI: 0.0749-6.9084). Reducing the average number of sexual contacts to two per week effectively reduces the reproduction number to below one.

CONCLUSION

We need to pay attention to the re-emergence of the epidemics caused by low-risk groups when an outbreak dominated by high-risk groups is under control. Numerical simulations show that reducing the average number of sexual contacts to two per week is effective in slowing down the rapid spread of the epidemic. Our findings offer guidance for the public health authorities of the Democratic Republic of Congo in developing effective mitigation strategies.

Parameter estimation in behavioral epidemic models with endogenous societal risk-response

Behavioral epidemic models incorporating endogenous societal risk-response, where changes in risk perceptions prompt adjustments in contact rates, are crucial for predicting pandemic trajectories. Accurate parameter estimation in these models is vital for validation and precise projections. However, few studies have examined the problem of identifiability in models where disease and behavior parameters must be jointly estimated. To address this gap, we conduct simulation experiments to assess the effect on parameter estimation accuracy of a) delayed risk response, b) neglecting behavioral response in model structure, and c) integrating disease and public behavior data. Our findings reveal systematic biases in estimating behavior parameters even with comprehensive and accurate disease data and a well-structured simulation model when data are limited to the first wave. This is due to the significant delay between evolving risks and societal reactions, corresponding to the duration of a pandemic wave. Moreover, we demonstrate that conventional SEIR models, which disregard behavioral changes, may fit well in the early stages of a pandemic but exhibit significant errors after the initial peak. Furthermore, early on, relatively small data samples of public behavior, such as mobility, can significantly improve estimation accuracy. However, the marginal benefits decline as the pandemic progresses. These results highlight the challenges associated with the joint estimation of disease and behavior parameters in a behavioral epidemic model.

Bayesian modeling of dynamic behavioral change during an epidemic

For many infectious disease outbreaks, the at-risk population changes their behavior in response to the outbreak severity, causing the transmission dynamics to change in real-time. Behavioral change is often ignored in epidemic modeling efforts, making these models less useful than they could be. We address this by introducing a novel class of data-driven epidemic models which characterize and accurately estimate behavioral change. Our proposed model allows time-varying transmission to be captured by the level of "alarm" in the population, with alarm specified as a function of the past epidemic trajectory. We investigate the estimability of the population alarm across a wide range of scenarios, applying both parametric functions and non-parametric functions using splines and Gaussian processes. The model is set in the data-augmented Bayesian framework to allow estimation on partially observed epidemic data. The benefit and utility of the proposed approach is illustrated through applications to data from real epidemics.

Disentangling the role of virus infectiousness and awareness-based human behavior during the early phase of the COVID-19 pandemic in the European Union

In this work, we manage to disentangle the role of virus infectiousness and awareness-based human behavior in the COVID-19 pandemic. Using Bayesian inference, we quantify the uncertainty of a state-space model whose propagator is based on an unusual SEIR-type model since it incorporates the effective population fraction as a parameter. Within the Markov Chain Monte Carlo (MCMC) algorithm, Unscented Kalman Filter (UKF) may be used to evaluate the likelihood approximately. UKF is a suitable strategy in many cases, but it is not well-suited to deal with non-negativity restrictions on the state variables. To overcome this difficulty, we modify the UKF, conveniently truncating Gaussian distributions, which allows us to deal with such restrictions. We use official infection notification records to analyze the first 22 weeks of infection spread in each of the 27 countries of the European Union (EU). It is known that such records are the primary source of information to assess the early evolution of the pandemic and, at the same time, usually suffer underreporting and backlogs. Our model explicitly accounts for uncertainty in the dynamic model parameters, the dynamic model adequacy, and the infection observation process. We argue that this modeling paradigm allows us to disentangle the role of the contact rate, the effective population fraction, and the infection observation probability across time and space with an imperfect first principles model. Our findings agree with phylogenetic evidence showing little variability in the contact rate, or virus infectiousness, across EU countries during the early phase of the pandemic, highlighting the advantage of incorporating the effective population fraction into pandemic modeling for heterogeneity in both human behavior and reporting. Finally, to evaluate the consistency of our data assimilation method, we performed a forecast that adequately fits the actual data.

Statement of significance

Data-driven and model-based epidemiological studies aimed at learning the number of people infected early during a pandemic should explicitly consider the behavior-induced effective population effect. Indeed, the non-isolated, or effective, fraction of the population during the early phase of the pandemic is time-varying, and first-principles modeling with quantified uncertainty is imperative for an adequate analysis across time and space. We argue that, although good inference results may be obtained using the classical SEIR type model, the model posed in this work has allowed us to disentangle the role of virus infectiousness and awareness-based human behavior during the early phase of the COVID-19 pandemic in the European Union from official infection notification records.

