Spontaneous behavioural changes in response to epidemics

Linking Spontaneous Behavioral Changes to Disease Transmission Dynamics: Behavior Change Includes Periodic Oscillation

Behavior change significantly influences the transmission of diseases during outbreaks. To incorporate spontaneous preventive measures, we propose a model that integrates behavior change with disease transmission. The model represents behavior change through an imitation process, wherein players exclusively adopt the behavior associated with higher payoff. We find that relying solely on spontaneous behavior change is insufficient for eradicating the disease. The dynamics of behavior change are contingent on the basic reproduction number R a corresponding to the scenario where all players adopt non-pharmaceutical interventions (NPIs). WhenR a < 1 , partial adherence to NPIs remains consistently feasible. We can ensure that the disease stays at a low level or maintains minor fluctuations around a lower value by increasing sensitivity to perceived infection. In cases where oscillations occur, a further reduction in the maximum prevalence of infection over a cycle can be achieved by increasing the rate of behavior change. WhenR a > 1 , almost all players consistently adopt NPIs if they are highly sensitive to perceived infection. Further consideration of saturated recovery leads to saddle-node homoclinic and Bogdanov-Takens bifurcations, emphasizing the adverse impact of limited medical resources on controlling the scale of infection. Finally, we parameterize our model with COVID-19 data and Tokyo subway ridership, enabling us to illustrate the disease spread co-evolving with behavior change dynamics. We further demonstrate that an increase in sensitivity to perceived infection can accelerate the peak time and reduce the peak size of infection prevalence in the initial wave.

Heterogeneous risk tolerance, in-groups, and epidemic waves

There is a growing interest in the joint modeling of the dynamics of disease and health-related beliefs and attitudes, but coupling mechanisms are yet to be understood. We introduce a model where risk information, which can be delayed, comes in two flavors, including historical risk derived from perceived incidence data and predicted risk information. Our model also includes an interpretation domain where the behavioral response to risk information is subject to in-group pressure. We then simulate how the strength of behavioral reaction impacts epidemic severity as measured by epidemic peak size, number of waves, and final size. Simulated behavioral response is not effective when the level of protection that prophylactic behavior provides is as small as 50% or lower. At a higher level of 75% or more, we see the emergence of multiple epidemic waves. In addition, simulations show that different behavioral response profiles can lead to various epidemic outcomes that are non-monotonic with the strength of reaction to risk information. We also modeled heterogeneity in the response profile of a population and find they can lead to less severe epidemic outcome in terms of peak size.

Time delay of the appearance of a new strain can affect vaccination behavior and disease dynamics: An evolutionary explanation

The emergence of a novel strain during a pandemic, like the current COVID-19, is a major concern to the healthcare system. The most effective strategy to control this type of pandemic is vaccination. Many previous studies suggest that the existing vaccine may not be fully effective against the new strain. Additionally, the new strain's late arrival has a significant impact on the disease dynamics and vaccine coverage. Focusing on these issues, this study presents a two-strain epidemic model in which the new strain appears with a time delay. We considered two vaccination provisions, namely preinfection and postinfection vaccinations, which are governed by human behavioral dynamics. In such a framework, individuals have the option to commit vaccination before being infected with the first strain. Additionally, people who forgo vaccination and become infected with the first train have the chance to be vaccinated (after recovery) in an attempt to avoid infection from the second strain. However, a second strain can infect vaccinated and unvaccinated individuals. People may have additional opportunities to be vaccinated and to protect themselves from the second strain due to the time delay. Considering the cost of the vaccine, the severity of the new strain, and the vaccine's effectiveness, our results indicated that delaying the second strain decreases the peak size of the infected individuals. Finally, by estimating the social efficiency deficit, we discovered that the social dilemma for receiving immunization decreases with the delay in the arrival of the second strain.

Kinetic Models for Epidemic Dynamics in the Presence of Opinion Polarization

Understanding the impact of collective social phenomena in epidemic dynamics is a crucial task to effectively contain the disease spread. In this work, we build a mathematical description for assessing the interplay between opinion polarization and the evolution of a disease. The proposed kinetic approach describes the evolution of aggregate quantities characterizing the agents belonging to epidemiologically relevant states and will show that the spread of the disease is closely related to consensus dynamics distribution in which opinion polarization may emerge. In the present modelling framework, microscopic consensus formation dynamics can be linked to macroscopic epidemic trends to trigger the collective adherence to protective measures. We conduct numerical investigations which confirm the ability of the model to describe different phenomena related to the spread of an epidemic.

Waves of infection emerging from coupled social and epidemiological dynamics

The coronavirus (SARS-CoV-2) exhibited waves of infection in 2020 and 2021 in Japan. The number of infected had multiple distinct peaks at intervals of several months. One possible process causing these waves of infection is people switching their activities in response to the prevalence of infection. In this paper, we present a simple model for the coupling of social and epidemiological dynamics. The assumptions are as follows. Each person switches between active and restrained states. Active people move more often to crowded areas, interact with each other, and suffer a higher rate of infection than people in the restrained state. The rate of transition from restrained to active states is enhanced by the fraction of currently active people (conformity), whereas the rate of backward transition is enhanced by the abundance of infected people (risk avoidance). The model may show transient or sustained oscillations, initial-condition dependence, and various bifurcations. The infection is maintained at a low level if the recovery rate is between the maximum and minimum levels of the force of infection. In addition, waves of infection may emerge instead of converging to the stationary abundance of infected people if both conformity and risk avoidance of people are strong.

Exploring the impact of motivations on individual online and offline preventive actions against COVID-19

Having accurate and sufficient information about the outbreak and actively adopting preventive actions are important to reduce the adverse effects of COVID-19 and control the spread of the epidemic. To this end, grounded in the situational theory of problem solving (STOPS) and self-concern and other-orientation theory, this study aims to examine motivations of individuals to adopt online and offline preventive actions during the COVID-19 pandemic. We explored the effects of three motivations, i.e., situational motivation, concern-for-self and concern-for-others motivation, and their antecedents on individual online and offline preventive actions. We used PLS-SEM to analyze the results of 628 questionnaires and found that: first, individual online preventive actions have a positive predictive effect on offline actions; secondly, individual online preventive actions are positively affected by situational motivation and concern-for-others motivation, and individual offline preventive actions are positively affected by concern-for-self and concern-for-others motivation; finally, three situational perceptual factors including problem, involvement and constraint recognition have significant effects on the three motivations. The findings of this study enriched the research results on individual behaviors in the context of COVID-19, and provided a basis for making decisions on the guidance and management of the individuals' COVID-19 preventive actions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04283-z.

