Strategies for containing an emerging influenza pandemic in Southeast Asia

Study on the impact of COVID-19 epidemic and agent disease risk simulation model based on individual factors in Xi'an City

Introduction

Since the first discovery and reporting of the COVID - 19 pandemic towards the end of 2019, the virus has rapidly propagated across the world. This has led to a remarkable spike in the number of infections. Even now, doubt lingers over whether it has completely disappeared. Moreover, the issue of restoring normal life while ensuring safety continues to be a crucial challenge that public health agencies and people globally are eager to tackle.

Methods

To thoroughly understand the epidemic's outbreak and transmission traits and formulate timely prevention measures to fully safeguard human lives and property, this paper presents an agent - based model incorporating individual - level factors.

Results

The model designates Xi'an-where a characteristic disease outbreak occurred-as the research area. The simulation results demonstrate substantial consistency with official records, effectively validating the model's applicability, adaptability, and generalizability. This validated capacity enables accurate prediction of epidemic trends and comprehensive assessment of disease risks.

Discussion

From late 2021 to early 2022, it employs a one - to - one population simulation approach and simulates epidemic impacts and disease risks. Initially, using building statistical data in the study area, the model reconstructs the local real - world geographical environment. Leveraging data from the seventh national population census, it also replicates the study area's population characteristics. Next, the model takes into account population mobility, contact tracing, patient treatment, and the diagnostic burden of COVID - 19 - like influenza symptoms. It integrates epidemic transmission impact parameters into the model framework. Eventually, the model's results are compared with official data for validation, and it's applied to hypothetical scenarios. It provides scientific theoretical tools to support the implementation of government - driven prevention and control measures. Additionally, it facilitates the adjustment of individual behavioral guidelines, promoting more effective epidemic management.

An analysis of spatial and temporal uncertainty propagation in agent-based models

Spatially explicit simulations of complex systems lead to inherent uncertainties in spatial outcomes. Visualizing the temporal propagation of spatial uncertainties is crucial to communicate the reliability of such models. However, the current Uncertainty Analyses (UAs) either consider spatial uncertainty at the end of model runs, or consider non-spatial uncertainties at different model states. To address this, we propose a Spatio-Temporal UA (ST-UA) approach to generate an uncertainty propagation index and visualize the temporal propagation of different uncertainty measures between two temporal model states. We select the total effects sensitivity measure (a Sobol index) for a sample application within the ST-UA approach. The application is the Tobacco Town ABM, a spatial model simulating smoking behaviours. We showcase the effect of the statistical distributions of wages and smoking rates on the propensity to buy cigarettes, which leads to the propagation of uncertainty in the number of purchased cigarettes by individuals. The findings highlight the usefulness of the ST-UA in (i) communicating the reliability of the spatial outcomes of the model; and (ii) guiding modellers towards the spatial areas with relatively high uncertainties at different temporal steps. This approach can be readily transferred to other application areas that are characterized with spatio-temporal uncertainty.This article is part of the theme issue 'Uncertainty quantification for healthcare and biological systems (Part 2)'.

Modeling the impact of early vaccination in an influenza pandemic in the United States

We modeled the impact of initiating one-dose influenza vaccination at 3 months vs 6 months after declaration of a pandemic over a 1-year timeframe in the US population. Three vaccine effectiveness (VE) and two pandemic severity levels were considered, using an epidemic curve based on typical seasonal influenza epidemics. Vaccination from 3 months with a high, moderate, or low effectiveness vaccine would prevent ~95%, 84%, or 38% deaths post-vaccination, respectively, compared with 21%, 18%, and 8%, respectively following vaccination at 6 months, irrespective of pandemic severity. While the pandemic curve would not be flattened from vaccination from 6 months, a moderate/high effectiveness vaccine could flatten the curve if administered from 3 months. Overall, speed of initiating a vaccination campaign is more important than VE in reducing the health impacts of an influenza pandemic. Preparedness strategies may be able to minimize future pandemic impacts by prioritizing rapid vaccine roll-out.

Class-specific school closures for seasonal influenza: Optimizing timing and duration to prevent disease spread and minimize educational losses

School closures are a safe and important strategy for preventing infectious diseases in schools. However, the effects of school closures have not been fully demonstrated, and prolonged school closures have a negative impact on students and communities. This study evaluated class-specific school closure strategies to prevent the spread of seasonal influenza and determine the optimal timing and duration. We constructed a new model to describe the incidence of influenza in each class based on a stochastic susceptible-exposed-infected-removed model. We collected data on the number of infected absentees and class-specific school closures due to influenza from four high schools and the number of infected cases from the community in a Japanese city over three seasons (2016-2017, 2017-2018, and 2018-2019). The parameters included in the model were estimated using epidemic data. We evaluated the effects of class-specific school closures by measuring the reduced cumulative incidence of class closures per day. The greatest reduction in the cumulative absences per day was observed in the four-day class closure. When class-specific school closures lasted for four days, the reduction in the cumulative number of infections per class closure day was greater when the closure was timed earlier. The highest reduction in the number of class closures per person-day occurred when the threshold was around 5.0%. Large variations in the reduction of cumulative incidence were noted owing to stochastic factors. Reactive, class-specific school closures for seasonal influenza were most efficient when the percentage of newly infected students exceeded around 5.0%, with a closure duration of four days. The optimal strategy of class-specific school closure provides good long-term performance but may be affected by random variations.

BharatSim: An agent-based modelling framework for India

BharatSim is an open-source agent-based modelling framework for the Indian population. It can simulate populations at multiple scales, from small communities to states. BharatSim uses a synthetic population created by applying statistical methods and machine learning algorithms to survey data from multiple sources, including the Census of India, the India Human Development Survey, the National Sample Survey, and the Gridded Population of the World. This synthetic population defines individual agents with multiple attributes, among them age, gender, home and work locations, pre-existing health conditions, and socio-economic and employment status. BharatSim's domain-specific language provides a framework for the simulation of diverse models. Its computational core, coded in Scala, supports simulations of a large number of individual agents, up to 50 million. Here, we describe the design and implementation of BharatSim, using it to address three questions motivated by the COVID-19 pandemic in India: (i) When can schools be safely reopened given specified levels of hybrid immunity?, (ii) How do new variants alter disease dynamics in the background of prior infections and vaccinations? and (iii) How can the effects of varied non-pharmaceutical interventions (NPIs) be quantified for a model Indian city? Through its India-specific synthetic population, BharatSim allows disease modellers to address questions unique to this country. It should also find use in the computational social sciences, potentially providing new insights into emergent patterns in social behaviour.

Forecasting SARS-CoV-2 epidemic dynamic in Poland with the pDyn agent-based model

We employ pDyn (derived from "pandemics dynamics"), an agent-based epidemiological model, to forecast the fourth wave of the SARS-CoV-2 epidemic, primarily driven by the Delta variant, in Polish society. The model captures spatiotemporal dynamics of the epidemic spread, predicting disease-related states based on pathogen properties and behavioral factors. We assess pDyn's validity, encompassing pathogen variant succession, immunization level, and the proportion of vaccinated among confirmed cases. We evaluate its predictive capacity for pandemic dynamics, including wave peak timing, magnitude, and duration for confirmed cases, hospitalizations, ICU admissions, and deaths, nationally and regionally in Poland. Validation involves comparing pDyn's estimates with real-world data (excluding data used for calibration) to evaluate whether pDyn accurately reproduced the epidemic dynamics up to the simulation time. To assess the accuracy of pDyn's predictions, we compared simulation results with real-world data acquired after the simulation date. The findings affirm pDyn's accuracy in forecasting and enhancing our understanding of epidemic mechanisms.