The impact of threshold decision mechanisms of collective behavior on disease spread

Humans are a hyper-social species, which greatly impacts the spread of infectious diseases. How do social dynamics impact epidemiology and what are the implications for public health policy? Here, we develop a model of disease transmission that incorporates social dynamics and a behavior that reduces the spread of disease, a voluntary nonpharmaceutical intervention (NPI). We use a "tipping-point" dynamic, previously used in the sociological literature, where individuals adopt a behavior given a sufficient prevalence of the behavior in the population. The thresholds at which individuals adopt the NPI behavior are modulated by the perceived risk of infection, i.e., the disease prevalence and transmission rate, costs to adopt the NPI behavior, and the behavior of others. Social conformity creates a type of "stickiness" whereby individuals are resistant to changing their behavior due to the population's inertia. In this model, we observe a nonmonotonicity in the attack rate as a function of various biological and social parameters such as the transmission rate, efficacy of the NPI, costs of the NPI, weight of social consequences of shirking the social norm, and the degree of heterogeneity in the population. We also observe that the attack rate can be highly sensitive to these parameters due to abrupt shifts in the collective behavior of the population. These results highlight the complex interplay between the dynamics of epidemics and norm-driven collective behaviors.

Epidemic modeling with heterogeneity and social diffusion

We propose and analyze a family of epidemiological models that extend the classic Susceptible-Infectious-Recovered/Removed (SIR)-like framework to account for dynamic heterogeneity in infection risk. The family of models takes the form of a system of reaction-diffusion equations given populations structured by heterogeneous susceptibility to infection. These models describe the evolution of population-level macroscopic quantities S, I, R as in the classical case coupled with a microscopic variable f, giving the distribution of individual behavior in terms of exposure to contagion in the population of susceptibles. The reaction terms represent the impact of sculpting the distribution of susceptibles by the infection process. The diffusion and drift terms that appear in a Fokker-Planck type equation represent the impact of behavior change both during and in the absence of an epidemic. We first study the mathematical foundations of this system of reaction-diffusion equations and prove a number of its properties. In particular, we show that the system will converge back to the unique equilibrium distribution after an epidemic outbreak. We then derive a simpler system by seeking self-similar solutions to the reaction-diffusion equations in the case of Gaussian profiles. Notably, these self-similar solutions lead to a system of ordinary differential equations including classic SIR-like compartments and a new feature: the average risk level in the remaining susceptible population. We show that the simplified system exhibits a rich dynamical structure during epidemics, including plateaus, shoulders, rebounds and oscillations. Finally, we offer perspectives and caveats on ways that this family of models can help interpret the non-canonical dynamics of emerging infectious diseases, including COVID-19.

Adaptive behaviors and vaccination on curbing COVID-19 transmission: Modeling simulations in eight countries

Current persistent outbreak of COVID-19 is triggering a series of collective responses to avoid infection. To further clarify the impact mechanism of adaptive protection behavior and vaccination, we developed a new transmission model via a delay differential system, which parameterized the roles of adaptive behaviors and vaccination, and allowed to simulate the dynamic infection process among people. By validating the model with surveillance data during March 2020 and October 2021 in America, India, South Africa, Philippines, Brazil, UK, Spain and Germany, we quantified the protection effect of adaptive behaviors by different forms of activity function. The modeling results indicated that (1) the adaptive activity function can be used as a good indicator for fitting the intervention outcome, which exhibited short-term awareness in these countries, and it could reduce the total human infections by 3.68, 26.16, 15.23, 4.23, 7.26, 1.65, 5.51 and 7.07 times, compared with the reporting; (2) for complete prevention, the average proportions of people with immunity should be larger than 90%, 92%, 86%, 71%, 92%, 84%, 82% and 76% with adaptive protection behaviors, or 91%, 97%, 94%, 77%, 92%, 88%, 85% and 90% without protection behaviors; and (3) the required proportion of humans being vaccinated is a sub-linear decreasing function of vaccine efficiency, with small heterogeneity in different countries. This manuscript was submitted as part of a theme issue on "Modelling COVID-19 and Preparedness for Future Pandemics".

Transmission trends of the global COVID-19 pandemic with combined effects of adaptive behaviours and vaccination

We developed a mechanism model which allows for simulating the novel coronavirus (COVID-19) transmission dynamics with the combined effects of human adaptive behaviours and vaccination, aiming at predicting the end time of COVID-19 infection in global scale. Based on the surveillance information (reported cases and vaccination data) between 22 January 2020 and 18 July 2022, we validated the model by Markov Chain Monte Carlo (MCMC) fitting method. We found that (1) if without adaptive behaviours, the epidemic could sweep the world in 2022 and 2023, causing 3.098 billion of human infections, which is 5.39 times of current number; (2) 645 million people could be avoided from infection due to vaccination; and (3) in current scenarios of protective behaviours and vaccination, infection cases would increase slowly, levelling off around 2023, and it would end completely in June 2025, causing 1.024 billion infections, with 12.5 million death. Our findings suggest that vaccination and the collective protection behaviour remain the key determinants against the global process of COVID-19 transmission.