Multilayer networks with higher-order interaction reveal the impact of collective behavior on epidemic dynamics

The ongoing COVID-19 pandemic has inflicted tremendous economic and societal losses. In the absence of pharmaceutical interventions, the population behavioral response, including situational awareness and adherence to non-pharmaceutical intervention policies, has a significant impact on contagion dynamics. Game-theoretic models have been used to reproduce the concurrent evolution of behavioral responses and disease contagion, and social networks are critical platforms on which behavior imitation between social contacts, even dispersed in distant communities, takes place. Such joint contagion dynamics has not been sufficiently explored, which poses a challenge for policies aimed at containing the infection. In this study, we present a multi-layer network model to study contagion dynamics and behavioral adaptation. It comprises two physical layers that mimic the two solitary communities, and one social layer that encapsulates the social influence of agents from these two communities. Moreover, we adopt high-order interactions in the form of simplicial complexes on the social influence layer to delineate the behavior imitation of individual agents. This model offers a novel platform to articulate the interaction between physically isolated communities and the ensuing coevolution of behavioral change and spreading dynamics. The analytical insights harnessed therefrom provide compelling guidelines on coordinated policy design to enhance the preparedness for future pandemics.

Controlling Multiple COVID-19 Epidemic Waves: An Insight from a Multi-scale Model Linking the Behaviour Change Dynamics to the Disease Transmission Dynamics

COVID-19 epidemics exhibited multiple waves regionally and globally since 2020. It is important to understand the insight and underlying mechanisms of the multiple waves of COVID-19 epidemics in order to design more efficient non-pharmaceutical interventions (NPIs) and vaccination strategies to prevent future waves. We propose a multi-scale model by linking the behaviour change dynamics to the disease transmission dynamics to investigate the effect of behaviour dynamics on COVID-19 epidemics using game theory. The proposed multi-scale models are calibrated and key parameters related to disease transmission dynamics and behavioural dynamics with/without vaccination are estimated based on COVID-19 epidemic data (daily reported cases and cumulative deaths) and vaccination data. Our modeling results demonstrate that the feedback loop between behaviour changes and COVID-19 transmission dynamics plays an essential role in inducing multiple epidemic waves. We find that the long period of high-prevalence or persistent deterioration of COVID-19 epidemics could drive almost all of the population to change their behaviours and maintain the altered behaviours. However, the effect of behaviour changes fades out gradually along the progress of epidemics. This suggests that it is essential to have not only persistent, but also effective behaviour changes in order to avoid subsequent epidemic waves. In addition, our model also suggests the importance to maintain the effective altered behaviours during the initial stage of vaccination, and to counteract relaxation of NPIs, it requires quick and massive vaccination to avoid future epidemic waves.

Impact of biological sex and gender-related factors on public engagement in protective health behaviours during the COVID-19 pandemic: cross-sectional analyses from a global survey

OBJECTIVE

Given the role of sociocultural gender in shaping human behaviours, the main objective of this study was to examine whether sex and gender-related factors were associated with the public's adherence to COVID-19-recommended protective health behaviours.

DESIGN

This was a retrospective analysis of the survey that captured data on people's awareness, attitudes and behaviours as they relate to the COVID-19 policies.

SETTING

Data from the International COVID-19 Awareness and Responses Evaluation survey collected between March 2020 and February 2021 from 175 countries.

PARTICIPANTS

Convenience sample around the world.

MAIN OUTCOME MEASURES

We examined the role of sex and gender-related factors in relation to non-adherence of protective health behaviours including: (1) hand washing; (2) mask wearing; and (3) physical distancing. Multivariable logistic regression was conducted to determine the factors associated with non-adherence to behaviours.

RESULTS

Among 48 668 respondents (mean age: 43 years; 71% female), 98.3% adopted hand washing, 68.5% mask wearing and 76.9% physical distancing. Compared with males, females were more likely to adopt hand washing (OR=1.97, 95% CI: 1.71 to 2.28) and maintain physical distancing (OR=1.28, 95% CI: 1.22 to 1.34). However, in multivariable sex-stratified models, females in countries with higher Gender Inequality Indexes (GII) were less likely to report hand washing (adjusted OR (aOR)=0.47, 95% CI: 0.21 to 1.05). Females who reported being employed (aOR=0.22, 95% CI: 0.10 to 0.48) and in countries with low/medium GIIs (aOR=0.18, 95% CI 0.06 to 0.51) were less likely to report mask wearing. Females who reported being employed were less likely to report physical distancing (aOR=0.39, 95% CI: 0.32 to 0.49).

CONCLUSION

While females showed greater adherence to COVID-19 protective health behaviours, gender-related factors, including employment status and high country-wide gender inequality, were independently associated with non-adherence. These findings may inform public health and vaccination policies in current as well as future pandemics.

How the nature of behavior change affects the impact of asymptomatic coronavirus transmission

SARS-CoV-2 has caused severe respiratory illnesses and deaths since late 2019 and spreads globally. While asymptomatic cases play a crucial role in transmitting COVID-19, they do not contribute to the observed prevalence, which drives behavior change during the pandemic. This study aims to identify the effect of the proportion of asymptomatic infections on the magnitude of an epidemic under behavior change scenarios by developing a compartmental mathematical model. In this interest, we discuss three different behavior change cases separately: constant behavior change, instantaneous behavior change response to the disease’s perceived prevalence, and piecewise constant behavior change response to government policies. Our results imply that the proportion of asymptomatic infections which maximizes the spread of the epidemic depends on the nature of the dominant force driving behavior changes.

Game-Theoretic Frameworks for Epidemic Spreading and Human Decision-Making: A Review

This review presents and reviews various solved and open problems in developing, analyzing, and mitigating epidemic spreading processes under human decision-making. We provide a review of a range of epidemic models and explain the pros and cons of different epidemic models. We exhibit the art of coupling between epidemic models and decision models in the existing literature. More specifically, we provide answers to fundamental questions in human decision-making amid epidemics, including what interventions to take to combat the disease, who are decision-makers, and when and how to take interventions, and how to make interventions. Among many decision models, game-theoretic models have become increasingly crucial in modeling human responses or behavior amid epidemics in the last decade. In this review, we motivate the game-theoretic approach to human decision-making amid epidemics. This review provides an overview of the existing literature by developing a multi-dimensional taxonomy, which categorizes existing literature based on multiple dimensions, including (1) types of games, such as differential games, stochastic games, evolutionary games, and static games; (2) types of interventions, such as social distancing, vaccination, quarantine, and taking antidotes; (3) the types of decision-makers, such as individuals, adversaries, and central authorities at different hierarchical levels. A fine-grained dynamic game framework is proposed to capture the essence of game-theoretic decision-making amid epidemics. We showcase three representative frameworks with unique ways of integrating game-theoretic decision-making into the epidemic models from a vast body of literature. Each of the three frameworks has their unique way of modeling and analyzing and develops results from different angles. In the end, we identify several main open problems and research gaps left to be addressed and filled.

Identification and Control of Game-Based Epidemic Models

The effectiveness of control measures against the diffusion of the COVID-19 pandemic is grounded on the assumption that people are prepared and disposed to cooperate. From a strategic decision point of view, cooperation is the unreachable strategy of the Prisoner’s Dilemma game, where the temptation to exploit the others and the fear of being betrayed by them drives the people’s behavior, which eventually results in a fully defective outcome. In this work, we integrate a standard epidemic model with the replicator equation of evolutionary games in order to study the interplay between the infection spreading and the propensity of people to be cooperative under the pressure of the epidemic. The developed model shows high performance in fitting real measurements of infected, recovered and dead people during the whole period of COVID-19 epidemic spread, from March 2020 to September 2021 in Italy. The estimated parameters related to cooperation result to be significantly correlated with vaccination and screening data, thus validating the model. The stability analysis of the multiple steady states present in the proposed model highlights the possibility to tune fundamental control parameters to dramatically reduce the number of potential dead people with respect to the non-controlled case.

