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1. The unintended consequences of inconsistent closure policies and mobility restrictions during epidemics

   https://doi.org/10.1186/s44263-023-00028-z  

   Althouse, Benjamin M. ; Wallace, Brendan ; Case, B. K. M. ; Scarpino, Samuel V. ; Allard, Antoine ; Berdahl, Andrew M. ; White, Easton R. ; Hébert-Dufresne, Laurent ( December 2023 , BMC Global and Public Health)

   Controlling the spread of infectious diseases―even when safe, transmission-blocking vaccines are available―may require the effective use of non-pharmaceutical interventions (NPIs), e.g., mask wearing, testing, limits on group sizes, venue closure. During the SARS-CoV-2 pandemic, many countries implemented NPIs inconsistently in space and time. This inconsistency was especially pronounced for policies in the United States of America (US) related to venue closure.

   Here, we investigate the impact of inconsistent policies associated with venue closure using mathematical modeling and high-resolution human mobility, Google search, and county-level SARS-CoV-2 incidence data from the USA. Specifically, we look at high-resolution location data and perform a US-county-level analysis of nearly 8 million SARS-CoV-2 cases and 150 million location visits, including 120 million church visitors across 184,677 churches, 14 million grocery visitors across 7662 grocery stores, and 13.5 million gym visitors across 5483 gyms.

   Analyzing the interaction between venue closure and changing mobility using a mathematical model shows that, across a broad range of model parameters, inconsistent or partial closure can be worse in terms of disease transmission as compared to scenarios with no closures at all. Importantly, changes in mobility patterns due to epidemic control measures can lead to increase in the future number of cases. In the most severe cases, individuals traveling to neighboring jurisdictions with different closure policies can result in an outbreak that would otherwise have been contained. To motivate our mathematical models, we turn to mobility data and find that while stay-at-home orders and closures decreased contacts in most areas of the USA, some specific activities and venues saw an increase in attendance and an increase in the distance visitors traveled to attend. We support this finding using search query data, which clearly shows a shift in information seeking behavior concurrent with the changing mobility patterns.

   While coarse-grained observations are not sufficient to validate our models, taken together, they highlight the potential unintended consequences of inconsistent epidemic control policies related to venue closure and stress the importance of balancing the societal needs of a population with the risk of an outbreak growing into a large epidemic.

    

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2. Vaccination and three non-pharmaceutical interventions determine the dynamics of COVID-19 in the US

   https://doi.org/10.1057/s41599-022-01142-3  

   Zhong, Lu ; Diagne, Mamadou ; Wang, Qi ; Gao, Jianxi ( December 2022 , Humanities and Social Sciences Communications)

   Abstract The rapid rollout of the COVID-19 vaccine raises the question of whether and when the ongoing pandemic could be eliminated with vaccination and non-pharmaceutical interventions (NPIs). Despite advances in the impact of NPIs and the conceptual belief that NPIs and vaccination control COVID-19 infections, we lack evidence to employ control theory in real-world social human dynamics in the context of disease spreading. We bridge the gap by developing a new analytical framework that treats COVID-19 as a feedback control system with the NPIs and vaccination as the controllers and a computational model that maps human social behaviors into input signals. This approach enables us to effectively predict the epidemic spreading in 381 Metropolitan statistical areas (MSAs) in the US by learning our model parameters utilizing the time series NPIs (i.e., the stay-at-home order, face-mask wearing, and testing) data. This model allows us to optimally identify three NPIs to predict infections accurately in 381 MSAs and avoid over-fitting. Our numerical results demonstrate our approach’s excellent predictive power with R 2  > 0.9 for all the MSAs regardless of their sizes, locations, and demographic status. Our methodology allows us to estimate the needed vaccine coverage and NPIs for achieving R e to a manageable level and how the variants of concern diminish the likelihood for disease elimination at each location. Our analytical results provide insights into the debates surrounding the elimination of COVID-19. NPIs, if tailored to the MSAs, can drive the pandemic to an easily containable level and suppress future recurrences of epidemic cycles. 

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3. SARS-CoV-2 transmission dynamics in Belarus in 2020 revealed by genomic and incidence data analysis

   https://doi.org/10.1038/s43856-021-00031-1  

   Nemira, Alina ; Adeniyi, Ayotomiwa Ezekiel ; Gasich, Elena L. ; Bulda, Kirill Y. ; Valentovich, Leonid N. ; Krasko, Anatoly G. ; Glebova, Olga ; Kirpich, Alexander ; Skums, Pavel ( September 2021 , Communications Medicine)

   Non-pharmaceutical interventions (NPIs) have been implemented worldwide to curb COVID-19 spread. Belarus is a rare case of a country with a relatively modern healthcare system, where highly limited NPIs have been enacted. Thus, investigation of Belarusian COVID-19 dynamics is essential for the local and global assessment of the impact of NPI strategies.