Real-time social distance measurement and face mask detection in public transportation systems during the COVID-19 pandemic and post-pandemic Era: Theoretical approach and case study in Italy

Due to its remarkable learning ability and benefits in several areas of real-life, deep learning-based applications have recovered to be a research topic of great importance in the last few years. This article presents a method devoted to guaranteeing safety conditions in public transportation systems (PTS) during the COVID-19 pandemic and post-pandemic era. The paper describes a viable real-time model based on deep learning for monitoring social distance between users and detecting face masks in stop areas and inside vehicles of public transportation systems. Detections are made using the deep learning approach and YOLOv3 algorithm. The safety rule violations are represented by red bounding boxes and red circles in a bird's eye view as output of the video surveillance analysis. The datasets used to train the neural network are the "Caltech Pedestrian Dataset" and the "COVID-19 Medical Face Mask Detection Dataset". Metrics, such Loss Accuracy, and Precision, obtained in the testing process of the neural network were used to evaluate the performance of the model in detecting users and face masks. The proposed method was recently tested in the Public Transportation System of the Municipality of Piazza Armerina (Italy). The results show a significant reliability of the method in detecting real-time interactions between users of the PTS in terms of over-time variations in their mutual distancing, as well as in recognising cases of violation of the imposed social distancing and FFP2 face mask use.

Effect of Human Behavior on the Evolution of Viral Strains During an Epidemic

It is well known in the literature that human behavior can change as a reaction to disease observed in others, and that such behavioral changes can be an important factor in the spread of an epidemic. It has been noted that human behavioral traits in disease avoidance are under selection in the presence of infectious diseases. Here, we explore a complementary trend: the pathogen itself might experience a force of selection to become less “visible,” or less “symptomatic,” in the presence of such human behavioral trends. Using a stochastic SIR agent-based model, we investigated the co-evolution of two viral strains with cross-immunity, where the resident strain is symptomatic while the mutant strain is asymptomatic. We assumed that individuals exercised self-regulated social distancing (SD) behavior if one of their neighbors was infected with a symptomatic strain. We observed that the proportion of asymptomatic carriers increased over time with a stronger effect corresponding to higher levels of self-regulated SD. Adding mandated SD made the effect more significant, while the existence of a time-delay between the onset of infection and the change of behavior reduced the advantage of the asymptomatic strain. These results were consistent under random geometric networks, scale-free networks, and a synthetic network that represented the social behavior of the residents of New Orleans.

VACCINE HESITANCY, PASSPORTS, AND THE DEMAND FOR VACCINATION

Vaccine hesitancy is modeled as an endogenous decision within a behavioral epidemiological model with endogenous agent activity. It is shown that policy interventions that directly target costs associated with vaccine adoption may counter vaccine hesitancy whereas those that manipulate the utility of unvaccinated agents will either lead to the same or lower rates of vaccine adoption. This latter effect arises with vaccine passports whose effects are mitigated in equilibrium by reductions in viral/disease prevalence that themselves reduce the demand for vaccination.

Optimal lockdowns

This paper provides a framework for understanding optimal lockdowns and makes three contributions. First, it theoretically analyzes lockdown policies and argues that policy makers systematically enact too strict lockdowns because their incentives are misaligned with achieving desired ends and they cannot adapt to changing circumstances. Second, it provides a benchmark to determine how strongly policy makers in different locations should respond to COVID-19. Finally, it provides a framework for understanding how, when, and why lockdown policy is expected to change.

Cash transfers as a response to COVID-19: Experimental evidence from Kenya

We deliver one month's average profit to a randomly selected group of female microenterprise owners in Dandora, Kenya, arriving just in advance of an exponential growth in COVID-19 cases. Relative to a control group, firms recoup about one third of their initial decline in profit, and food expenditures increase. Control profit responds to economic conditions and government announcements during our study period, and treatment effects are largest when control profit is at its lowest. PPE spending and precautionary management practices increase to mitigate the health risks of more intensive firm operation, but only among those who perceive COVID-19 as a major risk.

Behavioral Economics in the Epidemiology of the COVID-19 Pandemic: Theory and Simulations

We provide a game-theoretical epidemiological model for the COVID-19 pandemic that takes into account that: (1) asymptomatic individuals can be contagious, (2) contagion is behavior-dependent, (3) behavior is determined by a game that depends on beliefs and social interactions, (4) there can be systematic biases in the perceptions and beliefs about the pandemic. We incorporate lockdown decisions by the government into the model. The citizens’ and government’s beliefs can exhibit several biases that we discuss from the point of view of behavioral economics. We provide simulations to understand the effect of lockdown decisions and the possibility of “nudging” citizens in the right direction by improving the accuracy of their beliefs.