Effects of social-distancing on infectious disease dynamics: an evolutionary game theory and economic perspective

We propose two models inspired by the COVID-19 pandemic: a coupled disease-human behaviour (or disease-game theoretic), and a coupled disease-human behaviour-economic model, both of which account for the impact of social-distancing on disease control and economic growth. The models exhibit rich dynamical behaviour including multistable equilibria, a backward bifurcation, and sustained bounded periodic oscillations. Analyses of the first model suggests that the disease can be eliminated if everybody practices full social-distancing, but the most likely outcome is some level of disease coupled with some level of social-distancing. The same outcome is observed with the second model when the economy is weaker than the social norms to follow health directives. However, if the economy is stronger, it can support some level of social-distancing that can lead to disease elimination.

Dynamic Games of Social Distancing During an Epidemic: Analysis of Asymmetric Solutions

Individual behaviors play an essential role in the dynamics of transmission of infectious diseases, including COVID-19. This paper studies a dynamic game model that describes the social distancing behaviors during an epidemic, assuming a continuum of players and individual infection dynamics. The evolution of the players' infection states follows a variant of the well-known SIR dynamics. We assume that the players are not sure about their infection state, and thus, they choose their actions based on their individually perceived probabilities of being susceptible, infected, or removed. The cost of each player depends both on her infection state and on the contact with others. We prove the existence of a Nash equilibrium and characterize Nash equilibria using nonlinear complementarity problems. We then exploit some monotonicity properties of the optimal policies to obtain a reduced-order characterization for Nash equilibrium and reduce its computation to the solution of a low-dimensional optimization problem. It turns out that, even in the symmetric case, where all the players have the same parameters, players may have very different behaviors. We finally present some numerical studies that illustrate this interesting phenomenon and investigate the effects of several parameters, including the players' vulnerability, the time horizon, and the maximum allowed actions, on the optimal policies and the players' costs.

Game-theoretic modeling of collective decision making during epidemics

The spreading dynamics of an epidemic and the collective behavioral pattern of the population over which it spreads are deeply intertwined and the latter can critically shape the outcome of the former. Motivated by this, we design a parsimonious game-theoretic behavioral-epidemic model, in which an interplay of realistic factors shapes the coevolution of individual decision making and epidemics on a network. Although such a coevolution is deeply intertwined in the real world, existing models schematize population behavior as instantaneously reactive, thus being unable to capture human behavior in the long term. Our paradigm offers a unified framework to model and predict complex emergent phenomena, including successful collective responses, periodic oscillations, and resurgent epidemic outbreaks. The framework also allows us to provide analytical insights on the epidemic process and to assess the effectiveness of different policy interventions on ensuring a collective response that successfully eradicates the outbreak. Two case studies, inspired by real-world diseases, are presented to illustrate the potentialities of the proposed model.

Verification of the accuracy of the SIR model in forecasting based on the improved SIR model with a constant ratio of recovery to infection rate by comparing with monitored second wave data

The temporal evolution of second and subsequent waves of epidemics such as Covid-19 is investigated. Analytic expressions for the peak time and asymptotic behaviours, early doubling time, late half decay time, and a half-early peak law, characterizing the dynamical evolution of number of cases and fatalities, are derived, where the pandemic evolution exhibiting multiple waves is described by the semi-time SIR model. The asymmetry of the epidemic wave and its exponential tail are affected by the initial conditions, a feature that has no analogue in the all-time SIR model. Our analysis reveals that the immunity is very strongly increasing in several countries during the second Covid-19 wave. Wave-specific SIR parameters describing infection and recovery rates we find to behave in a similar fashion. Still, an apparently moderate change of their ratio can have significant consequences. As we show, the probability of an additional wave is however low in several countries due to the fraction of immune inhabitants at the end of the second wave, irrespective of the ongoing vaccination efforts. We compare with alternate approaches and data available at the time of submission. Most recent data serves to demonstrate the successful forecast and high accuracy of the SIR model in predicting the evolution of pandemic outbreaks as long as the assumption underlying our analysis, an unchanged situation of the distribution of variants of concern and the fatality fraction, do not change dramatically during a wave. With the rise of the α variant at the time of submission the second wave did not terminate in some countries, giving rise to a superposition of waves that is not treated by the present contribution.

Agent-based analysis of contagion events according to sourcing locations

The first human infected with the Covid-19 virus was traced to a seafood market in Wuhan, China. Research shows that there are comparable types of viruses found in different and mutually distant areas. This raises several questions: what if the virus originated in another location? How will future waves of epidemics behave if they originate from different locations with a smaller/larger population than Wuhan? To explore these questions, we implement an agent-based model within fractal cities. Cities radiate gravitational social attraction based on their Zipfian population. The probability and predictability of contagion events are analyzed by examining fractal dimensions and lacunarity. Results show that weak gravitational forces of small locations help dissipate infections across country quicker if the pathogen had originated from that location. Gravitational forces of large cities help contain infections within them if they are the starting locations for the pathogen. Greater connectedness and symmetry allow for a more predictable epidemic outcome since there are no obstructions to spreading. To test our hypothesis, we implement datasets from two countries, Sierra Leone and Liberia, and two diseases, Ebola and Covid-19, and obtain the same results.

Dynamic coupling between the COVID-19 epidemic timeline and the behavioral response to PAUSE in New York State counties

Behavioral epidemiology suggests that there is a tight dynamic coupling between the timeline of an epidemic outbreak, and the social response in the affected population (with a typical course involving physical distancing between individuals, avoidance of large gatherings, wearing masks, etc). We study the bidirectional coupling between the epidemic dynamics of COVID-19 and the population social response in the state of New York, between March 1, 2020 (which marks the first confirmed positive diagnosis in the state), until June 20, 2020. This window captures the first state-wide epidemic wave, which peaked to over 11,000 confirmed cases daily in April (making New York one of the US states most severely affected by this first wave), and subsided by the start of June to a count of consistently under 1,500 confirmed cases per day (suggesting temporary state-wide control of the epidemic). In response to the surge in cases, social distancing measures were gradually introduced over two weeks in March, culminating with the PAUSE directive on March 22nd, which mandated statewide shutdown of all nonessential activity. The mandates were then gradually relaxed in stages throughout summer, based on how epidemic benchmarks were met in various New York regions. In our study, we aim to examine on one hand, whether different counties exhibited different responses to the PAUSE centralized measures depending on their epidemic situation immediately preceding PAUSE. On the other hand, we explore whether these different county-wide responses may have contributed in turn to modulating the counties’ epidemic timelines. We used the public domain to extract county-wise epidemic measures (such as cumulative and daily incidence of COVID-19), and social mobility measures for different modalities (driving, walking, public transit) and to different destinations. Our correlation analyses between the epidemic and the mobility time series found significant correlations between the size of the epidemic and the degree of mobility drop after PAUSE, as well as between the mobility comeback patterns and the epidemic recovery timeline. In line with existing literature on the role of the population behavioral response during an epidemic outbreak, our results support the potential importance of the PAUSE measures to the control of the first epidemic wave in New York State.