Improved resolution of avian influenza virus using Oxford Nanopore R10 sequencing chemistry

Highly pathogenic avian influenza viruses continue to pose global risks to One Health, including agriculture, public, and animal health. Rapid and accurate genomic surveillance is critical for monitoring viral mutations, tracing transmission, and guiding interventions in near real-time. Oxford Nanopore sequencing holds promise for real-time influenza genotyping, but data quality from R9 chemistry has limited its adoption due to challenges resolving low-complexity regions such as the biologically critical hemagglutinin cleavage site, a homopolymer of basic amino acids that distinguish highly pathogenic strains. In this study, human and avian influenza isolates (n = 45) from Cambodia were sequenced using both R9.4.1 and R10.4.1 flow cells and chemistries to evaluate performance between approaches. Overall, R10.4.1 yielded increased data output with higher average quality compared to R9.4.1, producing improved consensus sequences using a reference-based bioinformatics approach. R10.4.1 had significantly lower minor population insertion and deletion frequencies, driven by improved performance in low sequence complexity regions prone to insertion and deletion errors, such as homopolymers. Within the hemagglutinin cleavage site, R10.4.1 resolved the correct motif in 90% of genomes compared to only 60% with R9.4.1. Further examination showed reduced frameshift mutations in consensus sequences generated with R10.4.1 that could result in incorrectly classified virulence with automated pipelines. Improved consensus genome quality from nanopore sequencing approaches, especially across biologically important low-complexity regions, is critical to reduce subjective hand-curation and will improve local and global genomic surveillance responses.

IMPORTANCE

This study demonstrates significant advancement in the field of influenza virus genomic surveillance by showcasing the superior accuracy and data quality of the Oxford Nanopore R10 sequencing chemistry compared to the older R9 chemistry. Improved resolution, including in the critical hemagglutinin multi-basic cleavage site, enables more reliable monitoring and tracking of viral mutations. This accelerates the ability to respond quickly to outbreaks, potentially improving impacts on public health, agriculture, and the economy by enabling more accurate and timely interventions.

Multiple pandemic waves vs multi-period/multi-phasic epidemics: Global shape of the COVID-19 pandemic

The overall course of the COVID-19 pandemic in Western countries has been characterized by complex sequences of phases. In the period before the arrival of vaccines, these phases were mainly due to the alternation between the strengthening/lifting of social distancing measures, with the aim to balance the protection of health and that of the society as a whole. After the arrival of vaccines, this multi-phasic character was further emphasized by the complicated deployment of vaccination campaigns and the onset of virus' variants. To cope with this multi-phasic character, we propose a theoretical approach to the modeling of overall pandemic courses, that we term multi-period/multi-phasic, based on a specific definition of phase. This allows a unified and parsimonious representation of complex epidemic courses even when vaccination and virus' variants are considered, through sequences of weak ergodic renewal equations that become fully ergodic when appropriate conditions are met. Specific hypotheses on epidemiological and intervention parameters allow reduction to simple models. The framework suggest a simple, theory driven, approach to data explanation that allows an accurate reproduction of the overall course of the COVID-19 epidemic in Italy since its beginning (February 2020) up to omicron onset, confirming the validity of the concept.

Integrating information from historical data into mechanistic models for influenza forecasting

Seasonal influenza causes significant annual morbidity and mortality worldwide. In France, it is estimated that, on average, 2 million individuals consult their GP for influenza-like-illness (ILI) every year. Traditionally, mathematical models used for epidemic forecasting can either include parameters capturing the infection process (mechanistic or compartmental models) or rely on time series analysis approaches that do not make mechanistic assumptions (statistical or phenomenological models). While the latter make extensive use of past epidemic data, mechanistic models are usually independently initialized in each season. As a result, forecasts from such models can contain trajectories that are vastly different from past epidemics. We developed a mechanistic model that takes into account epidemic data from training seasons when producing forecasts. The parameters of the model are estimated via a first particle filter running on the observed data. A second particle filter is then used to produce forecasts compatible with epidemic trajectories from the training set. The model was calibrated and tested on 35 years' worth of surveillance data from the French Sentinelles Network, representing the weekly number of patients consulting for ILI over the period 1985-2019. Our results show that the new method improves upon standard mechanistic approaches. In particular, when retrospectively tested on the available data, our model provides increased accuracy for short-term forecasts (from one to four weeks into the future) and peak timing and intensity. Our new approach for epidemic forecasting allows the integration of key strengths of the statistical approach into the mechanistic modelling framework and represents an attempt to provide accurate forecasts by making full use of the rich surveillance dataset collected in France since 1985.

Antigenic drift and subtype interference shape A(H3N2) epidemic dynamics in the United States

Influenza viruses continually evolve new antigenic variants, through mutations in epitopes of their major surface proteins, hemagglutinin (HA) and neuraminidase (NA). Antigenic drift potentiates the reinfection of previously infected individuals, but the contribution of this process to variability in annual epidemics is not well understood. Here, we link influenza A(H3N2) virus evolution to regional epidemic dynamics in the United States during 1997-2019. We integrate phenotypic measures of HA antigenic drift and sequence-based measures of HA and NA fitness to infer antigenic and genetic distances between viruses circulating in successive seasons. We estimate the magnitude, severity, timing, transmission rate, age-specific patterns, and subtype dominance of each regional outbreak and find that genetic distance based on broad sets of epitope sites is the strongest evolutionary predictor of A(H3N2) virus epidemiology. Increased HA and NA epitope distance between seasons correlates with larger, more intense epidemics, higher transmission, greater A(H3N2) subtype dominance, and a greater proportion of cases in adults relative to children, consistent with increased population susceptibility. Based on random forest models, A(H1N1) incidence impacts A(H3N2) epidemics to a greater extent than viral evolution, suggesting that subtype interference is a major driver of influenza A virus infection ynamics, presumably via heterosubtypic cross-immunity.

A systematic review of epidemiological modelling in response to lumpy skin disease outbreaks

Lumpy skin disease (LSD) is an infectious disease currently spreading worldwide and poses a serious global threat. However, there is limited evidence and understanding to support the use of models to inform decision-making in LSD outbreak responses. This review aimed to identify modelling approaches that can be used before and during an outbreak of LSD, examining their characteristics and priorities, and proposing a structured workflow. We conducted a systematic review and identified 60 relevant publications on LSD outbreak modelling. The review identified six categories of question to be addressed following outbreak detection (origin, entry pathway, outbreak severity, risk factors, spread, and effectiveness of control measures), and five analytical techniques used to address them (descriptive epidemiology, risk factor analysis, spatiotemporal analysis, dynamic transmission modelling, and simulation modelling). We evaluated the questions each analytical technique can address, along with their data requirements and limitations, and accordingly assigned priorities to the modelling. Based on this, we propose a structured workflow for modelling during an LSD outbreak. Additionally, we emphasise the importance of pre-outbreak preparation and continuous updating of modelling post-outbreak for effective decision-making. This study also discusses the inherent limitations and uncertainties in the identified modelling approaches. To support this workflow, high-quality data must be collected in standardised formats, and efforts should be made to reduce inherent uncertainties of the models. The suggested modelling workflow can be used as a process to support rapid response for countries facing their first LSD occurrence and can be adapted to other transboundary diseases.