   We integrate genomic epidemiology and surveillance methods to investigate the spread of SARS-CoV-2 in Belarus in 2020. We utilize phylodynamics, phylogeography, and probabilistic bias inference to study the virus import and export routes, the dynamics of the effective reproduction number, and the incidence of SARS-CoV-2 infection.

   Here we show that the estimated cumulative number of infections by June 2020 exceeds the confirmed case number by a factor of ~4 (95% confidence interval (2; 9)). Intra-country SARS-CoV-2 genomic diversity originates from at least 18 introductions from different regions, with a high proportion of regional transmissions. Phylodynamic analysis indicates a moderate reduction of the effective reproductive number after the introduction of limited NPIs, but its magnitude is lower than for developed countries with large-scale NPIs. On the other hand, the effective reproduction number estimate is comparable with that for the neighboring Ukraine, where NPIs were broader.

   The example of Belarus demonstrates how countries with relatively low outward population mobility continue to be integral parts of the global epidemiological environment. Comparison of the effective reproduction number dynamics for Belarus and other countries reveals the effect of different NPI strategies but also emphasizes the role of regional Eastern European sociodemographic factors in the virus spread.

    

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4. Excess mortality in Belarus during the COVID-19 pandemic as the case study of a country with limited non-pharmaceutical interventions and limited reporting

   https://doi.org/10.1038/s41598-022-09345-z  

   Kirpich, Alexander ; Shishkin, Aleksandr ; Weppelmann, Thomas A. ; Tchernov, Alexander Perez ; Skums, Pavel ; Gankin, Yuriy ( December 2022 , Scientific Reports)

   Abstract Public health intervention to contain the ongoing COVID-19 pandemic significantly differed by country since the SARS-CoV-2 spread varied regionally in time and in scale. Since vaccinations were not available until the end of 2020 non-pharmaceutical interventions (NPIs) remained the only strategies to mitigate the pandemic spread at that time. Belarus in Europe is one of a few countries with a high Human Development Index where no lockdowns have ever been implemented and only limited NPIs have taken place for a period of time. Therefore, the Belarusian case was evaluated and compared in terms of the mortality burden. Since the COVID-19 mortality was low, the excess overall mortality was studied for Belarus. Since no overall mortality data have been reported past June 2020 the analysis was complemented by the study of Google Trends funeral-related search queries up until August 2021. Depending on the model, the Belarusian mortality for June of 2020 was 29 to 39% higher than otherwise expected with the corresponding estimated excess death was from 2953 to 3690 while the reported COVID-19 mortality for June 2020 was only 157 cases. The Belarusian excess mortality for June 2020 was higher than for all neighboring countries with an excess of 5% for Poland, 5% for Ukraine, 8% for Russia, 11% for Lithuania and 11% for Latvia. The relationship between Google Trends and mortality time series was studied using Granger’s test and the results were statistically significant. The results for Google Trends searches did vary by key phrase with the largest excess of 138% for April 2020 and 148% for September 2020 was observed for a key phrase “coffin”, while the largest excess of 218% for January 2021 was observed for “funeral services”. In summary, there are indications of the excess overall mortality in Belarus, which is larger than the reported COVID-19-related mortality. 

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5. Policies for a Second Wave

   Baqaee, D. ; Farhi, E. ; Mina, M. ; Stock, J. ( July 2020 , Brookings papers on economic activity)

   Eberly, Jan ; Romer, David (Ed.)

   In the spring of 2020, the initial surge of COVID-19 infections and deaths was flattened using a combination of economic shutdowns and noneconomic non-pharmaceutical interventions (NPIs). The possibility of a second wave of infections and deaths raises the question of what interventions can be used to significantly reduce deaths while supporting, not preventing, economic recovery. We use a five-age epidemiological model combined with sixty-six-sector economic accounting to examine policies to avert and to respond to a second wave. We find that a second round of economic shutdowns alone are neither sufficient nor necessary to avert or quell a second wave. In contrast, noneconomic NPIs, such as wearing masks and personal distancing, increasing testing and quarantine, reintroducing restrictions on social and recreational gatherings, and enhancing protections for the elderly together can mitigate a second wave while leaving room for an economic recovery. 

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