Compliance with NPIs and possible deleterious effects on mitigation of an epidemic outbreak

The first attempt to control and mitigate an epidemic outbreak caused by a previously unknown virus occurs primarily via non-pharmaceutical interventions (NPIs). In case of the SARS-CoV-2 virus, which since the early days of 2020 caused the COVID-19 pandemic, NPIs aimed at reducing transmission-enabling contacts between individuals. The effectiveness of contact reduction measures directly correlates with the number of individuals adhering to such measures. Here, we illustrate by means of a very simple compartmental model how partial noncompliance with NPIs can prevent these from stopping the spread of an epidemic.

Geometric singular perturbation theory analysis of an epidemic model with spontaneous human behavioral change

We consider a model due to Piero Poletti and collaborators that adds spontaneous human behavioral change to the standard SIR epidemic model. In its simplest form, the Poletti model adds one differential equation, motivated by evolutionary game theory, to the SIR model. The new equation describes the evolution of a variable x that represents the fraction of the population following normal behavior. The remaining fraction [Formula: see text] uses altered behavior such as staying home, social isolation, mask wearing, etc. Normal behavior offers a higher payoff when the number of infectives is low; altered behavior offers a higher payoff when the number is high. We show that the entry-exit function of geometric singular perturbation theory can be used to analyze the model in the limit in which behavior changes on a much faster time scale than that of the epidemic. In particular, behavior does not change as soon as a different behavior has a higher payoff; current behavior is sticky. The delay until behavior changes is predicted by the entry-exit function.

Shared mobility in post-COVID era: New challenges and opportunities

This study is aimed at exploring the challenges and opportunities that the COVID-19 outbreak presents to the sustainability of shared mobility. To date, the sustainability of shared mobility has received little attention in the literature, and this study determines its central constructs that are critical to the sustainability of shared mobility. We accordingly conducted a three-phase Delphi approach composed of both qualitative and quantitative methods. Feedback was obtained from 18 international experts who are very knowledgeable regarding civil engineering and shared mobility, initially finding 18 challenges and 18 opportunities. Finally, we identified 12 key constructs as highly critical to the sustainability of shared mobility. The current work is an attempt to address gaps in exploring the challenges and opportunities that the COVID-19 outbreak has created in shared mobility, particularly when a comprehensive examination is needed. This study will serve as an inspiration and catalog for new studies within this field.

Endogenous social distancing and its underappreciated impact on the epidemic curve

Social distancing is an effective strategy to mitigate the impact of infectious diseases. If sick or healthy, or both, predominantly socially distance, the epidemic curve flattens. Contact reductions may occur for different reasons during a pandemic including health-related mobility loss (severity of symptoms), duty of care for a member of a high-risk group, and forced quarantine. Other decisions to reduce contacts are of a more voluntary nature. In particular, sick people reduce contacts consciously to avoid infecting others, and healthy individuals reduce contacts in order to stay healthy. We use game theory to formalize the interaction of voluntary social distancing in a partially infected population. This improves the behavioral micro-foundations of epidemiological models, and predicts differential social distancing rates dependent on health status. The model's key predictions in terms of comparative statics are derived, which concern changes and interactions between social distancing behaviors of sick and healthy. We fit the relevant parameters for endogenous social distancing to an epidemiological model with evidence from influenza waves to provide a benchmark for an epidemic curve with endogenous social distancing. Our results suggest that spreading similar in peak and case numbers to what partial immobilization of the population produces, yet quicker to pass, could occur endogenously. Going forward, eventual social distancing orders and lockdown policies should be benchmarked against more realistic epidemic models that take endogenous social distancing into account, rather than be driven by static, and therefore unrealistic, estimates for social mixing that intrinsically overestimate spreading.

An epidemiological model with voluntary quarantine strategies governed by evolutionary game dynamics

During pandemic events, strategies such as social distancing can be fundamental to reduce simultaneous infections and mitigate the disease spreading, which is very relevant to the risk of a healthcare system collapse. Although these strategies can be recommended, or even imposed, their actual implementation may depend on the population perception of the risks associated with a potential infection. The current COVID-19 crisis, for instance, is showing that some individuals are much more prone than others to remain isolated. To better understand these dynamics, we propose an epidemiological SIR model that uses evolutionary game theory for combining in a single process social strategies, individual risk perception, and viral spreading. In particular, we consider a disease spreading through a population, whose agents can choose between self-isolation and a lifestyle careless of any epidemic risk. The strategy adoption is individual and depends on the perceived disease risk compared to the quarantine cost. The game payoff governs the strategy adoption, while the epidemic process governs the agent's health state. At the same time, the infection rate depends on the agent's strategy while the perceived disease risk depends on the fraction of infected agents. Our results show recurrent infection waves, which are usually seen in previous historic epidemic scenarios with voluntary quarantine. In particular, such waves re-occur as the population reduces disease awareness. Notably, the risk perception is found to be fundamental for controlling the magnitude of the infection peak, while the final infection size is mainly dictated by the infection rates. Low awareness leads to a single and strong infection peak, while a greater disease risk leads to shorter, although more frequent, peaks. The proposed model spontaneously captures relevant aspects of a pandemic event, highlighting the fundamental role of social strategies.

Behaviour adoption approaches during public health emergencies: implications for the COVID-19 pandemic and beyond

Human behaviour will continue to play an important role as the world grapples with public health threats. In this paper, we draw from the emerging evidence on behaviour adoption during diverse public health emergencies to develop a framework that contextualises behaviour adoption vis-à-vis a combination of top-down, intermediary and bottom-up approaches. Using the COVID-19 pandemic as a case study, we operationalise the contextual framework to demonstrate how these three approaches differ in terms of their implementation, underlying drivers of action, enforcement, reach and uptake. We illustrate how blended strategies that include all three approaches can help accelerate and sustain protective behaviours that will remain important even when safe and effective vaccines become more widely available. As the world grapples with the COVID-19 pandemic and prepares to respond to (re)emerging public health threats, our contextual framework can inform the design, implementation, tracking and evaluation of comprehensive public health and social measures during health emergencies.

A mindful path to the COVID-19 pandemic: an approach to promote physical distancing behavior

Purpose

The present situation is marked by the threat of COVID-19 pandemic on entire humankind and researchers across the globe are looking forward to vaccines or medicines to tackle COVID-19. However, according to the scholars and health-care agencies, vaccines alone would not be of much help and in the longer run adhering to the physical distancing policy along with sanitation could be the only solution. Moreover, extant studies across different areas have noted a positive association between various human psychological factors and prosocial behaviours. Additionally, an empirical study undertaken in the western context has tried exploring the association between human psychological factors and physical distancing behaviour (a kind of prosocial behaviour) in the COVID-19 context. The results of the extant study seem intriguing and encouraging enough to undertake a more robust exploratory study in this developing area. Against this background, this study aims to explore the relationship between individuals’ mindfulness and physical distancing behaviour, along with the mediating role of empathy during the COVID-19 pandemic.