Leveraging artificial intelligence and software engineering methods in epidemiology for the co-creation of decision-support tools based on mechanistic models

Epidemiological modeling is a key lever for infectious disease control and prevention on farms. It makes it possible to understand the spread of pathogens, but also to compare intervention scenarios even in counterfactual situations. However, the actual capability of decision makers to use mechanistic models to support timely interventions is limited. This study demonstrates how artificial intelligence (AI) techniques can make mechanistic epidemiological models more accessible to farmers and veterinarians, and how to transform such models into user-friendly decision-support tools (DST). By leveraging knowledge representation methods, such as the textual formalization of model components through a domain-specific language (DSL), the co-design of mechanistic models and DST becomes more efficient and collaborative. This facilitates the integration of explicit expert knowledge and practical insights into the modeling process. Furthermore, the utilization of AI and software engineering enables the automation of web application generation based on existing mechanistic models. This automation simplifies the development of DST, as tool designers can focus on identifying users' needs and specifying expected features and meaningful presentations of outcomes, instead of wasting time in writing code to wrap models into web apps. To illustrate the practical application of this approach, we consider the example of Bovine Respiratory Disease (BRD), a tough challenge in fattening farms where young beef bulls often develop BRD shortly after being allocated into pens. BRD is a multi-factorial, multi-pathogen disease that is difficult to anticipate and control, often resulting in the massive use of antimicrobials to mitigate its impact on animal health, welfare, and economic losses. The DST developed from an existing mechanistic BRD model empowers users, including farmers and veterinarians, to customize scenarios based on their specific farm conditions. It enables them to anticipate the effects of various pathogens, compare the epidemiological and economic outcomes associated with different farming practices, and decide how to balance the reduction of disease impact and the reduction of antimicrobial usage (AMU). The generic method presented in this article illustrates the potential of artificial intelligence (AI) and software engineering methods to enhance the co-creation of DST based on mechanistic models in veterinary epidemiology. The corresponding pipeline is distributed as an open-source software. By leveraging these advancements, this research aims to bridge the gap between theoretical models and the practical usage of their outcomes on the field.

Antigenic drift and subtype interference shape A(H3N2) epidemic dynamics in the United States

Influenza viruses continually evolve new antigenic variants, through mutations in epitopes of their major surface proteins, hemagglutinin (HA) and neuraminidase (NA). Antigenic drift potentiates the reinfection of previously infected individuals, but the contribution of this process to variability in annual epidemics is not well understood. Here we link influenza A(H3N2) virus evolution to regional epidemic dynamics in the United States during 1997-2019. We integrate phenotypic measures of HA antigenic drift and sequence-based measures of HA and NA fitness to infer antigenic and genetic distances between viruses circulating in successive seasons. We estimate the magnitude, severity, timing, transmission rate, age-specific patterns, and subtype dominance of each regional outbreak and find that genetic distance based on broad sets of epitope sites is the strongest evolutionary predictor of A(H3N2) virus epidemiology. Increased HA and NA epitope distance between seasons correlates with larger, more intense epidemics, higher transmission, greater A(H3N2) subtype dominance, and a greater proportion of cases in adults relative to children, consistent with increased population susceptibility. Based on random forest models, A(H1N1) incidence impacts A(H3N2) epidemics to a greater extent than viral evolution, suggesting that subtype interference is a major driver of influenza A virus infection dynamics, presumably via heterosubtypic cross-immunity.

Relative Role of Age Groups and Indoor Environments in Influenza Transmission Under Different Urbanization Rates in China

Exploring the relative role of different indoor environments in respiratory infections transmission remains unclear, which is crucial for developing targeted nonpharmaceutical interventions. In this study, a total of 2,583,441 influenza-like illness cases tested from 2010 to 2017 in China were identified. An agent-based model was built and calibrated with the surveillance data, to assess the roles of 3 age groups (children <19 years, younger adults 19-60 years, older adults >60 years) and 4 types of indoor environments (home, schools, workplaces, and community areas) in influenza transmission by province with varying urbanization rates. When the urbanization rates increased from 35% to 90%, the proportion of children aged <19 years among influenza cases decreased from 76% to 45%. Additionally, we estimated that infections originating from children decreased from 95.1% (95% confidence interval (CI): 92.7, 97.5) to 59.3% (95% CI: 49.8, 68.7). Influenza transmission in schools decreased from 80.4% (95% CI: 76.5, 84.3) to 36.6% (95% CI: 20.6, 52.5), while transmission in the community increased from 2.4% (95% CI: 1.9, 2.8) to 45.4% (95% CI: 35.9, 54.8). With increasing urbanization rates, community areas and younger adults contributed more to infection transmission. These findings could help the development of targeted public health policies. This article is part of a Special Collection on Environmental Epidemiology. This article is part of a Special Collection on Environmental Epidemiology.

What Influence Could the Acceptance of Visitors Cause on the Epidemic Dynamics of a Reinfectious Disease?: A Mathematical Model

The globalization in business and tourism becomes crucial more and more for the economical sustainability of local communities. In the presence of an epidemic outbreak, there must be such a decision on the policy by the host community as whether to accept visitors or not, the number of acceptable visitors, or the condition for acceptable visitors. Making use of an SIRI type of mathematical model, we consider the influence of visitors on the spread of a reinfectious disease in a community, especially assuming that a certain proportion of accepted visitors are immune. The reinfectivity of disease here means that the immunity gained by either vaccination or recovery is imperfect. With the mathematical results obtained by our analysis on the model for such an epidemic dynamics of resident and visitor populations, we find that the acceptance of visitors could have a significant influence on the disease's endemicity in the community, either suppressive or supportive.

Optimal social distancing in epidemic control: cost prioritization, adherence and insights into preparedness principles

The COVID-19 pandemic experience has highlighted the importance of developing general control principles to inform future pandemic preparedness based on the tension between the different control options, ranging from elimination to mitigation, and related costs. Similarly, during the COVID-19 pandemic, social distancing has been confirmed to be the critical response tool until vaccines become available. Open-loop optimal control of a transmission model for COVID-19 in one of its most aggressive outbreaks is used to identify the best social distancing policies aimed at balancing the direct epidemiological costs of a threatening epidemic with its indirect (i.e., societal level) costs arising from enduring control measures. In particular, we analyse how optimal social distancing varies according to three key policy factors, namely, the degree of prioritization of indirect costs, the adherence to control measures, and the timeliness of intervention. As the prioritization of indirect costs increases, (i) the corresponding optimal distancing policy suddenly switches from elimination to suppression and, finally, to mitigation; (ii) the "effective" mitigation region-where hospitals' overwhelming is prevented-is dramatically narrow and shows multiple control waves; and (iii) a delicate balance emerges, whereby low adherence and lack of timeliness inevitably force ineffective mitigation as the only accessible policy option. The present results show the importance of open-loop optimal control, which is traditionally absent in public health preparedness, for studying the suppression-mitigation trade-off and supplying robust preparedness guidelines.

Influenza transmission dynamics quantified from RNA in wastewater in Switzerland

INTRODUCTION

Influenza infections are challenging to monitor at the population level due to many mild and asymptomatic cases and similar symptoms to other common circulating respiratory diseases, including COVID-19. Methods for tracking cases outside of typical reporting infrastructure could improve monitoring of influenza transmission dynamics. Influenza shedding into wastewater represents a promising source of information where quantification is unbiased by testing or treatment-seeking behaviours.

METHODS

We quantified influenza A and B virus loads from influent at Switzerland's three largest wastewater treatment plants, serving about 14% of the Swiss population (1.2 million individuals). We estimated trends in infection incidence and the effective reproductive number (Re) in these catchments during a 2021/22 epidemic and compared our estimates to typical influenza surveillance data.

