Curbing the COVID-19 pandemic with facility-based isolation of mild cases: a mathematical modeling study.
Curbing the COVID-19 pandemic with facility-based isolation of mild cases: a mathematical modeling study.
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DOI：
10.1093/jtm/taaa226
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发表时间：
2021-02-23
影响因子：
25.7
通讯作者：
Bärnighausen T
中科院分区：
文献类型：
--
作者：
Chen S;Chen Q;Yang J;Lin L;Li L;Jiao L;Geldsetzer P;Wang C;Wilder-Smith A;Bärnighausen T
在许多国家，2019年冠状病毒病（COVID-19）轻度患者被告知在家自我隔离，但不完善的合规性以及与未感染者共享的生活空间限制了居家隔离的有效性。我们研究了基于设施的隔离与在家自我隔离对美国持续流行的影响。我们开发了一个房室模型来模拟COVID-19的动态传播，并将其校准为美国2020年3月至9月的关键流行指标。我们模拟设施为基础的隔离策略，不同的能力和不同的诊断率下的开始时间。我们的主要模型结果是从2020年10月起的两个月内的新感染和死亡。除了国家层面的估计，我们还探讨了美国主要人口普查地区在不同流行病负担下基于设施的隔离的影响。我们通过改变主要模型假设和参数进行敏感度分析。我们发现，以设施为基础的隔离与以家庭为基础的隔离相比，以每万总人口5张床位的适度容量，可以在2个月内避免417万（95%可信区间165 - 711）例新感染和16 000（8000-23 000）例死亡。这些结果相当于新发感染相对减少57%（44-61%），死亡相对减少37%（27-40%）。以设施为基础的隔离，每10000人10张病床的高容量，可以实现减少76%（62-84%）的新感染和52%（37-64%）的死亡时，支持扩大测试，额外的20%的每日诊断率。延迟执行将大大减少基于设施的隔离的影响。设施隔离的有效能力和影响因各地区的流行阶段而异。对轻度COVID-19病例及时进行基于设施的隔离可以大幅减少新感染人数，并有效遏制美国的持续流行。地方流行病负担应决定基于设施的隔离战略的规模。
In many countries, patients with mild coronavirus disease 2019 (COVID-19) are told to self-isolate at home, but imperfect compliance and shared living space with uninfected people limit the effectiveness of home-based isolation. We examine the impact of facility-based isolation compared to self-isolation at home on the continuing epidemic in the USA. We developed a compartment model to simulate the dynamic transmission of COVID-19 and calibrated it to key epidemic measures in the USA from March to September 2020. We simulated facility-based isolation strategies with various capacities and starting times under different diagnosis rates. Our primary model outcomes are new infections and deaths over 2 months from October 2020 onwards. In addition to national-level estimations, we explored the effects of facility-based isolation under different epidemic burdens in major US Census Regions. We performed sensitivity analyses by varying key model assumptions and parameters. We find that facility-based isolation with moderate capacity of 5 beds per 10 000 total population could avert 4.17 (95% credible interval 1.65–7.11) million new infections and 16 000 (8000–23 000) deaths in 2 months compared with home-based isolation. These results are equivalent to relative reductions of 57% (44–61%) in new infections and 37% (27–40%) in deaths. Facility-based isolation with high capacity of 10 beds per 10 000 population could achieve reductions of 76% (62–84%) in new infections and 52% (37–64%) in deaths when supported by expanded testing with an additional 20% daily diagnosis rate. Delays in implementation would substantially reduce the impact of facility-based isolation. The effective capacity and the impact of facility-based isolation varied by epidemic stage across regions. Timely facility-based isolation for mild COVID-19 cases could substantially reduce the number of new infections and effectively curb the continuing epidemic in the USA. Local epidemic burdens should determine the scale of facility-based isolation strategies.
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影响因子：
2.7
作者：
Cai, Yuwen;Huang, Tianlun;Xu, Gaosi
通讯作者：
Xu, Gaosi
影响因子：
9.7
作者：
Courtemanche, Charles;Garuccio, Joseph;Yelowitz, Aaron
通讯作者：
Yelowitz, Aaron
DOI：
10.15585/mmwr.mm6912e2
发表时间：
2020-03-27
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
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作者：
CDC COVID-19 Response Team
通讯作者：
CDC COVID-19 Response Team
DOI：
10.1007/978-3-540-78911-6_3
发表时间：
2008-01-01
期刊：
MATHEMATICAL EPIDEMIOLOGY
影响因子：
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作者：
Allen, Linda J. S.
通讯作者：
Allen, Linda J. S.
DOI：
10.1016/j.eng.2020.07.018
发表时间：
2020-10
期刊：
Engineering (Beijing, China)
影响因子：
--
作者：
Chen S;Chen Q;Yang W;Xue L;Liu Y;Yang J;Wang C;Bärnighausen T
通讯作者：
Bärnighausen T