skip to main content
US FlagAn official website of the United States government
dot gov icon
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
https lock icon
Secure .gov websites use HTTPS
A lock ( lock ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.


Title: Analysing how changes in the health status of healthcare workers affects epidemic outcomes
Abstract During a disease outbreak, healthcare workers (HCWs) are essential to treat infected individuals. However, these HCWs are themselves susceptible to contracting the disease. As more HCWs get infected, fewer are available to provide care for others, and the overall quality of care available to infected individuals declines. This depletion of HCWs may contribute to the epidemic's severity. To examine this issue, we explicitly model declining quality of care in four differential equation-based susceptible, infected and recovered-type models with vaccination. We assume that vaccination, recovery and survival rates are affected by quality of care delivered. We show that explicitly modelling HCWs and accounting for declining quality of care significantly alters model-predicted disease outcomes, specifically case counts and mortality. Models neglecting the decline of quality of care resulting from infection of HCWs may significantly under-estimate cases and mortality. These models may be useful to inform health policy that may differ for HCWs and the general population. Models accounting for declining quality of care may therefore improve the management interventions considered to mitigate the effects of a future outbreak.  more » « less
Award ID(s):
1714654 2028301 1514704
PAR ID:
10302309
Author(s) / Creator(s):
; ; ;
Date Published:
Journal Name:
Epidemiology and Infection
Volume:
149
ISSN:
0950-2688
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. Lau, Eric HY (Ed.)
    The presence of heterogeneity in susceptibility, differences between hosts in their likelihood of becoming infected, can fundamentally alter disease dynamics and public health responses, for example, by changing the final epidemic size, the duration of an epidemic, and even the vaccination threshold required to achieve herd immunity. Yet, heterogeneity in susceptibility is notoriously difficult to detect and measure, especially early in an epidemic. Here we develop a method that can be used to detect and estimate heterogeneity in susceptibility given contact by using contact tracing data, which are typically collected early in the course of an outbreak. This approach provides the capability, given sufficient data, to estimate and account for the effects of this heterogeneity before they become apparent during an epidemic. It additionally provides the capability to analyze the wealth of contact tracing data available for previous epidemics and estimate heterogeneity in susceptibility for disease systems in which it has never been estimated previously. The premise of our approach is that highly susceptible individuals become infected more often than less susceptible individuals, and so individuals not infected after appearing in contact networks should be less susceptible than average. This change in susceptibility can be detected and quantified when individuals show up in a second contact network after not being infected in the first. To develop our method, we simulated contact tracing data from artificial populations with known levels of heterogeneity in susceptibility according to underlying discrete or continuous distributions of susceptibilities. We analyzed these data to determine the parameter space under which we are able to detect heterogeneity and the accuracy with which we are able to estimate it. We found that our power to detect heterogeneity increases with larger sample sizes, greater heterogeneity, and intermediate fractions of contacts becoming infected in the discrete case or greater fractions of contacts becoming infected in the continuous case. We also found that we are able to reliably estimate heterogeneity and disease dynamics. Ultimately, this means that contact tracing data alone are sufficient to detect and quantify heterogeneity in susceptibility. 
    more » « less
  2. Borri, Alessandro (Ed.)
    Ever since the outbreak of the COVID-19 epidemic, various public health control strategies have been proposed and tested against the coronavirus SARS-CoV-2. We study three specific COVID-19 epidemic control models: the susceptible, exposed, infectious, recovered (SEIR) model with vaccination control; the SEIR model with shield immunity control; and the susceptible, un-quarantined infected, quarantined infected, confirmed infected (SUQC) model with quarantine control. We express the control requirement in metric temporal logic (MTL) formulas (a type of formal specification languages) which can specify the expected control outcomes such as “ the deaths from the infection should never exceed one thousand per day within the next three months ” or “ the population immune from the disease should eventually exceed 200 thousand within the next 100 to 120 days ”. We then develop methods for synthesizing control strategies with MTL specifications. To the best of our knowledge, this is the first paper to systematically synthesize control strategies based on the COVID-19 epidemic models with formal specifications. We provide simulation results in three different case studies: vaccination control for the COVID-19 epidemic with model parameters estimated from data in Lombardy, Italy; shield immunity control for the COVID-19 epidemic with model parameters estimated from data in Lombardy, Italy; and quarantine control for the COVID-19 epidemic with model parameters estimated from data in Wuhan, China. The results show that the proposed synthesis approach can generate control inputs such that the time-varying numbers of individuals in each category (e.g., infectious, immune) satisfy the MTL specifications. The results also show that early intervention is essential in mitigating the spread of COVID-19, and more control effort is needed for more stringent MTL specifications. For example, based on the model in Lombardy, Italy, achieving less than 100 deaths per day and 10000 total deaths within 100 days requires 441.7% more vaccination control effort than achieving less than 1000 deaths per day and 50000 total deaths within 100 days. 
    more » « less
  3. We provide a new global strict Lyapunov function construction for a susceptible, infected, and recovered (or SIR) disease dynamics that includes quarantine of infected individuals and mass vaccination. We use the Lyapunov function to design feedback controls to asymptotically stabilize a desired endemic equilibrium, and to prove input-to-state stability for the dynamics with a suitable restriction on the disturbances. Our simulations illustrate the potential of our feedback controls to reduce peak levels of infected individuals. 
    more » « less
  4. Abstract Background Estimating real-world vaccine effectiveness is challenging as a variety of population factors can impact vaccine effectiveness. We aimed to assess the population-level reduction in cumulative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, hospitalizations, and mortality due to the BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccination campaign in Israel during January–February 2021. Methods A susceptible-infected-recovered/removed (SIR) model and a Dynamic Survival Analysis (DSA) statistical approach were used. Daily counts of individuals who tested positive and of vaccine doses administered, obtained from the Israeli Ministry of Health, were used to calibrate the model. The model was parameterized using values derived from a previous phase of the pandemic during which similar lockdown and other preventive measures were implemented in order to take into account the effect of these prevention measures on COVID-19 spread. Results Our model predicted for the total population a reduction of 648 585 SARS-CoV-2 cases (75% confidence interval [CI], 25 877–1 396 963) during the first 2 months of the vaccination campaign. The number of averted hospitalizations for moderate to severe conditions was 16 101 (75% CI, 2010–33 035), and reduction of death was estimated at 5123 (75% CI, 388–10 815) fatalities. Among children aged 0–19 years, we estimated a reduction of 163 436 (75% CI, 0–433 233) SARS-CoV-2 cases, which we consider to be an indirect effect of the vaccine. Conclusions Our results suggest that the rapid vaccination campaign prevented hundreds of thousands of new cases as well as thousands of hospitalizations and fatalities and has probably averted a major health care crisis. 
    more » « less
  5. We explore the effects of cross-diffusion dynamics in epidemiological models. Using reaction–diffusion models of infectious disease, we explicitly consider situations where an individual in a category will move according to the concentration of individuals in other categories. Namely, we model susceptible individuals moving away from infected and infectious individuals. Here, we show that including these cross-diffusion dynamics results in a delay in the onset of an epidemic and an increase in the total number of infectious individuals. This representation provides more realistic spatiotemporal dynamics of the disease classes in an Erlang SEIR model and allows us to study how spatial mobility, due to social behavior, can affect the spread of an epidemic. We found that tailored control measures, such as targeted testing, contact tracing, and isolation of infected individuals, can be more effective in mitigating the spread of infectious diseases while minimizing the negative impact on society and the economy. 
    more » « less