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Chen S, Chen Q, Yang J, Lin L, Li L, Jiao L, Geldsetzer P, Wang C, Wilder-Smith A, Bärnighausen T. Curbing the COVID-19 pandemic with facility-based isolation of mild cases: a mathematical modeling study. J Travel Med 2021; 28:taaa226. [PMID: 33274387 PMCID: PMC7799023 DOI: 10.1093/jtm/taaa226] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/19/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In many countries, patients with mild coronavirus disease 2019 (COVID-19) are told to self-isolate at home, but imperfect compliance and shared living space with uninfected people limit the effectiveness of home-based isolation. We examine the impact of facility-based isolation compared to self-isolation at home on the continuing epidemic in the USA. METHODS We developed a compartment model to simulate the dynamic transmission of COVID-19 and calibrated it to key epidemic measures in the USA from March to September 2020. We simulated facility-based isolation strategies with various capacities and starting times under different diagnosis rates. Our primary model outcomes are new infections and deaths over 2 months from October 2020 onwards. In addition to national-level estimations, we explored the effects of facility-based isolation under different epidemic burdens in major US Census Regions. We performed sensitivity analyses by varying key model assumptions and parameters. RESULTS We find that facility-based isolation with moderate capacity of 5 beds per 10 000 total population could avert 4.17 (95% credible interval 1.65-7.11) million new infections and 16 000 (8000-23 000) deaths in 2 months compared with home-based isolation. These results are equivalent to relative reductions of 57% (44-61%) in new infections and 37% (27-40%) in deaths. Facility-based isolation with high capacity of 10 beds per 10 000 population could achieve reductions of 76% (62-84%) in new infections and 52% (37-64%) in deaths when supported by expanded testing with an additional 20% daily diagnosis rate. Delays in implementation would substantially reduce the impact of facility-based isolation. The effective capacity and the impact of facility-based isolation varied by epidemic stage across regions. CONCLUSION Timely facility-based isolation for mild COVID-19 cases could substantially reduce the number of new infections and effectively curb the continuing epidemic in the USA. Local epidemic burdens should determine the scale of facility-based isolation strategies.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany, 69120
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 100730
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA, 16802
| | - Juntao Yang
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China, 100005
| | - Lin Lin
- Department of Statistics, The Pennsylvania State University, University Park, PA, USA, 16802
| | - Linye Li
- Chinese Academy of Social Sciences, Beijing, China, 100732
| | | | - Pascal Geldsetzer
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany, 69120
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA, 94305
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 100730
- National Center for Respiratory Medicine, Beijing, China, 100029
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing, China, 100029
| | - Annelies Wilder-Smith
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany, 69120
- Department of Disease Control, London School of Hygiene and Tropical Medicine, United Kingdom, WC1E 7HT
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany, 69120
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 100730
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