Behavioral responses to risk promote vaccinating high-contact individuals first

How should communities prioritize COVID-19 vaccinations? Prior studies found that prioritizing the elderly and most vulnerable minimizes deaths. However, prior research has ignored how behavioral responses to risk of disease endogenously change transmission rates. We show that incorporating risk-driven behavioral responses enhances fit to data and may change prioritization to vaccinating high-contact individuals. Behavioral responses matter because deaths grow exponentially until communities are compelled to reduce contacts, with deaths stabilizing at levels that oblige higher-contact groups to sufficiently cut their interactions and slow transmissions. More lives may be saved by vaccinating and taking those high-contact groups out of transmission chains earlier because the remaining groups will take more precautions while waiting for their turn for vaccination. These findings are especially important considering the need for further vaccination in many countries, the emergence of new variants, and the expected challenge of distributing new vaccines in the coming months and years. © 2022 The Author. System Dynamics Review published by John Wiley & Sons Ltd on behalf of System Dynamics Society.

Individual risk-aversion responses tune epidemics to critical transmissibility (R = 1)

Changes in human behaviour are a major determinant of epidemic dynamics. Collective activity can be modified through imposed control measures, but spontaneous changes can also arise as a result of uncoordinated individual responses to the perceived risk of contagion. Here, we introduce a stochastic epidemic model implementing population responses driven by individual time-varying risk aversion. The model reveals an emergent mechanism for the generation of multiple infection waves of decreasing amplitude that progressively tune the effective reproduction number to its critical value R = 1. In successive waves, individuals with gradually lower risk propensity are infected. The overall mechanism shapes well-defined risk-aversion profiles over the whole population as the epidemic progresses. We conclude that uncoordinated changes in human behaviour can by themselves explain major qualitative and quantitative features of the epidemic process, like the emergence of multiple waves and the tendency to remain around R = 1 observed worldwide after the first few waves of COVID-19.

Real time deep learning framework to monitor social distancing using improved single shot detector based on overhead position

The current COVID 19 halo infection has caused a severe catastrophe with its deadly spread. Despite the implementation of the vaccine, the severity of the infection has not diminished, and it has become stronger and more destructive. So, the only solution to protect ourselves from infection is social-distancing. Although social-distancing has been in practice for a long time, in most places it is not effectively followed, and it is very difficult to find out manually at all times whether people are following it or not. Therefore, we introduced a newly developed framework of deep-learning technique to automatically identify whether people maintain social-distancing or not using remote sensing top view images. Initially, we are detecting the context of image which includes information about the environment. Our detection model recognizes individuals using the boundary box. Then centroid is determined over every detected boundary box. By means of applying Euclidean distance, the pair range distances of the detected boundary box centroid are determined. To evaluate whether the distance measurement exceeds the minimum social distance limit, the violation threshold is established. We used Improved Single Shot Detector model for detecting a person over an image. Experiments are carried out on widely collected remote sensing images from various environments. Based on the object detection algorithm of deep learning, a variety of performance metrics are compared to evaluate the efficiency of the proposed model. Research outcome shows that, our proposed model outperforms well while recognize and detect a person in a well excellent way.

The effectiveness of Non-pharmaceutical interventions in reducing the COVID-19 contagion in the UK, an observational and modelling study

Epidemiological models used to inform government policies aimed to reduce the contagion of COVID-19, assume that the reproduction number is reduced through Non-Pharmaceutical Interventions (NPIs) leading to physical distancing. Available data in the UK show an increase in physical distancing before the NPIs were implemented and a fall soon after implementation. We aimed to estimate the effect of people’s behaviour on the epidemic curve and the effect of NPIs taking into account this behavioural component. We have estimated the effects of confirmed daily cases on physical distancing and we used this insight to design a behavioural SEIR model (BeSEIR), simulated different scenaria regarding NPIs and compared the results to the standard SEIR. Taking into account behavioural insights improves the description of the contagion dynamics of the epidemic significantly. The BeSEIR predictions regarding the number of infections without NPIs were several orders of magnitude less than the SEIR. However, the BeSEIR prediction showed that early measures would still have an important influence in the reduction of infections. The BeSEIR model shows that even with no intervention the percentage of the cumulative infections within a year will not be enough for the epidemic to resolve due to a herd immunity effect. On the other hand, a standard SEIR model significantly overestimates the effectiveness of measures. Without taking into account the behavioural component, the epidemic is predicted to be resolved much sooner than when taking it into account and the effectiveness of measures are significantly overestimated.