RESULTS

Wastewater data captured the same overall trends in infection incidence as laboratory-confirmed case data at the catchment level. However, the wastewater data were more sensitive in capturing a transient peak in incidence in December 2021 than the case data. The Re estimated from the wastewater data was roughly at or below the epidemic threshold of 1 during work-from-home measures in December 2021 but increased to at or above the epidemic threshold in two of the three catchments after the relaxation of these measures. The third catchment yielded qualitatively the same results but with wider confidence intervals. The confirmed case data at the catchment level yielded comparatively less precise R_e estimates before and during the work-from-home period, with confidence intervals that included one before and during the work-from-home period.

DISCUSSION

Overall, we show that influenza RNA in wastewater can help monitor nationwide influenza transmission dynamics. Based on this research, we developed an online dashboard for ongoing wastewater-based influenza surveillance in Switzerland.

The Epidemiological and Economic Impact of COVID-19 in Kazakhstan: An Agent-Based Modeling

BACKGROUND

Our study aimed to assess how effective the preventative measures taken by the state authorities during the pandemic were in terms of public health protection and the rational use of material and human resources.

MATERIALS AND METHODS

We utilized a stochastic agent-based model for COVID-19's spread combined with the WHO-recommended COVID-ESFT version 2.0 tool for material and labor cost estimation.

RESULTS

Our long-term forecasts (up to 50 days) showed satisfactory results with a steady trend in the total cases. However, the short-term forecasts (up to 10 days) were more accurate during periods of relative stability interrupted by sudden outbreaks. The simulations indicated that the infection's spread was highest within families, with most COVID-19 cases occurring in the 26-59 age group. Government interventions resulted in 3.2 times fewer cases in Karaganda than predicted under a "no intervention" scenario, yielding an estimated economic benefit of 40%.

CONCLUSION

The combined tool we propose can accurately forecast the progression of the infection, enabling health organizations to allocate specialists and material resources in a timely manner.

Evaluation of COVID-19 intervention policies in South Korea using the stochastic individual-based model

The COVID-19 pandemic has swept the globe, and countries have responded with various intervention policies to prevent its spread. In this study, we aim to analyze the effectiveness of intervention policies implemented in South Korea. We use a stochastic individual-based model (IBM) with a synthetic population to simulate the spread of COVID-19. Using statistical data, we make the synthetic population and assign sociodemographic attributes to each individual. Individuals go about their daily lives based on their assigned characteristics, and encountering infectors in their daily lives stochastically determines whether they are infected. We reproduce the transmission of COVID-19 using the IBM simulation from November 2020 to February 2021 when three phases of increasingly stringent intervention policies were implemented, and then assess their effectiveness. Additionally, we predict how the spread of infection would have been different if these policies had been implemented in January 2022. This study offers valuable insights into the effectiveness of intervention policies in South Korea, which can assist policymakers and public health officials in their decision-making process.

Non-smooth dynamics of a SIR model with nonlinear state-dependent impulsive control

The classic SIR model is often used to evaluate the effectiveness of controlling infectious diseases. Moreover, when adopting strategies such as isolation and vaccination based on changes in the size of susceptible populations and other states, it is necessary to develop a non-smooth SIR infectious disease model. To do this, we first add a non-linear term to the classical SIR model to describe the impact of limited medical resources or treatment capacity on infectious disease transmission, and then involve the state-dependent impulsive feedback control, which is determined by the convex combinations of the size of the susceptible population and its growth rates, into the model. Further, the analytical methods have been developed to address the existence of non-trivial periodic solutions, the existence and stability of a disease-free periodic solution (DFPS) and its bifurcation. Based on the properties of the established Poincaré map, we conclude that DFPS exists, which is stable under certain conditions. In particular, we show that the non-trivial order-1 periodic solutions may exist and a non-trivial order-$ k $ ($ k\geq 1 $) periodic solution in some special cases may not exist. Moreover, the transcritical bifurcations around the DFPS with respect to the parameters $ p $ and $ AT $ have been investigated by employing the bifurcation theorems of discrete maps.

Modeling the effects of farming practices on bovine respiratory disease in a multi-batch cattle fattening farm

Bovine Respiratory Disease (BRD) affects young bulls, causing animal welfare and health concerns as well as economical costs. BRD is caused by an array of viruses and bacteria and also by environmental and abiotic factors. How farming practices influence the spread of these causal pathogens remains unclear. Our goal was to assess the impact of zootechnical practices on the spread of three causal agents of BRD, namely the bovine respiratory syncytial virus (BRSV), Mannheimia haemolytica and Mycoplasma bovis. In that extent, we used an individual based stochastic mechanistic model monitoring risk factors, infectious processes, detection and treatment in a farm possibly featuring several batches simultaneously. The model was calibrated with three sets of parameters relative to each of the three pathogens using data extracted from literature. Separated batches were found to be more effective than a unique large one for reducing the spread of pathogens, especially for BRSV and M.bovis. Moreover, it was found that allocating high risk and low risk individuals into separated batches participated in reducing cumulative incidence, epidemic peaks and antimicrobial usage, especially for M. bovis. Theses findings rise interrogations on the optimal farming practices in order to limit BRD occurrence and pave the way to models featuring coinfections and collective treatments p { line-height: 115%; margin-bottom: 0.25 cm; background: transparent}a:link { color: #000080; text-decoration: underline}a.cjk:link { so-language: zxx}a.ctl:link { solanguage: zxx}.

Impact of school operating scenarios on COVID-19 transmission under vaccination in the U.S.: an agent-based simulation model

At the height of the COVID-19 pandemic, K-12 schools struggled to safely operate under the fast-changing pandemic situation. However, little is known about the impact of different school operating scenarios considering the ongoing efforts of vaccination. In this study, we deployed an agent-based simulation model to mimic disease transmission in a mid-sized community consisting of 10,000 households. A total of eight school operating scenarios were simulated, in decreasing order of restrictiveness regarding COVID-19 mitigation measures. When masks were worn at school, work, and community environments, increasing in-person education from 50% to 100% would result in only 1% increase in cumulative infections. When there were no masks nor contact tracing while schools were 100% in person, the cumulative infection increased by 86% compared to the scenario when both masking and contact tracing were in place. In the sensitivity analysis for vaccination efficacy, we found that higher vaccination efficacy was essential in reducing overall infections. Our findings showed that full in-person education was safe, especially when contact tracing, masking, and widespread vaccination were in place. If no masking nor contact tracing was practiced, the transmission would rose dramatically but eventually slow down due to herd immunity.

Should infectious disease modelling research be subject to ethics review?

Should research projects involving epidemiological modelling be subject to ethical scrutiny and peer review prior to publication? Mathematical modelling had considerable impacts during the COVID-19 pandemic, leading to social distancing and lockdowns. Imperial College conducted research leading to the website publication of a paper, Report 9, on non-pharmaceutical interventions (NPIs) and COVID-19 mortality demand dated 16th March 2020, arguing for a Government policy of non-pharmaceutical interventions (e.g. lockdowns, social distancing, mask wearing, working from home, furlough, school closures, reduced family interaction etc.) to counter COVID 19. Enquiries and Freedom of Information requests to the institution indicate that there was no formal ethical committee review of this specific research, nor was there any peer review prior to their online publication of Report 9. This paper considers the duties placed upon researchers, institutions and research funders under the UK 'Concordat to Support Research Integrity' (CSRI), across various bioethical domains, and whether ethical committee scrutiny should be required for this research.

Predicting zoonotic potential of viruses: where are we?

The prospect of identifying high-risk viruses and designing interventions to pre-empt their emergence into human populations is enticing, but controversial, particularly when used to justify large-scale virus discovery initiatives. We review the current state of these efforts, identifying three broad classes of predictive models that have differences in data inputs that define their potential utility for triaging newly discovered viruses for further investigation. Prospects for model predictions of public health risk to guide preparedness depend not only on computational improvements to algorithms, but also on more efficient data generation in laboratory, field and clinical settings. Beyond public health applications, efforts to predict zoonoses provide unique research value by creating generalisable understanding of the ecological and evolutionary factors that promote viral emergence.