Design/methodology/approach

To achieve the study objectives, this study has used an online survey method and has collected responses from the general adult population in India spread across all six regions. The survey was conducted during May 2020 when India was under a nationwide lockdown to mitigate the risk of COVID-19 pandemic. The respondents were identified based on convenience and snowball sampling techniques. Using social media platforms, the prospective respondents were contacted through WhatsApp, LinkedIn and Facebook or e-mails. Post data cleaning, a total of 315 responses were found to be suitable for analysis. For analysis, confirmatory factor analysis was conducted to establish the validity and reliability of the conceptual model, whereas Pearson correlation was undertaken to study the relationship between variables and mediation was examined using the PROCESS macro of Hayes.

Findings

The findings were encouraging and could become the foundation stone for further research and a practical guide for policymakers, agencies working in the health-care areas and even corporate leaders. As expected, an individual’s mindfulness was noted to be positively-related and influencing physical distancing behaviour. The mediation analysis indicated the intervening role of empathy in the association between an individual’s mindfulness and physical distancing behaviour.

Practical implications

The findings of the present could be a game-changer in restricting the spread of the COVID-19 pandemic. As espoused by various scholars, as well as health-care organizations about the use of physical distancing in mitigating the risk of COVID-19, policymakers, health-care authorities and even corporate leaders could look forward to strategizing and execute the dissemination of various mindfulness-based programs among the individuals. These mindfulness-based programs, which could be disseminated offline and online through smartphones, could, in turn, help in positively influence physical distancing behaviour among the individuals leading to the success of physical distancing policy.

Social implications

This study relates and extends the mechanism of mindfulness in influencing individuals’ physical distancing behaviour in the pandemic situation, notably the COVID-19 pandemic. Moreover, based on the “empathy-altruism hypothesis”, as well as Schwartz’s theory of fundamental values, the intervening role of empathy has been explored and the findings further helped in extended these two theories in the domain of pandemic.

Originality/value

This study could be the first to conceptualize and examine the human psychological factors, particularly the relationship and role of an individual’s mindfulness with physical distancing behaviour among the general public during the COVID-19 pandemic. Additionally, this could also be the first study to conceptualize and explore the intervening role of empathy in the relationship between an individual’s mindfulness and physical distancing behaviour. Moreover, in conceptualizing and exploring the relationship between an individual’s mindfulness and physical distancing behaviour, this study explored and extended the “reperceiving” mechanism of mindfulness and the “empathy-altruism hypothesis” along with Schwartz’s theory of fundamental values in the domain of pandemic.

Game theoretic modelling of infectious disease dynamics and intervention methods: a review

We review research studies which use game theory to model the decision-making of individuals during an epidemic, attempting to classify the literature and identify the emerging trends in this field. The literature is classified based on (i) type of population modelling (classical or network-based), (ii) frequency of the game (non-repeated or repeated), and (iii) type of strategy adoption (self-learning or imitation). The choice of model is shown to depend on many factors such as the immunity to the disease, the strength of immunity conferred by the vaccine, the size of population and the level of mixing therein. We highlight that while early studies used classical compartmental modelling with self-learning games, in recent years, there is a substantial growth of network-based modelling with imitation games. The review indicates that game theory continues to be an effective tool to model decision-making by individuals with respect to intervention (vaccination or social distancing).

Buying Time for an Effective Epidemic Response: The Impact of a Public Holiday for Outbreak Control on COVID-19 Epidemic Spread

Rapid responses in the early stage of a new epidemic are crucial in outbreak control. Public holidays for outbreak control could provide a critical time window for a rapid rollout of social distancing and other control measures at a large population scale. The objective of our study was to explore the impact of the timing and duration of outbreak-control holidays on the coronavirus disease 2019 (COVID-19) epidemic spread during the early stage in China. We developed a compartment model to simulate the dynamic transmission of COVID-19 in China starting from January 2020. We projected and compared epidemic trajectories with and without an outbreak-control holiday that started during the Chinese Lunar New Year. We considered multiple scenarios of the outbreak-control holiday with different durations and starting times, and under different assumptions about viral transmission rates. We estimated the delays in days to reach certain thresholds of infections under different scenarios. Our results show that the outbreak-control holiday in China likely stalled the spread of COVID-19 for several days. The base case outbreak-control holiday (21 d for Hubei Province and 10 d for all other provinces) delayed the time to reach 100 000 confirmed infections by 7.54 d. A longer outbreak-control holiday would have had stronger effects. A nationwide outbreak-control holiday of 21 d would have delayed the time to 100 000 confirmed infections by nearly 10 d. Furthermore, we find that outbreak-control holidays that start earlier in the course of a new epidemic are more effective in stalling epidemic spread than later holidays and that additional control measures during the holidays can boost the holiday effect. In conclusion, an outbreak-control holiday can likely effectively delay the transmission of epidemics that spread through social contacts. The temporary delay in the epidemic trajectory buys time, which scientists can use to discover transmission routes and identify effective public health interventions and which governments can use to build physical infrastructure, organize medical supplies, and deploy human resources for long-term epidemic mitigation and control efforts.

On the dynamics emerging from pandemics and infodemics

This position paper discusses emerging behavioral, social, and economic dynamics related to the COVID-19 pandemic and puts particular emphasis on two emerging issues: First, delayed effects (or second strikes) of pandemics caused by dread risk effects are discussed whereby two factors which might influence the existence of such effects are identified, namely the accessibility of (mis-)information and the effects of policy decisions on adaptive behavior. Second, the issue of individual preparedness to hazardous events is discussed. As events such as the COVID-19 pandemic unfolds complex behavioral patterns which are hard to predict, sophisticated models which account for behavioral, social, and economic dynamics are required to assess the effectivity and efficiency of decision-making.

Decisions and disease: a mechanism for the evolution of cooperation

In numerous contexts, individuals may decide whether they take actions to mitigate the spread of disease, or not. Mitigating the spread of disease requires an individual to change their routine behaviours to benefit others, resulting in a 'disease dilemma' similar to the seminal prisoner's dilemma. In the classical prisoner's dilemma, evolutionary game dynamics predict that all individuals evolve to 'defect.' We have discovered that when the rate of cooperation within a population is directly linked to the rate of spread of the disease, cooperation evolves under certain conditions. For diseases which do not confer immunity to recovered individuals, if the time scale at which individuals receive accurate information regarding the disease is sufficiently rapid compared to the time scale at which the disease spreads, then cooperation emerges. Moreover, in the limit as mitigation measures become increasingly effective, the disease can be controlled; the number of infections tends to zero. It has been suggested that disease spreading models may also describe social and group dynamics, indicating that this mechanism for the evolution of cooperation may also apply in those contexts.