Saving lives during the COVID-19 pandemic: the benefits of the first Swiss lockdown

The implementation of a lockdown to control the spread of the COVID-19 pandemic has led to a strong economic and political debate in several countries. This makes it crucial to shed light on the actual benefits of such kind of policy. To this purpose, we focus on the Swiss lockdown during the first wave of COVID-19 infections and estimate the number of potentially saved lives. To predict the number of deaths in the absence of any restrictive measure, we develop a novel age-structured SIRDC model which accounts for age-specific endogenous behavioral responses and for seasonal patterns in the spread of the virus. Including the additional fatalities which would have materialized because of the shortage of healthcare resources, our estimates suggest that the lockdown prevented more than 11,200 deaths between March and the beginning of September 2020.

Heterogeneity in susceptibility dictates the order of epidemic models

The fundamental models of epidemiology describe the progression of an infectious disease through a population using compartmentalized differential equations, but typically do not incorporate population-level heterogeneity in infection susceptibility. Here we combine a generalized analytical framework of contagion with computational models of epidemic dynamics to show that variation strongly influences the rate of infection, while the infection process simultaneously sculpts the susceptibility distribution. These joint dynamics influence the force of infection and are, in turn, influenced by the shape of the initial variability. We find that certain susceptibility distributions (the exponential and the gamma) are unchanged through the course of the outbreak, and lead naturally to power-law behavior in the force of infection; other distributions are often sculpted towards these "eigen-distributions" through the process of contagion. The power-law behavior fundamentally alters predictions of the long-term infection rate, and suggests that first-order epidemic models that are parameterized in the exponential-like phase may systematically and significantly over-estimate the final severity of the outbreak. In summary, our study suggests the need to examine the shape of susceptibility in natural populations as part of efforts to improve prediction models and to prioritize interventions that leverage heterogeneity to mitigate against spread.

A review and agenda for integrated disease models including social and behavioural factors

Social and behavioural factors are critical to the emergence, spread and containment of human disease, and are key determinants of the course, duration and outcomes of disease outbreaks. Recent epidemics of Ebola in West Africa and coronavirus disease 2019 (COVID-19) globally have reinforced the importance of developing infectious disease models that better integrate social and behavioural dynamics and theories. Meanwhile, the growth in capacity, coordination and prioritization of social science research and of risk communication and community engagement (RCCE) practice within the current pandemic response provides an opportunity for collaboration among epidemiological modellers, social scientists and RCCE practitioners towards a mutually beneficial research and practice agenda. Here, we provide a review of the current modelling methodologies and describe the challenges and opportunities for integrating them with social science research and RCCE practice. Finally, we set out an agenda for advancing transdisciplinary collaboration for integrated disease modelling and for more robust policy and practice for reducing disease transmission.

The social dynamics of COVID-19

We add a simple dynamic process for adaptive "social distancing" measures to a standard SIR model of the COVID pandemic. With a limited attention span and in the absence of a consistent long-term strategy against the pandemic, this process leads to a sweeping of an instability, i.e. fluctuations in the effective reproduction number around its bifurcation value of R e f f = 1 . While mitigating the pandemic in the short-run, this process remains intrinsically fragile and does not constitute a sustainable strategy that societies could follow for an extended period of time.

An Extended SEIR Model with Vaccination for Forecasting the COVID-19 Pandemic in Saudi Arabia Using an Ensemble Kalman Filter

In this paper, an extended SEIR model with a vaccination compartment is proposed to simulate the novel coronavirus disease (COVID-19) spread in Saudi Arabia. The model considers seven stages of infection: susceptible (S), exposed (E), infectious (I), quarantined (Q), recovered (R), deaths (D), and vaccinated (V). Initially, a mathematical analysis is carried out to illustrate the non-negativity, boundedness, epidemic equilibrium, existence, and uniqueness of the endemic equilibrium, and the basic reproduction number of the proposed model. Such numerical models can be, however, subject to various sources of uncertainties, due to an imperfect description of the biological processes governing the disease spread, which may strongly limit their forecasting skills. A data assimilation method, mainly, the ensemble Kalman filter (EnKF), is then used to constrain the model outputs and its parameters with available data. We conduct joint state-parameters estimation experiments assimilating daily data into the proposed model using the EnKF in order to enhance the model’s forecasting skills. Starting from the estimated set of model parameters, we then conduct short-term predictions in order to assess the predicability range of the model. We apply the proposed assimilation system on real data sets from Saudi Arabia. The numerical results demonstrate the capability of the proposed model in achieving accurate prediction of the epidemic development up to two-week time scales. Finally, we investigate the effect of vaccination on the spread of the pandemic.