Genomic assessment of invasion dynamics of SARS-CoV-2 Omicron BA.1

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) now arise in the context of heterogeneous human connectivity and population immunity. Through a large-scale phylodynamic analysis of 115,622 Omicron BA.1 genomes, we identified >6,000 introductions of the antigenically distinct VOC into England and analyzed their local transmission and dispersal history. We find that six of the eight largest English Omicron lineages were already transmitting when Omicron was first reported in southern Africa (22 November 2021). Multiple datasets show that importation of Omicron continued despite subsequent restrictions on travel from southern Africa as a result of export from well-connected secondary locations. Initiation and dispersal of Omicron transmission lineages in England was a two-stage process that can be explained by models of the country's human geography and hierarchical travel network. Our results enable a comparison of the processes that drive the invasion of Omicron and other VOCs across multiple spatial scales.

Effect of Rapid Urbanization in Mainland China on the Seasonal Influenza Epidemic: Spatiotemporal Analysis of Surveillance Data From 2010 to 2017

BACKGROUND

The world is undergoing an unprecedented wave of urbanization. However, the effect of rapid urbanization during the early or middle stages of urbanization on seasonal influenza transmission remains unknown. Since about 70% of the world population live in low-income countries, exploring the impact of urbanization on influenza transmission in urbanized countries is significant for global infection prediction and prevention.

OBJECTIVE

The aim of this study was to explore the effect of rapid urbanization on influenza transmission in China.

METHODS

We performed spatiotemporal analyses of province-level influenza surveillance data collected in Mainland China from April 1, 2010, to March 31, 2017. An agent-based model based on hourly human contact-related behaviors was built to simulate the influenza transmission dynamics and to explore the potential mechanism of the impact of urbanization on influenza transmission.

RESULTS

We observed persistent differences in the influenza epidemic attack rates among the provinces of Mainland China across the 7-year study period, and the attack rate in the winter waves exhibited a U-shaped relationship with the urbanization rates, with a turning point at 50%-60% urbanization across Mainland China. Rapid Chinese urbanization has led to increases in the urban population density and percentage of the workforce but decreases in household size and the percentage of student population. The net effect of increased influenza transmission in the community and workplaces but decreased transmission in households and schools yielded the observed U-shaped relationship.

CONCLUSIONS

Our results highlight the complicated effects of urbanization on the seasonal influenza epidemic in China. As the current urbanization rate in China is approximately 59%, further urbanization with no relevant interventions suggests a worrisome increasing future trend in the influenza epidemic attack rate.

Investigation of airborne spread of COVID-19 using a hybrid agent-based model: a case study of the UK

Agent-based models have been proven to be quite useful in understanding and predicting the SARS-CoV-2 virus-originated COVID-19 infection. Person-to-person contact was considered as the main mechanism of viral transmission in these models. However, recent understanding has confirmed that airborne transmission is the main route to infection spread of COVID-19. We have developed a computationally efficient agent-based hybrid model to study the aerial propagation of the virus and subsequent spread of infection. We considered virus, a continuous variable, spreads diffusively in air and members of populations as discrete agents possessing one of the eight different states at a particular time. The transition from one state to another is probabilistic and age linked. Recognizing that population movement is a key aspect of infection spread, the model allows unbiased movement of agents. We benchmarked the model to recapture the temporal stochastic infection count data of the UK. The model investigates various key factors such as movement, infection susceptibility, new variants, recovery rate and duration, incubation period and vaccination on the infection propagation over time. Furthermore, the model was applied to capture the infection spread in Italy and France.

Compact living or policy inaction? Effects of urban density and lockdown on the COVID-19 outbreak in the US

The coronavirus pandemic has reignited the debate over urban density. Popular media has been quick to blame density as a key contributor to rapid disease transmission, questioning whether compact cities are still a desirable planning goal. Past research on the density-pandemic connection have produced mixed results. This article offers a critical perspective on this debate by unpacking the effects of alternative measures of urban density, and examining the impacts of mandatory lockdowns and the stringency of other government restrictions on cumulative Covid-19 infection and mortality rates during the early phase of the pandemic in the US. Our results show a consistent positive effect of density on Covid-19 outcomes across urban areas during the first six months of the outbreak. However, we find modest variations in the density-pandemic relationship depending on how densities are measured. We also find relatively longer duration mandatory lockdowns to be associated with lower infection and mortality rates, and lockdown duration's effect to be relatively more pronounced in high-density urban areas. Moreover, we find that the timing of lockdown imposition and the stringency of the government's response additionally influence Covid-19 outcomes, and that the effects vary by urban density. We argue that the adverse impact of density on pandemics could be mitigated by adopting strict lockdowns and other stringent human mobility and interaction restriction policies in a spatially targeted manner. Our study helps to inform current and future government policies to contain the virus, and to make our cities more resilient against future shocks and threats.

Intrinsic randomness in epidemic modelling beyond statistical uncertainty

Uncertainty can be classified as either aleatoric (intrinsic randomness) or epistemic (imperfect knowledge of parameters). The majority of frameworks assessing infectious disease risk consider only epistemic uncertainty. We only ever observe a single epidemic, and therefore cannot empirically determine aleatoric uncertainty. Here, we characterise both epistemic and aleatoric uncertainty using a time-varying general branching process. Our framework explicitly decomposes aleatoric variance into mechanistic components, quantifying the contribution to uncertainty produced by each factor in the epidemic process, and how these contributions vary over time. The aleatoric variance of an outbreak is itself a renewal equation where past variance affects future variance. We find that, superspreading is not necessary for substantial uncertainty, and profound variation in outbreak size can occur even without overdispersion in the offspring distribution (i.e. the distribution of the number of secondary infections an infected person produces). Aleatoric forecasting uncertainty grows dynamically and rapidly, and so forecasting using only epistemic uncertainty is a significant underestimate. Therefore, failure to account for aleatoric uncertainty will ensure that policymakers are misled about the substantially higher true extent of potential risk. We demonstrate our method, and the extent to which potential risk is underestimated, using two historical examples.

Assessing the heterogeneity in the transmission of infectious diseases from time series of epidemiological data

Structural features and the heterogeneity of disease transmissions play an essential role in the dynamics of epidemic spread. But these aspects can not completely be assessed from aggregate data or macroscopic indicators such as the effective reproduction number. We propose in this paper an index of effective aggregate dispersion (EffDI) that indicates the significance of infection clusters and superspreading events in the progression of outbreaks by carefully measuring the level of relative stochasticity in time series of reported case numbers using a specially crafted statistical model for reproduction. This allows to detect potential transitions from predominantly clustered spreading to a diffusive regime with diminishing significance of singular clusters, which can be a decisive turning point in the progression of outbreaks and relevant in the planning of containment measures. We evaluate EffDI for SARS-CoV-2 case data in different countries and compare the results with a quantifier for the socio-demographic heterogeneity in disease transmissions in a case study to substantiate that EffDI qualifies as a measure for the heterogeneity in transmission dynamics.

