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  1. Low, Nicola (Ed.)
    Background While booster vaccinations clearly reduce the risk of severe Coronavirus Disease 2019 (COVID-19) and death, the impact of boosters on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections has not been fully characterized: Doing so requires understanding their impact on asymptomatic and mildly symptomatic infections that often go unreported but nevertheless play an important role in spreading SARS-CoV-2. We sought to estimate the impact of COVID-19 booster doses on SARS-CoV-2 infections in a vaccinated population of young adults during an Omicron BA.1-predominant period. Methods and findings We implemented a cohort study of young adults in a college environment (Cornell University’s Ithaca campus) from a period when Omicron BA.1 was the predominant SARS-CoV-2 variant on campus (December 5 to December 31, 2021). Participants included 15,800 university students who completed initial vaccination series with vaccines approved by the World Health Organization for emergency use, were enrolled in mandatory at-least-weekly surveillance polymerase chain reaction (PCR) testing, and had no positive SARS-CoV-2 PCR test within 90 days before the start of the study period. Robust multivariable Poisson regression with the main outcome of a positive SARS-CoV-2 PCR test was performed to compare those who completed their initial vaccination series and a booster dose to those without a booster dose. A total of 1,926 unique SARS-CoV-2 infections were identified in the study population. Controlling for sex, student group membership, date of completion of initial vaccination series, initial vaccine type, and temporal effect during the study period, our analysis estimates that receiving a booster dose further reduces the rate of having a PCR-detected SARS-CoV-2 infection relative to an initial vaccination series by 56% (95% confidence interval [42%, 67%], P < 0.001). While most individuals had recent booster administration before or during the study period (a limitation of our study), this result is robust to the assumed delay over which a booster dose becomes effective (varied from 1 day to 14 days). The mandatory active surveillance approach used in this study, under which 86% of the person-days in the study occurred, reduces the likelihood of outcome misclassification. Key limitations of our methodology are that we did not have an a priori protocol or statistical analysis plan because the analysis was initially done for institutional research purposes, and some analysis choices were made after observing the data. Conclusions We observed that boosters are effective, relative to completion of initial vaccination series, in further reducing the rate of SARS-CoV-2 infections in a college student population during a period when Omicron BA.1 was predominant; booster vaccinations for this age group may play an important role in reducing incidence of COVID-19. 
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  2. We consider epidemiological modeling for the design of COVID-19 interventions in university populations, which have seen significant outbreaks during the pandemic. A central challenge is sensitivity of predictions to input parameters coupled with uncertainty about these parameters. Nearly 2 y into the pandemic, parameter uncertainty remains because of changes in vaccination efficacy, viral variants, and mask mandates, and because universities’ unique characteristics hinder translation from the general population: a high fraction of young people, who have higher rates of asymptomatic infection and social contact, as well as an enhanced ability to implement behavioral and testing interventions. We describe an epidemiological model that formed the basis for Cornell University’s decision to reopen for in-person instruction in fall 2020 and supported the design of an asymptomatic screening program instituted concurrently to prevent viral spread. We demonstrate how the structure of these decisions allowed risk to be minimized despite parameter uncertainty leading to an inability to make accurate point estimates and how this generalizes to other university settings. We find that once-per-week asymptomatic screening of vaccinated undergraduate students provides substantial value against the Delta variant, even if all students are vaccinated, and that more targeted testing of the most social vaccinated students provides further value. 
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  3. We consider information design in spatial resource competition, motivated by ride sharing platforms sharing information with drivers about rider demand. Each of N co-located agents (drivers) decides whether to move to another location with an uncertain and possibly higher resource level (rider demand), where the utility for moving increases in the resource level and decreases in the number of other agents that move. A principal who can observe the resource level wishes to share this information in a way that ensures a welfare-maximizing number of agents move. Analyzing the principal’s information design problem using the Bayesian persuasion framework, we study both private signaling mechanisms, where the principal sends personalized signals to each agent, and public signaling mechanisms, where the principal sends the same information to all agents. We show: 1) For private signaling, computing the optimal mechanism using the standard approach leads to a linear program with 2 N variables, rendering the computation challenging. We instead describe a computationally efficient two-step approach to finding the optimal private signaling mechanism. First, we perform a change of variables to solve a linear program with O(N^2) variables that provides the marginal probabilities of recommending each agent move. Second, we describe an efficient sampling procedure over sets of agents consistent with these optimal marginal probabilities; the optimal private mechanism then asks the sampled set of agents to move and the rest to stay. 2) For public signaling, we first show the welfare-maximizing equilibrium given any common belief has a threshold structure. Using this, we show that the optimal public mechanism with respect to the sender-preferred equilibrium can be computed in polynomial time. 3) We support our analytical results with numerical computations that show the optimal private and public signaling mechanisms achieve substantially higher social welfare when compared with no-information and full-information benchmarks. 
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