An adaptive social distancing SIR model for COVID-19 disease spreading and forecasting

Recently, various mathematical models have been proposed to model COVID-19 outbreak. These models are an effective tool to study the mechanisms of coronavirus spreading and to predict the future course of COVID-19 disease. They are also used to evaluate strategies to control this pandemic. Generally, SIR compartmental models are appropriate for understanding and predicting the dynamics of infectious diseases like COVID-19. The classical SIR model is initially introduced by Kermack and McKendrick (cf. (Anderson, R. M. 1991. “Discussion: the Kermack–McKendrick Epidemic Threshold Theorem.” Bulletin of Mathematical Biology 53 (1): 3–32; Kermack, W. O., and A. G. McKendrick. 1927. “A Contribution to the Mathematical Theory of Epidemics.” Proceedings of the Royal Society 115 (772): 700–21)) to describe the evolution of the susceptible, infected and recovered compartment. Focused on the impact of public policies designed to contain this pandemic, we develop a new nonlinear SIR epidemic problem modeling the spreading of coronavirus under the effect of a social distancing induced by the government measures to stop coronavirus spreading. To find the parameters adopted for each country (for e.g. Germany, Spain, Italy, France, Algeria and Morocco) we fit the proposed model with respect to the actual real data. We also evaluate the government measures in each country with respect to the evolution of the pandemic. Our numerical simulations can be used to provide an effective tool for predicting the spread of the disease.

Reacting to outbreaks at neighboring localities

We study the dynamics of epidemics in a networked metapopulation model. In each subpopulation, representing a locality, the disease propagates according to a modified susceptible-exposed-infected-recovered (SEIR) dynamics. In the modified SEIR dynamics, individuals reduce their number of contacts as a function of the weighted sum of cumulative number of cases within the locality and in neighboring localities. We consider a scenario with two localities where disease originates in one locality and is exported to the neighboring locality via travel of exposed (latently infected) individuals. We establish a lower bound on the outbreak size at the origin as a function of the speed of spread. Using the lower bound on the outbreak size at the origin, we establish an upper bound on the outbreak size at the importing locality as a function of the speed of spread and the level of preparedness for the low mobility regime. We evaluate the critical levels of preparedness that stop the disease from spreading at the importing locality. Finally, we show how the benefit of preparedness diminishes under high mobility rates. Our results highlight the importance of preparedness at localities where cases are beginning to rise such that localities can help stop local outbreaks when they respond to the severity of outbreaks in neighboring localities.

Monitoring social distancing under various low light conditions with deep learning and a single motionless time of flight camera

The purpose of this work is to provide an effective social distance monitoring solution in low light environments in a pandemic situation. The raging coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has brought a global crisis with its deadly spread all over the world. In the absence of an effective treatment and vaccine the efforts to control this pandemic strictly rely on personal preventive actions, e.g., handwashing, face mask usage, environmental cleaning, and most importantly on social distancing which is the only expedient approach to cope with this situation. Low light environments can become a problem in the spread of disease because of people's night gatherings. Especially, in summers when the global temperature is at its peak, the situation can become more critical. Mostly, in cities where people have congested homes and no proper air cross-system is available. So, they find ways to get out of their homes with their families during the night to take fresh air. In such a situation, it is necessary to take effective measures to monitor the safety distance criteria to avoid more positive cases and to control the death toll. In this paper, a deep learning-based solution is proposed for the above-stated problem. The proposed framework utilizes the you only look once v4 (YOLO v4) model for real-time object detection and the social distance measuring approach is introduced with a single motionless time of flight (ToF) camera. The risk factor is indicated based on the calculated distance and safety distance violations are highlighted. Experimental results show that the proposed model exhibits good performance with 97.84% mean average precision (mAP) score and the observed mean absolute error (MAE) between actual and measured social distance values is 1.01 cm.

Forecasting hospital demand in metropolitan areas during the current COVID-19 pandemic and estimates of lockdown-induced 2nd waves

We present a forecasting model aim to predict hospital occupancy in metropolitan areas during the current COVID-19 pandemic. Our SEIRD type model features asymptomatic and symptomatic infections with detailed hospital dynamics. We model explicitly branching probabilities and non-exponential residence times in each latent and infected compartments. Using both hospital admittance confirmed cases and deaths, we infer the contact rate and the initial conditions of the dynamical system, considering breakpoints to model lockdown interventions and the increase in effective population size due to lockdown relaxation. The latter features let us model lockdown-induced 2nd waves. Our Bayesian approach allows us to produce timely probabilistic forecasts of hospital demand. We have applied the model to analyze more than 70 metropolitan areas and 32 states in Mexico.