Forecasting COVID-19 spreading through an ensemble of classical and machine learning models: Spain's case study

In this work the applicability of an ensemble of population and machine learning models to predict the evolution of the COVID-19 pandemic in Spain is evaluated, relying solely on public datasets. Firstly, using only incidence data, we trained machine learning models and adjusted classical ODE-based population models, especially suited to capture long term trends. As a novel approach, we then made an ensemble of these two families of models in order to obtain a more robust and accurate prediction. We then proceed to improve machine learning models by adding more input features: vaccination, human mobility and weather conditions. However, these improvements did not translate to the overall ensemble, as the different model families had also different prediction patterns. Additionally, machine learning models degraded when new COVID variants appeared after training. We finally used Shapley Additive Explanation values to discern the relative importance of the different input features for the machine learning models' predictions. The conclusion of this work is that the ensemble of machine learning models and population models can be a promising alternative to SEIR-like compartmental models, especially given that the former do not need data from recovered patients, which are hard to collect and generally unavailable.

An appraisal of peer-reviewed published literature on Influenza, 2000-2021 from countries in South-East Asia Region

Background

Influenza poses a major public health challenge in South-East Asia Region (SEAR). To address the challenge, there is a need to generate contextual evidence that could inform policy makers and program managers for response preparedness and impact mitigation. The World Health Organization has identified priority areas across five streams for research evidence generation at a global level (WHO Public Health Research Agenda). Stream 1 focuses on research for reducing the risk of emergence, Stream 2 on limiting the spread, Stream 3 on minimizing the impact, Stream 4 on optimizing the treatment and Stream 5 on promoting public health tools and technologies for Influenza. However, evidence generation from SEAR has been arguably low and needs a relook for alignment with priorities. This study aimed to undertake a bibliometric analysis of medical literature on Influenza over the past 21 years to identify gaps in research evidence and for identifying major areas for focusing with a view to provide recommendations to member states and SEAR office for prioritizing avenues for future research.

Methods

We searched Scopus, PubMed, Embase, and Cochrane databases in August 2021. We identified studies on influenza published from the 11 countries in WHO SEAR in the date range of 1 January 2000-31 December 2021. Data was retrieved, tagged and analyzed based on the WHO priority streams for Influenza, member states, study design and type of research. Bibliometric analysis was done on Vosviewer.

Findings

We included a total of 1,641 articles (Stream 1: n = 307; Stream 2: n = 516; Stream 3: n = 470; Stream 4: n = 309; Stream 5: n = 227). Maximum number of publications were seen in Stream 2, i.e., limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza which majorly included transmission, spread of virus at global and local levels and public health measures to limit the transmission. The highest number of publications was from India (n = 524) followed by Thailand (n = 407), Indonesia (n = 214) and Bangladesh (n = 158). Bhutan (n = 10), Maldives (n = 1), Democratic People's Republic of Korea (n = 1), and Timor-Leste (n = 3) had the least contribution in Influenza research. The top-most journal was PloS One which had the maximum number of influenza articles (n = 94) published from SEAR countries. Research that generated actionable evidence, i.e., implementation and intervention related topics were less common. Similarly, research on pharmaceutical interventions and on innovations was low. SEAR member states had inconsistent output across the five priority research streams, and there was a much higher scope and need for collaborative research. Basic science research showed declining trends and needed reprioritization.

Interpretation

While a priority research agenda has been set for influenza at the global level through the WHO Global Influenza Program since 2009, and subsequently revisited in 2011 and again in 2016-2017, a structured contextualized approach to guide actionable evidence generation activities in SEAR has been lacking. In the backset of the Global Influenza Strategy 2019-2030 and the COVID-19 pandemic, attuning research endeavors in SEAR could help in improved pandemic influenza preparedness planning. There is a need to prioritize contextually relevant research themes within priority streams. Member states must inculcate a culture of within and inter-country collaboration to produce evidence that has regional as well as global value.

A new method for the joint estimation of instantaneous reproductive number and serial interval during epidemics

Although some methods for estimating the instantaneous reproductive number during epidemics have been developed, the existing frameworks usually require information on the distribution of the serial interval and/or additional contact tracing data. However, in the case of outbreaks of emerging infectious diseases with an unknown natural history or undetermined characteristics, the serial interval and/or contact tracing data are often not available, resulting in inaccurate estimates for this quantity. In the present study, a new framework was specifically designed for joint estimates of the instantaneous reproductive number and serial interval. Concretely, a likelihood function for the two quantities was first introduced. Then, the instantaneous reproductive number and the serial interval were modeled parametrically as a function of time using the interpolation method and a known traditional distribution, respectively. Using the Bayesian information criterion and the Markov Chain Monte Carlo method, we ultimately obtained their estimates and distribution. The simulation study revealed that our estimates of the two quantities were consistent with the ground truth. Seven data sets of historical epidemics were considered and further verified the robust performance of our method. Therefore, to some extent, even if we know only the daily incidence, our method can accurately estimate the instantaneous reproductive number and serial interval to provide crucial information for policymakers to design appropriate prevention and control interventions during epidemics.

Optimal timing of non-pharmaceutical interventions during an epidemic

In response to the recent outbreak of the SARS-CoV-2 virus governments have aimed to reduce the virus's spread through, inter alia, non-pharmaceutical intervention. We address the question when such measures should be implemented and, once implemented, when to remove them. These issues are viewed through a real-options lens and we develop an SIRD-like continuous-time Markov chain model to analyze a sequence of options: the option to intervene and introduce measures and, after intervention has started, the option to remove these. Measures can be imposed multiple times. We implement our model using estimates from empirical studies and, under fairly general assumptions, our main conclusions are that: (1) measures should be put in place not long after the first infections occur; (2) if the epidemic is discovered when there are many infected individuals already, then it is optimal never to introduce measures; (3) once the decision to introduce measures has been taken, these should stay in place until the number of susceptible or infected members of the population is close to zero; (4) it is never optimal to introduce a tier system to phase-in measures but it is optimal to use a tier system to phase-out measures; (5) a more infectious variant may reduce the duration of measures being in place; (6) the risk of infections being brought in by travelers should be curbed even when no other measures are in place. These results are robust to several variations of our base-case model.

Assessment of 2021/22 influenza epidemic scenarios in Italy during SARS-CoV-2 outbreak

Global mitigation strategies to tackle the threat posed by SARS-CoV-2 have produced a significant decrease of the severity of 2020/21 seasonal influenza, which might result in a reduced population natural immunity for the upcoming 2021/22 influenza season. To predict the spread of influenza virus in Italy and the impact of prevention and control measures, we present an age-structured Susceptible-Exposed-Infectious-Removed (SEIR) model including the role of social mixing patterns and the impact of age-stratified vaccination strategies and Non-Pharmaceutical Interventions (NPIs) such as school closures, partial lockdown, as well as the adoption of personal protective equipment and the practice of hand hygiene. We find that vaccination campaigns with standard coverage would produce a remarkable mitigation of the spread of the disease in moderate influenza seasons, making the adoption of NPIs unnecessary. However, in case of severe seasonal epidemics, a standard vaccination coverage would not be sufficiently effective in fighting the epidemic, thus implying that a combination with the adoption of NPIs is necessary to contain the disease. Alternatively, our results show that the enhancement of the vaccination coverage would reduce the need to adopt NPIs, thus limiting the economic and social impacts that NPIs might produce. Our results highlight the need to respond to the influenza epidemic by strengthening the vaccination coverage.

Stochastic simulation of successive waves of COVID-19 in the province of Barcelona

Analytic compartmental models are currently used in mathematical epidemiology to forecast the COVID-19 pandemic evolution and explore the impact of mitigation strategies. In general, such models treat the population as a single entity, losing the social, cultural and economical specificities. We present a network model that uses socio-demographic datasets with the highest available granularity to predict the spread of COVID-19 in the province of Barcelona. The model is flexible enough to incorporate the effect of containment policies, such as lockdowns or the use of protective masks, and can be easily adapted to future epidemics. We follow a stochastic approach that combines a compartmental model with detailed individual microdata from the population census, including social determinants and age-dependent strata, and time-dependent mobility information. We show that our model reproduces the dynamical features of the disease across two waves and demonstrates its capability to become a powerful tool for simulating epidemic events.