Towards a data-driven characterization of behavioral changes induced by the seasonal flu

In this work, we aim to determine the main factors driving self-initiated behavioral changes during the seasonal flu. To this end, we designed and deployed a questionnaire via Influweb, a Web platform for participatory surveillance in Italy, during the 2017 - 18 and 2018 - 19 seasons. We collected 599 surveys completed by 434 users. The data provide socio-demographic information, level of concerns about the flu, past experience with illnesses, and the type of behavioral changes voluntarily implemented by each participant. We describe each response with a set of features and divide them in three target categories. These describe those that report i) no (26%), ii) only moderately (36%), iii) significant (38%) changes in behaviors. In these settings, we adopt machine learning algorithms to investigate the extent to which target variables can be predicted by looking only at the set of features. Notably, 66% of the samples in the category describing more significant changes in behaviors are correctly classified through Gradient Boosted Trees. Furthermore, we investigate the importance of each feature in the classification task and uncover complex relationships between individuals' characteristics and their attitude towards behavioral change. We find that intensity, recency of past illnesses, perceived susceptibility to and perceived severity of an infection are the most significant features in the classification task and are associated to significant changes in behaviors. Overall, the research contributes to the small set of empirical studies devoted to the data-driven characterization of behavioral changes induced by infectious diseases.

The impact of behavioral change on the epidemic under the benefit comparison

Human behavior has a major impact on the spread of the disease during an epidemic. At the same time, the spread of disease has an impact on human behavior. In this paper, we propose a coupled model of human behavior and disease transmission, take into account both individual-based risk assessment and neighbor-based replicator dynamics. The transmission threshold of epidemic disease and the stability of disease-free equilibrium point are analyzed. Some numerical simulations are carried out for the system. Three kinds of return matrices are considered and analyzed one by one. The simulation results show that the change of human behavior can effectively inhibit the spread of the disease, individual-based risk assessments had a stronger effect on disease suppression, but also more hitchhikers. This work contributes to the study of the relationship between human behavior and disease epidemics.

The impact of news exposure on collective attention in the United States during the 2016 Zika epidemic

In recent years, many studies have drawn attention to the important role of collective awareness and human behaviour during epidemic outbreaks. A number of modelling efforts have investigated the interaction between the disease transmission dynamics and human behaviour change mediated by news coverage and by information spreading in the population. Yet, given the scarcity of data on public awareness during an epidemic, few studies have relied on empirical data. Here, we use fine-grained, geo-referenced data from three online sources—Wikipedia, the GDELT Project and the Internet Archive—to quantify population-scale information seeking about the 2016 Zika virus epidemic in the U.S., explicitly linking such behavioural signal to epidemiological data. Geo-localized Wikipedia pageview data reveal that visiting patterns of Zika-related pages in Wikipedia were highly synchronized across the United States and largely explained by exposure to national television broadcast. Contrary to the assumption of some theoretical epidemic models, news volume and Wikipedia visiting patterns were not significantly correlated with the magnitude or the extent of the epidemic. Attention to Zika, in terms of Zika-related Wikipedia pageviews, was high at the beginning of the outbreak, when public health agencies raised an international alert and triggered media coverage, but subsequently exhibited an activity profile that suggests nonlinear dependencies and memory effects in the relation between information seeking, media pressure, and disease dynamics. This calls for a new and more general modelling framework to describe the interaction between media exposure, public awareness and disease dynamics during epidemic outbreaks.

Despite its importance for public health policy-makers, understanding the impact of media coverage on collective attention during disease outbreaks remains an elusive research task, due to the lack of available data, especially at high spatial granularity. In this paper, we study the dynamics of collective attention received by the 2016 Zika epidemic in the USA and its interplay with the media coverage of the outbreak, at level of US states and cities. We measure the attention to Zika through geo-localized Wikipedia page view data, and we compare it with mentions of Zika in US news outlets and TV shows. We also compare the collective attention received by the outbreak with the incidence of Zika reported by the US Centers for Disease Control and Prevention in each state. We find that the attention dynamics was highly synchronized across states, irrespective of the local risk of transmission of the virus. By building a linear regression model, we show that the dynamics of collective attention is highly predictable, even at state level, only based on the national media coverage received by the outbreak.

Epidemics on networks: Reducing disease transmission using health emergency declarations and peer communication

Understanding individual decisions in a world where communications and information move instantly via cell phones and the internet, contributes to the development and implementation of policies aimed at stopping or ameliorating the spread of diseases. In this manuscript, the role of official social network perturbations generated by public health officials to slow down or stop a disease outbreak are studied over distinct classes of static social networks. The dynamics are stochastic in nature with individuals (nodes) being assigned fixed levels of education or wealth. Nodes may change their epidemiological status from susceptible, to infected and to recovered. Most importantly, it is assumed that when the prevalence reaches a pre-determined threshold level,P * , information, called awareness in our framework, starts to spread, a process triggered by public health authorities. Information is assumed to spread over the same static network and whether or not one becomes a temporary informer, is a function of his/her level of education or wealth and epidemiological status. Stochastic simulations show that threshold selectionP * and the value of the average basic reproduction number impact the final epidemic size differentially. For the Erdős-Rényi and Small-world networks, an optimal choice forP * that minimize the final epidemic size can be identified under some conditions while for Scale-free networks this is not case.

Contact Adaption During Epidemics: A Multilayer Network Formulation Approach

People change their physical contacts as a preventive response to infectious disease propagations. Yet, only a few mathematical models consider the coupled dynamics of the disease propagation and the contact adaptation process. This paper presents a model where each agent has a default contact neighborhood set, and switches to a different contact set once she becomes alert about infection among her default contacts. Since each agent can adopt either of two possible neighborhood sets, the overall contact network switches among [Formula: see text] possible configurations. Notably, a two-layer network representation can fully model the underlying adaptive, state-dependent contact network. Contact adaptation influences the size of the disease prevalence and the epidemic threshold-a characteristic measure of a contact network robustness against epidemics-in a nonlinear fashion. Particularly, the epidemic threshold for the presented adaptive contact network belongs to the solution of a nonlinear Perron-Frobenius (NPF) problem, which does not depend on the contact adaptation rate monotonically. Furthermore, the network adaptation model predicts a counter-intuitive scenario where adaptively changing contacts may adversely lead to lower network robustness against epidemic spreading if the contact adaptation is not fast enough. An original result for a class of NPF problems facilitate the analytical developments in this paper.

Epidemics in Competition: Partial Cross-Immunity

The competition between two pathogen strains during the course of an epidemic represents a fundamental step in the early evolution of emerging diseases as well as in the antigenic drift process of influenza. The outcome of the competition, however, depends not only on the epidemic properties of the two strains but also on the timing and size of the introduction, characteristics that are poorly captured by deterministic mean-field epidemic models. We describe those aspects of the competition that can be determined from the mean-field models giving the range of possible final sizes of susceptible hosts and cumulated attack rates that could be observed after an epidemic with two cross-reacting strains. In the limit where the size of the initial infection goes to zero, the possible outcomes lie on a (one dimensional) curve in the outcome space.