Awareness-driven behavior changes can shift the shape of epidemics away from peaks and toward plateaus, shoulders, and oscillations

The COVID-19 pandemic has caused more than 1,000,000 reported deaths globally, of which more than 200,000 have been reported in the United States as of October 1, 2020. Public health interventions have had significant impacts in reducing transmission and in averting even more deaths. Nonetheless, in many jurisdictions, the decline of cases and fatalities after apparent epidemic peaks has not been rapid. Instead, the asymmetric decline in cases appears, in most cases, to be consistent with plateau- or shoulder-like phenomena-a qualitative observation reinforced by a symmetry analysis of US state-level fatality data. Here we explore a model of fatality-driven awareness in which individual protective measures increase with death rates. In this model, fast increases to the peak are often followed by plateaus, shoulders, and lag-driven oscillations. The asymmetric shape of model-predicted incidence and fatality curves is consistent with observations from many jurisdictions. Yet, in contrast to model predictions, we find that population-level mobility metrics usually increased from low levels before fatalities reached an initial peak. We show that incorporating fatigue and long-term behavior change can reconcile the apparent premature relaxation of mobility reductions and help understand when post-peak dynamics are likely to lead to a resurgence of cases.

Beyond R0: heterogeneity in secondary infections and probabilistic epidemic forecasting

The basic reproductive number, R0, is one of the most common and most commonly misapplied numbers in public health. Often used to compare outbreaks and forecast pandemic risk, this single number belies the complexity that different epidemics can exhibit, even when they have the same R0. Here, we reformulate and extend a classic result from random network theory to forecast the size of an epidemic using estimates of the distribution of secondary infections, leveraging both its average R0 and the underlying heterogeneity. Importantly, epidemics with lower R0 can be larger if they spread more homogeneously (and are therefore more robust to stochastic fluctuations). We illustrate the potential of this approach using different real epidemics with known estimates for R0, heterogeneity and epidemic size in the absence of significant intervention. Further, we discuss the different ways in which this framework can be implemented in the data-scarce reality of emerging pathogens. Lastly, we demonstrate that without data on the heterogeneity in secondary infections for emerging infectious diseases like COVID-19 the uncertainty in outbreak size ranges dramatically. Taken together, our work highlights the critical need for contact tracing during emerging infectious disease outbreaks and the need to look beyond R0.

DeepSOCIAL: Social Distancing Monitoring and Infection Risk Assessment in COVID-19 Pandemic

Social distancing is a recommended solution by the World Health Organisation (WHO) to minimise the spread of COVID-19 in public places. The majority of governments and national health authorities have set the 2-m physical distancing as a mandatory safety measure in shopping centres, schools and other covered areas. In this research, we develop a hybrid Computer Vision and YOLOv4-based Deep Neural Network (DNN) model for automated people detection in the crowd in indoor and outdoor environments using common CCTV security cameras. The proposed DNN model in combination with an adapted inverse perspective mapping (IPM) technique and SORT tracking algorithm leads to a robust people detection and social distancing monitoring. The model has been trained against two most comprehensive datasets by the time of the research—the Microsoft Common Objects in Context (MS COCO) and Google Open Image datasets. The system has been evaluated against the Oxford Town Centre dataset (including 150,000 instances of people detection) with superior performance compared to three state-of-the-art methods. The evaluation has been conducted in challenging conditions, including occlusion, partial visibility, and under lighting variations with the mean average precision of 99.8% and the real-time speed of 24.1 fps. We also provide an online infection risk assessment scheme by statistical analysis of the spatio-temporal data from people’s moving trajectories and the rate of social distancing violations. We identify high-risk zones with the highest possibility of virus spread and infection. This may help authorities to redesign the layout of a public place or to take precaution actions to mitigate high-risk zones. The developed model is a generic and accurate people detection and tracking solution that can be applied in many other fields such as autonomous vehicles, human action recognition, anomaly detection, sports, crowd analysis, or any other research areas where the human detection is in the centre of attention.

Awareness-driven Behavior Changes Can Shift the Shape of Epidemics Away from Peaks and Towards Plateaus, Shoulders, and Oscillations

The COVID-19 pandemic has caused more than 1,000,000 reported deaths globally, of which more than 200,000 have been reported in the United States as of October 1, 2020. Public health interventions have had significant impacts in reducing transmission and in averting even more deaths. Nonetheless, in many jurisdictions the decline of cases and fatalities after apparent epidemic peaks has not been rapid. Instead, the asymmetric decline in cases appears, in most cases, to be consistent with plateau-or shoulder-like phenomena - a qualitative observation reinforced by a symmetry analysis of US state-level fatality data. Here we explore a model of fatality-driven awareness in which individual protective measures increase with death rates. In this model, fast increases to the peak are often followed by plateaus, shoulders, and lag-driven oscillations. The asymmetric shape of model-predicted incidence and fatality curves are consistent with observations from many jurisdictions. Yet, in contrast to model predictions, we find that population-level mobility metrics usually increased from low early-outbreak levels before peak levels of fatalities. We show that incorporating fatigue and long-term behavior change can reconcile the apparent premature relaxation of mobility reductions and help understand when post-peak dynamics are likely to lead to a resurgence of cases.