Effectiveness of feedback control and the trade-off between death by COVID-19 and costs of countermeasures

We provided a framework of a mathematical epidemic modeling and a countermeasure against the novel coronavirus disease (COVID-19) under no vaccines and specific medicines. The fact that even asymptomatic cases are infectious plays an important role for disease transmission and control. Some patients recover without developing the disease; therefore, the actual number of infected persons is expected to be greater than the number of confirmed cases of infection. Our study distinguished between cases of confirmed infection and infected persons in public places to investigate the effect of isolation. An epidemic model was established by utilizing a modified extended Susceptible-Exposed-Infectious-Recovered model incorporating three types of infectious and isolated compartments, abbreviated as SEIIIHHHR. Assuming that the intensity of behavioral restrictions can be controlled and be divided into multiple levels, we proposed the feedback controller approach to implement behavioral restrictions based on the active number of hospitalized persons. Numerical simulations were conducted using different detection rates and symptomatic ratios of infected persons. We investigated the appropriate timing for changing the degree of behavioral restrictions and confirmed that early initiating behavioral restrictions is a reasonable measure to reduce the burden on the health care system. We also examined the trade-off between reducing the cumulative number of deaths by the COVID-19 and saving the cost to prevent the spread of the virus. We concluded that a bang-bang control of the behavioral restriction can reduce the socio-economic cost, while a control of the restrictions with multiple levels can reduce the cumulative number of deaths by infection.

Incorporating infectious duration-dependent transmission into Bayesian epidemic models

Compartmental models are commonly used to describe the spread of infectious diseases by estimating the probabilities of transitions between important disease states. A significant challenge in fitting Bayesian compartmental models lies in the need to estimate the duration of the infectious period, based on limited data providing only symptom onset date or another proxy for the start of infectiousness. Commonly, the exponential distribution is used to describe the infectious duration, an overly simplistic approach, which is not biologically plausible. More flexible distributions can be used, but parameter identifiability and computational cost can worsen for moderately sized or large epidemics. In this article, we present a novel approach, which considers a curve of transmissibility over a fixed infectious duration. The incorporation of infectious duration-dependent (IDD) transmissibility, which decays to zero during the infectious period, is biologically reasonable for many viral infections and fixing the length of the infectious period eases computational complexity in model fitting. Through simulation, we evaluate different functional forms of IDD transmissibility curves and show that the proposed approach offers improved estimation of the time-varying reproductive number. We illustrate the benefit of our approach through a new analysis of the 1995 outbreak of Ebola Virus Disease in the Democratic Republic of the Congo.

An approximate Bayesian approach for estimation of the instantaneous reproduction number under misreported epidemic data

In epidemic models, the effective reproduction number is of central importance to assess the transmission dynamics of an infectious disease and to orient health intervention strategies. Publicly shared data during an outbreak often suffers from two sources of misreporting (underreporting and delay in reporting) that should not be overlooked when estimating epidemiological parameters. The main statistical challenge in models that intrinsically account for a misreporting process lies in the joint estimation of the time-varying reproduction number and the delay/underreporting parameters. Existing Bayesian approaches typically rely on Markov chain Monte Carlo algorithms that are extremely costly from a computational perspective. We propose a much faster alternative based on Laplacian-P-splines (LPS) that combines Bayesian penalized B-splines for flexible and smooth estimation of the instantaneous reproduction number and Laplace approximations to selected posterior distributions for fast computation. Assuming a known generation interval distribution, the incidence at a given calendar time is governed by the epidemic renewal equation and the delay structure is specified through a composite link framework. Laplace approximations to the conditional posterior of the spline vector are obtained from analytical versions of the gradient and Hessian of the log-likelihood, implying a drastic speed-up in the computation of posterior estimates. Furthermore, the proposed LPS approach can be used to obtain point estimates and approximate credible intervals for the delay and reporting probabilities. Simulation of epidemics with different combinations for the underreporting rate and delay structure (one-day, two-day, and weekend delays) show that the proposed LPS methodology delivers fast and accurate estimates outperforming existing methods that do not take into account underreporting and delay patterns. Finally, LPS is illustrated in two real case studies of epidemic outbreaks.

Modulating Immune Response in Viral Infection for Quantitative Forecasts of Drug Efficacy

The antiretroviral drug, the total level of viral production, and the effectiveness of immune responses are the main topics of this review because they are all dynamically interrelated. Immunological and viral processes interact in extremely complex and non-linear ways. For reliable analysis and quantitative forecasts that may be used to follow the immune system and create a disease profile for each patient, mathematical models are helpful in characterizing these non-linear interactions. To increase our ability to treat patients and identify individual differences in disease development, immune response profiling might be useful. Identifying which patients are moving from mild to severe disease would be more beneficial using immune system parameters. Prioritize treatments based on their inability to control the immune response and prevent T cell exhaustion. To increase treatment efficacy and spur additional research in this field, this review intends to provide examples of the effects of modelling immune response in viral infections, as well as the impact of pharmaceuticals on immune response.

Bayesian inference in epidemics: linear noise analysis

This paper offers a qualitative insight into the convergence of Bayesian parameter inference in a setup which mimics the modeling of the spread of a disease with associated disease measurements. Specifically, we are interested in the Bayesian model's convergence with increasing amounts of data under measurement limitations. Depending on how weakly informative the disease measurements are, we offer a kind of 'best case' as well as a 'worst case' analysis where, in the former case, we assume that the prevalence is directly accessible, while in the latter that only a binary signal corresponding to a prevalence detection threshold is available. Both cases are studied under an assumed so-called linear noise approximation as to the true dynamics. Numerical experiments test the sharpness of our results when confronted with more realistic situations for which analytical results are unavailable.

How regularly do people visit service places?

It is often believed that regularities are embedded in mobile behaviors. Highly regular mobile behaviors, such as daily commutes between home and workplace, have been actively investigated in the context of health risks. Less regular mobile behaviors, such as visits to service places (e.g., supermarkets and healthcare facilities), have not received much attention. This study explores the regularity in service place visits using a deep learning method and the effect of place type on the stability of recurring visits using an entropy assessment. Results reveal both periodic and bursty visit behaviors to service places. The periodic visits are prominent on the weekly and bi-weekly scales, and the bursty visits dominate the multi-day scales. Service place type indeed affects the stability of recurring visits, and certain place types have the strongest effect. The research findings substantially expand the knowledge of mobile behaviors and are valuable in informing both visitor-based and place-based health risks.

Indoor relative humidity shapes influenza seasonality in temperate and subtropical climates in China

OBJECTIVES

The aim of this study was to explore whether indoor or outdoor relative humidity (RH) modulates the influenza epidemic transmission in temperate and subtropical climates.

METHODS

In this study, the daily temperature and RH in 1558 households from March 2017 to January 2019 in five cities across both temperate and subtropical regions in China were collected. City-level outdoor temperature and RH from 2013 to 2019 were collected from the weather stations. We first estimated the effective reproduction number (R_t) of influenza and then used time-series analyses to explore the relationship between indoor/outdoor RH/absolute humidity and the R_t of influenza. Furthermore, we expanded the measured 1-year indoor temperature and the RH data into 5 years and used the same method to examine the relationship between indoor/outdoor RH and the R_t of influenza.