Dynamics of the impact of Twitter with time delay on the spread of infectious diseases

In this paper, a mathematical model to study the impact of Twitter in controlling infectious disease is proposed. The model includes the dynamics of “tweets” which may enhance awareness of the disease and cause behavioral changes among the public, thus reducing the transmission of the disease. Furthermore, the model is improved by introducing a time delay between the outbreak of disease and the release of Twitter messages. The basic reproduction number and the conditions for the stability of the equilibria are derived. It is shown that the system undergoes Hopf bifurcation when time delay is increased. Finally, numerical simulations are given to verify the analytical results.

Infection prevention behaviour and infectious disease modelling: a review of the literature and recommendations for the future

Background

Given the importance of person to person transmission in the spread of infectious diseases, it is critically important to ensure that human behaviour with respect to infection prevention is appropriately represented within infectious disease models. This paper presents a large scale scoping review regarding the incorporation of infection prevention behaviour in infectious disease models. The outcomes of this review are contextualised within the psychological literature concerning health behaviour and behaviour change, resulting in a series of key recommendations for the incorporation of human behaviour in future infectious disease models.

Methods

The search strategy focused on terms relating to behaviour, infectious disease and mathematical modelling. The selection criteria were developed iteratively to focus on original research articles that present an infectious disease model with human-human spread, in which individuals’ self-protective health behaviour varied endogenously within the model. Data extracted included: the behaviour that is modelled; how this behaviour is modelled; any theoretical background for the modelling of behaviour, and; any behavioural data used to parameterise the models.

Results

Forty-two papers from an initial total of 2987 were retained for inclusion in the final review. All of these papers were published between 2002 and 2015. Many of the included papers employed a multiple, linked models to incorporate infection prevention behaviour. Both cognitive constructs (e.g., perceived risk) and, to a lesser extent, social constructs (e.g., social norms) were identified in the included papers. However, only five papers made explicit reference to psychological health behaviour change theories. Finally, just under half of the included papers incorporated behavioural data in their modelling.

Conclusions

By contextualising the review outcomes within the psychological literature on health behaviour and behaviour change, three key recommendations for future behavioural modelling are made. First, modellers should consult with the psychological literature on health behaviour/ behaviour change when developing new models. Second, modellers interested in exploring the relationship between behaviour and disease spread should draw on social psychological literature to increase the complexity of the social world represented within infectious disease models. Finally, greater use of context-specific behavioural data (e.g., survey data, observational data) is recommended to parameterise models.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5223-1) contains supplementary material, which is available to authorized users.

Modeling the effect of time delay in budget allocation to control an epidemic through awareness

The emergence of any new infectious disease poses much stress on the government to control the spread of such disease. The easy, fast and less expensive way to slow down the spread of disease is to make the population be aware of its spread and possible control mechanisms. For this purpose, government allocates some funds to make public aware through mass media, print media, pamphlets, etc. Keeping this in view, in this paper, a nonlinear mathematical model is proposed and analyzed to assess the effect of time delay in providing funds by the government to warn people. It is assumed that susceptible individuals contract infection through the direct contact with infected individuals; however the rate of contracting infection is a decreasing function of funds availability. The proposed model is analyzed using stability theory of delay differential equations and numerical simulations. The model analysis shows that the increase in funds to warn people reduces the number of infected individuals but delay in providing the funds destabilizes the interior equilibrium and may cause stability switches.

Voluntary vaccination dilemma with evolving psychological perceptions

Voluntary vaccination is a universal control protocol for infectious diseases. Yet there exists a social dilemma between individual benefits and public health: non-vaccinators free ride via the herd immunity from adequate vaccinators who bear vaccination cost. This is due to the interplay between disease prevalence and individual vaccinating behavior. To complicate matters further, individual vaccinating behavior depends on the perceived vaccination cost rather than the actual one. The perception of vaccination cost is an individual trait, which varies from person to person, and evolves in response to the disease prevalence and vaccination coverage. To explore how evolving perception shapes individual vaccinating behavior and thus the vaccination dynamics, we provide a model combining epidemic dynamics with evolutionary game theory which captures the voluntary vaccination dilemma. In particular, individuals adjust their perception based on the inertia effect in psychology and then update their vaccinating behavior through imitating the behavior of a more successful peer. We find that i) vaccination is acceptable when the expected vaccination cost considering perception and actual vaccination cost is less than the maximum of the expected non-vaccination cost; ii) the evolution of perception is a "double-edged sword" for vaccination dynamics: it can improve vaccination coverage when most individuals perceive exaggerated vaccination cost, and it inhibits vaccination coverage in the other cases.

Impact of individual behaviour change on the spread of emerging infectious diseases

Human behaviour plays an important role in the spread of emerging infectious diseases, and understanding the influence of behaviour changes on epidemics can be key to improving control efforts. However, how the dynamics of individual behaviour changes affects the development of emerging infectious disease is a key public health issue. To develop different formula for individual behaviour change and introduce how to embed it into a dynamic model of infectious diseases, we choose A/H1N1 and Ebola as typical examples, combined with the epidemic reported cases and media related news reports. Thus, the logistic model with the health belief model is used to determine behaviour decisions through the health belief model constructs. Furthermore, we propose 4 candidate infectious disease models without and with individual behaviour change and use approximate Bayesian computation based on sequential Monte Carlo method for model selection. The main results indicate that the classical compartment model without behaviour change and the model with average rate of behaviour change depicted by an exponential function could fit the observed data best. The results provide a new way on how to choose an infectious disease model to predict the disease prevalence trend or to evaluate the influence of intervention measures on disease control. However, sensitivity analyses indicate that the accumulated number of hospital notifications and deaths could be largely reduced as the rate of behaviour change increases. Therefore, in terms of mitigating emerging infectious diseases, both media publicity focused on how to guide people's behaviour change and positive responses of individuals are critical.

Effects of reactive social distancing on the 1918 influenza pandemic

The 1918 influenza pandemic was characterized by multiple epidemic waves. We investigated reactive social distancing, a form of behavioral response where individuals avoid potentially infectious contacts in response to available information on an ongoing epidemic or pandemic. We modelled its effects on the three influenza waves in the United Kingdom. In previous studies, human behavioral response was modelled by a Power function of the proportion of recent influenza mortality in a population, and by a Hill function, which is a function of the number of recent influenza mortality. Using a simple epidemic model with a Power function and one common set of parameters, we provided a good model fit for the observed multiple epidemic waves in London boroughs, Birmingham and Liverpool. We further applied the model parameters from these three cities to all 334 administrative units in England and Wales and including the population sizes of individual administrative units. We computed the Pearson's correlation between the observed and simulated for each administrative unit. We found a median correlation of 0.636, indicating that our model predictions are performing reasonably well. Our modelling approach is an improvement from previous studies where separate models are fitted to each city. With the reduced number of model parameters used, we achieved computational efficiency gain without over-fitting the model. We also showed the importance of reactive behavioral distancing as a potential non-pharmaceutical intervention during an influenza pandemic. Our work has both scientific and public health significance.