Replicating and projecting the path of COVID-19 with a model-implied reproduction number

We demonstrate a methodology for replicating and projecting the path of COVID-19 using a simple epidemiology model. We fit the model to daily data on the number of infected cases in China, Italy, the United States, and Brazil. These four countries can be viewed as representing different stages, from later to earlier, of a COVID-19 epidemic cycle. We solve for a model-implied effective reproduction numberR t each day so that the model closely replicates the daily number of currently infected cases in each country. For out-of-sample projections, we fit a behavioral function to the in-sample data that allows for the endogenous response ofR t to movements in the lagged number of infected cases. We show that declines in measures of population mobility tend to precede declines in the model-implied reproduction numbers for each country. This pattern suggests that mandatory and voluntary stay-at-home behavior and social distancing during the early stages of the epidemic worked to reduce the effective reproduction number and mitigate the spread of COVID-19.

Epidemiological Modeling of COVID-19 in Saudi Arabia: Spread Projection, Awareness, and Impact of Treatment

The first case of COVID-19 originated in Wuhan, China, after which it spread across more than 200 countries. By 21 July 2020, the rapid global spread of this disease had led to more than 15 million cases of infection, with a mortality rate of more than 4.0% of the total number of confirmed cases. This study aimed to predict the prevalence of COVID-19 and to investigate the effect of awareness and the impact of treatment in Saudi Arabia. In this paper, COVID-19 data were sourced from the Saudi Ministry of Health, covering the period from 31 March 2020 to 21 July 2020. The spread of COVID-19 was predicted using four different epidemiological models, namely the susceptible–infectious–recovered (SIR), generalized logistic, Richards, and Gompertz models. The assessment of models’ fit was performed and compared using four statistical indices (root-mean-square error (RMSE), R squared (R2), adjusted R2 ( Radj2), and Akaike’s information criterion (AIC)) in order to select the most appropriate model. Modified versions of the SIR model were utilized to assess the influence of awareness and treatment on the prevalence of COVID-19. Based on the statistical indices, the SIR model showed a good fit to reported data compared with the other models (RMSE = 2790.69, R2 = 99.88%, Radj2 = 99.98%, and AIC = 1796.05). The SIR model predicted that the cumulative number of infected cases would reach 359,794 and that the pandemic would end by early September 2020. Additionally, the modified version of the SIR model with social distancing revealed that there would be a reduction in the final cumulative epidemic size by 9.1% and 168.2% if social distancing were applied over the short and long term, respectively. Furthermore, different treatment scenarios were simulated, starting on 8 July 2020, using another modified version of the SIR model. Epidemiological modeling can help to predict the cumulative number of cases of infection and to understand the impact of social distancing and pharmaceutical intervention on the prevalence of COVID-19. The findings from this study can provide valuable information for governmental policymakers trying to control the spread of this pandemic.

Spread of COVID-19 through Georgia, USA. Near-term projections and impacts of social distancing via a metapopulation model

Epidemiological forecasts of COVID-19 spread at the country and/or state level have helped shape public health interventions. However, such models leave a scale-gap between the spatial resolution of actionable information (i.e. the county or city level) and that of modeled viral spread. States and nations are not spatially homogeneous and different areas may vary in disease risk and severity. For example, COVID-19 has age-stratified risk. Similarly, ICU units, PPE and other vital equipment are not equally distributed within states. Here, we implement a county-level epidemiological framework to assess and forecast COVID-19 spread through Georgia, where 1,933 people have died from COVID-19 and 44,638 cases have been documented as of May 27, 2020. We find that county-level forecasts trained on heterogeneity due to clustered events can continue to predict epidemic spread over multi-week periods, potentially serving efforts to prepare medical resources, manage supply chains, and develop targeted public health interventions. We find that the premature removal of physical (social) distancing could lead to rapid increases in cases or the emergence of sustained plateaus of elevated fatalities.

Estimation of the reproduction number and early prediction of the COVID-19 outbreak in India using a statistical computing approach

Coronavirus disease 2019 (COVID-19), which causes severe respiratory illness, has become a pandemic. The World Health Organization has declared it a public health crisis of international concern. We developed a susceptible, exposed, infected, recovered (SEIR) model for COVID-19 to show the importance of estimating the reproduction number (R₀). This work is focused on predicting the COVID-19 outbreak in its early stage in India based on an estimation of R₀. The developed model will help policymakers to take active measures prior to the further spread of COVID-19. Data on daily newly infected cases in India from March 2, 2020 to April 2, 2020 were to estimate R₀ using the earlyR package. The maximum-likelihood approach was used to analyze the distribution of R₀ values, and the bootstrap strategy was applied for resampling to identify the most likely R₀ value. We estimated the median value of R₀ to be 1.471 (95% confidence interval [CI], 1.351 to 1.592) and predicted that the new case count may reach 39,382 (95% CI, 34,300 to 47,351) in 30 days.