RESULTS

Indoor RH displayed a seasonal pattern, with highs during the summer months and lows during the winter months, whereas outdoor RH fluctuated with no consistent pattern in subtropical regions. The R_t of influenza followed a U-shaped relationship with indoor RH in both temperate and subtropical regions, whereas a U-shaped relationship was not observed between outdoor RH and R_t. In addition, indoor RH may be a better indicator for R_t of influenza than indoor absolute humidity.

CONCLUSION

The findings indicated that indoor RH may be the driver of influenza seasonality in both temperate and subtropical locations in China.

A hospital demand and capacity intervention approach for COVID-19

The mathematical interpretation of interventions for the mitigation of epidemics in the literature often involves finding the optimal time to initiate an intervention and/or the use of the number of infections to manage impact. Whilst these methods may work in theory, in order to implement effectively they may require information which is not likely to be available in the midst of an epidemic, or they may require impeccable data about infection levels in the community. In reality, testing and cases data can only be as good as the policy of implementation and the compliance of the individuals, which implies that accurately estimating the levels of infections becomes difficult or complicated from the data that is provided. In this paper, we demonstrate a different approach to the mathematical modelling of interventions, not based on optimality or cases, but based on demand and capacity of hospitals who have to deal with the epidemic on a day to day basis. In particular, we use data-driven modelling to calibrate a susceptible-exposed-infectious-recovered-died type model to infer parameters that depict the dynamics of the epidemic in several regions of the UK. We use the calibrated parameters for forecasting scenarios and understand, given a maximum capacity of hospital healthcare services, how the timing of interventions, severity of interventions, and conditions for the releasing of interventions affect the overall epidemic-picture. We provide an optimisation method to capture when, in terms of healthcare demand, an intervention should be put into place given a maximum capacity on the service. By using an equivalent agent-based approach, we demonstrate uncertainty quantification on the likelihood that capacity is not breached, by how much if it does, and the limit on demand that almost guarantees capacity is not breached.

Coupling an individual adaptive-decision model with a SIRV model of influenza vaccination reveals new insights for epidemic control

Past seasonal influenza epidemics and vaccination experience may affect individuals' decisions on whether to be vaccinated or not, decisions that may be constantly reassessed in relation to recent influenza related experience. To understand the potentially complex interaction between experience and decisions and whether the vaccination rate is likely to reach a critical coverage level or not, we construct an adaptive-decision model. This model is then coupled with an influenza vaccination dynamics (SIRV) model to explore the interaction between individuals' decision-making and an influenza epidemic. Nonlinear least squares estimation is used to obtain the best-fit parameter values in the SIRV model based on data on new influenza-like illness (ILI) cases in Texas. Uncertainty and sensitivity analyses are then carried out to determine the impact of key parameters of the adaptive decision-making model on the ILI epidemic. The results showed that the necessary critical coverage rate of ILI vaccination could not be reached by voluntary vaccination. However, it could be reached in the fourth year if mass media reports improved individuals' memory of past vaccination experience. Individuals' memory of past vaccination experience, the proportion with histories of past vaccinations and the perceived cost of vaccination are important factors determining whether an ILI epidemic can be effectively controlled or not. Therefore, health authorities should guide people to improve their memory of past vaccination experience through media reports, publish timely data on annual vaccination proportions and adjust relevant measures to appropriately reduce vaccination perceived cost, in order to effectively control an ILI epidemic.

Decentralized governance may lead to higher infection levels and sub-optimal releases of quarantines amid the COVID-19 pandemic

The outbreak of the novel Coronavirus (COVID-19) has led countries worldwide to administer quarantine policies. However, each country or state independently decides what mobility restrictions to administer within its borders while aiming to maximize its own citizens' welfare. Since individuals travel between countries and states, the policy in one country affects the infection levels in other countries. Therefore, a major question is whether the policies dictated by multiple governments could be efficient. Here we focus on the decision regarding the timing of releasing quarantines, which were common during the first year of the pandemic. We consider a game-theoretical epidemiological model in which each government decides when to switch from a restrictive to a non-restrictive quarantine and vice versa. We show that, if travel between countries is frequent, then the policy dictated by multiple governments is sub-optimal. But if international travel is restricted, then the policy may become optimal.

Agent-based model using GPS analysis for infection spread and inhibition mechanism of SARS-CoV-2 in Tokyo

Analyzing the SARS-CoV-2 pandemic outbreak based on actual data while reflecting the characteristics of the real city provides beneficial information for taking reasonable infection control measures in the future. We demonstrate agent-based modeling for Tokyo based on GPS information and official national statistics and perform a spatiotemporal analysis of the infection situation in Tokyo. As a result of the simulation during the first wave of SARS-CoV-2 in Tokyo using real GPS data, the infection occurred in the service industry, such as restaurants, in the city center, and then the infected people brought back the virus to the residential area; the infection spread in each area in Tokyo. This phenomenon clarifies that the spread of infection can be curbed by suppressing going out or strengthening infection prevention measures in service facilities. It was shown that pandemic measures in Tokyo could be achieved not only by strong control, such as the lockdown of cities, but also by thorough infection prevention measures in service facilities, which explains the curb phenomena in real Tokyo.

Why COVID-19 modelling of progression and prevention fails to translate to the real-world

Mathematical models were used widely to inform policy during the COVID pandemic. However, there is a poor understanding of their limitations and how they influence decision-making. We used systematic review search methods to find early modelling studies that determined the reproduction number and analysed its use and application to interventions and policy in the UK. Up to March 2020, we found 42 reproduction number estimates (39 based on Chinese data: R₀ range 2.1-6.47). Several biases affect the quality of modelling studies that are infrequently discussed, and many factors contribute to significant differences in the results of individual studies that go beyond chance. The sources of effect estimates incorporated into mathematical models are unclear. There is often a lack of a relationship between transmission estimates and the timing of imposed restrictions, which is further affected by the lag in reporting. Modelling studies lack basic evidence-based methods that aid their quality assessment, reporting and critical appraisal. If used judiciously, models may be helpful, especially if they openly present the uncertainties and use sensitivity analyses extensively, which need to consider and explicitly discuss the limitations of the evidence. However, until the methodological and ethical issues are resolved, predictive models should be used cautiously.

A computer modeling method to analyze rideshare data for the surveillance of novel strains of SARS-CoV-2

PURPOSE

No method is available to systematically study SARS-CoV-2 transmission dynamics using the data that rideshare companies share with government agencies. We developed a proof-of-concept method for the analysis of SARS-CoV-2 transmissions between rideshare passengers and drivers.

METHOD

To assess whether this method could enable hypothesis testing about SARS-CoV-2, we repeated ten 200-day agent-based simulations of SARS-CoV-2 propagation within the Los Angeles County rideshare network. Assuming data access for 25% of infections, we estimated an epidemiologist's ability to analyze the observable infection patterns to correctly identify a baseline viral variant A, as opposed to viral variant A with mask use (50% reduction in viral particle exchange), or a more infectious viral variant B (300% higher cumulative viral load).

RESULTS

Simulations had an average of 190,387 potentially infectious rideshare interactions, resulting in 409 average diagnosed infections. Comparison of the number of observed and expected passenger-to-driver infections under each hypothesis demonstrated our method's ability to consistently discern large infectivity differences (viral variant A vs. viral variant B) given partial data from one large city, and to discern smaller infectivity differences (viral variant A vs. viral variant A with masks) given partial data aggregated across multiple cities.

CONCLUSIONS

This novel statistical method suggests that, for the present and subsequent pandemics, government-facilitated analysis of rideshare data combined with diagnosis records may augment efforts to better understand viral transmission dynamics and to measure changes in infectivity associated with nonpharmaceutical interventions and emergent viral strains.