Interplay between epidemic spread and information propagation on metapopulation networks

The spread of an infectious disease has been widely found to evolve with the propagation of information. Many seminal works have demonstrated the impact of information propagation on the epidemic spreading, assuming that individuals are static and no mobility is involved. Inspired by the recent observation of diverse mobility patterns, we incorporate the information propagation into a metapopulation model based on the mobility patterns and contagion process, which significantly alters the epidemic threshold. In more details, we find that both the information efficiency and the mobility patterns have essential impacts on the epidemic spread. We obtain different scenarios leading to the mitigation of the outbreak by appropriately integrating the mobility patterns and the information efficiency as well. The inclusion of the impacts of the information propagation into the epidemiological model is expected to provide an support to public health implications for the suppression of epidemics.

Mathematical model for the impact of awareness on the dynamics of infectious diseases

This paper analyses an SIRS-type model for infectious diseases with account for behavioural changes associated with the simultaneous spread of awareness in the population. Two types of awareness are included into the model: private awareness associated with direct contacts between unaware and aware populations, and public information campaign. Stability analysis of different steady states in the model provides information about potential spread of disease in a population, and well as about how the disease dynamics is affected by the two types of awareness. Numerical simulations are performed to illustrate the behaviour of the system in different dynamical regimes.

Toward a Realistic Modeling of Epidemic Spreading with Activity Driven Networks

Models of epidemic spreading are widely used to predict the evolution of an outbreak, test specific intervention scenarios, and steer interventions in the field. Compartmental models are the most common class of models. They are very effective for qualitative analysis, but they rely on simplifying assumptions, such as homogeneous mixing and time scale separation. On the other end of the spectrum, detailed agent-based models, based on realistic mobility pattern models, provide extremely accurate predictions. However, these models require significant computing power and are not suitable for analytical treatment. Our research aims at bridging the gap between these two approaches, toward time-varying network models that are sufficiently accurate to make predictions for real-world applications, while being computationally affordable and amenable to analytical treatment. We leverage the novel paradigm of activity driven networks (ADNs), a particular type of time-varying network that accounts for inherent inhomogeinities within a population. Starting from the basic incarnation of ADNs, we expand on the framework to include behavioral factors triggered by health status and spreading awareness. The enriched paradigm is then utilized to model the 2014–2015 Ebola Virus Disease (EVD) spreading in Liberia, and perform a what-if analysis on the timely application of sanitary interventions in the field. Finally, we propose a new formulation, which is amenable to analytical treatment, beyond the mere computation of the epidemic threshold.

School closure policies at municipality level for mitigating influenza spread: a model-based evaluation

Background

Nearly every year Influenza affects most countries worldwide and the risk of a new pandemic is always present. Therefore, influenza is a major concern for public health. School-age individuals are often the most affected group, suggesting that the inclusion in preparedness plans of school closure policies may represent an option for influenza mitigation. However, their applicability remains uncertain and their implementation should carefully be weighed on the basis of cost-benefit considerations.

Methods

We developed an individual-based model for influenza transmission integrating data on sociodemography and time use of the Italian population, face-to-face contacts in schools, and influenza natural history. The model was calibrated on the basis of epidemiological data from the 2009 influenza pandemic and was used to evaluate the effectiveness of three reactive school closure strategies, all based on school absenteeism.

Results

In the case of a new influenza pandemic sharing similar features with the 2009 H1N1 pandemic, gradual school closure strategies (i.e., strategies closing classes first, then grades or the entire school) could lead to attack rate reduction up to 20–25 % and to peak weekly incidence reduction up to 50–55 %, at the cost of about three school weeks lost per student. Gradual strategies are quite stable to variations in the start of policy application and to the threshold on student absenteeism triggering class (and school) closures. In the case of a new influenza pandemic showing different characteristics with respect to the 2009 H1N1 pandemic, we found that the most critical features determining the effectiveness of school closure policies are the reproduction number and the age-specific susceptibility to infection, suggesting that these two epidemiological quantities should be estimated early on in the spread of a new pandemic for properly informing response planners.

Conclusions

Our results highlight a potential beneficial effect of reactive gradual school closure policies in mitigating influenza spread, conditioned on the effort that decision makers are willing to afford. Moreover, the suggested strategies are solely based on routinely collected and easily accessible data (such as student absenteeism irrespective of the cause and ILI incidence) and thus they appear to be applicable in real world situations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1918-z) contains supplementary material, which is available to authorized users.

The cumulative effect of risk compensation on infection preventive measures

We study several epidemic models (with and without gender structure) that incorporate risk compensation behavior in response to a lower chance of acquiring the infection as a result of preventive measures that are only partially effective. We show that the cumulative risk compensation that occurs between a high risk susceptible and infectious individual may play an important role in whether the implementation of these measures is successful in lowering the epidemic reproductive number. In addition, we show that certain levels of risk compensation may cancel the benefit of the low infection risk practiced by diagnosed infectious individuals when the goal is a reduction of the epidemic reproductive number.

The impacts of simultaneous disease intervention decisions on epidemic outcomes

Mathematical models of the interplay between disease dynamics and human behavioural dynamics can improve our understanding of how diseases spread when individuals adapt their behaviour in response to an epidemic. Accounting for behavioural mechanisms that determine uptake of infectious disease interventions such as vaccination and non-pharmaceutical interventions (NPIs) can significantly alter predicted health outcomes in a population. However, most previous approaches that model interactions between human behaviour and disease dynamics have modelled behaviour of these two interventions separately. Here, we develop and analyze an agent based network model to gain insights into how behaviour toward both interventions interact adaptively with disease dynamics (and therefore, indirectly, with one another) during the course of a single epidemic where an SIRV infection spreads through a contact network. In the model, individuals decide to become vaccinated and/or practice NPIs based on perceived infection prevalence (locally or globally) and on what other individuals in the network are doing. We find that introducing adaptive NPI behaviour lowers vaccine uptake on account of behavioural feedbacks, and also decreases epidemic final size. When transmission rates are low, NPIs alone are as effective in reducing epidemic final size as NPIs and vaccination combined. Also, NPIs can compensate for delays in vaccine availability by hindering early disease spread, decreasing epidemic size significantly compared to the case where NPI behaviour does not adapt to mitigate early surges in infection prevalence. We also find that including adaptive NPI behaviour strongly mitigates the vaccine behavioural feedbacks that would otherwise result in higher vaccine uptake at lower vaccine efficacy as predicted by most previous models, and the same feedbacks cause epidemic final size to remain approximately constant across a broad range of values for vaccine efficacy. Finally, when individuals use local information about others' behaviour and infection prevalence, instead of population-level information, infection is controlled more efficiently through ring vaccination, and this is reflected in the time evolution of pair correlations on the network. This model shows that accounting for both adaptive NPI behaviour and adaptive vaccinating behaviour regarding social effects and infection prevalence can result in qualitatively different predictions than if only one type of adaptive behaviour is modelled.