Simulating the effect of school closure during COVID-19 outbreaks in Ontario, Canada
Simulating the effect of school closure during COVID-19 outbreaks in Ontario, Canada
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DOI：
10.1186/s12916-020-01705-8
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发表时间：
2020-07-24
期刊：
影响因子：
9.3
通讯作者：
Moghadas, Seyed M.
中科院分区：
文献类型：
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作者：
Abdollahi, Elaheh;Haworth-Brockman, Margaret;Moghadas, Seyed M.
背景加拿大安大略省已实施无限期停课及其他社交距离措施，以减轻2019新型冠状病毒病（COVID-19）大流行的影响。我们试图评估SC在COVID-19爆发期间降低发病率和重症护理需求的效果，同时考虑对有症状病例同时实施自我隔离（SI）的情况。方法我们开发了一个基于年龄结构的代理人模拟模型，并使用按年龄分层的安大略人口统计数据和COVID-19流行病学特征的最新估计值对其进行参数化。通过考虑组间和组内接触模式，模拟了不同年龄组内和组间的疾病传播。估计了不同持续时间的SC对总体发病率、爆发的程度和高峰时间以及人群中重症监护室（ICU）入院的需求的影响。其次，评估了对有症状的COVID-19病例同时进行基于社区的自愿SI的效果。结果当SC的持续时间从3周增加到16周时，当学校儿童之间的接触被限制60- 80%时，并且在轻微症状的人没有SI的情况下，SC使发病率降低7.2-12.7%。根据不同的情况，在整个疫情爆发期间，由于SC导致的ICU入院率总体下降幅度为3.3%至6.7%。当轻度症状者的SI被纳入并被实践20%时，在相应的场景中，发作率和ICU入院率的降低分别超过6.3%和9.1%（平均）。结论我们的研究结果表明，如果不采取措施在症状前和症状阶段中断传播链，SC对减轻COVID-19负担的影响可能有限。在强调SI的重要性的同时，我们的研究结果表明，需要更好地了解新兴疾病的流行病学特征对社交距离措施的有效性。
Background The province of Ontario, Canada, has instituted indefinite school closures (SC) as well as other social distancing measures to mitigate the impact of the novel coronavirus disease 2019 (COVID-19) pandemic. We sought to evaluate the effect of SC on reducing attack rate and the need for critical care during COVID-19 outbreaks, while considering scenarios with concurrent implementation of self-isolation (SI) of symptomatic cases. Methods We developed an age-structured agent-based simulation model and parameterized it with the demographics of Ontario stratified by age and the latest estimates of COVID-19 epidemiologic characteristics. Disease transmission was simulated within and between different age groups by considering inter- and intra-group contact patterns. The effect of SC of varying durations on the overall attack rate, magnitude and peak time of the outbreak, and requirement for intensive care unit (ICU) admission in the population was estimated. Secondly, the effect of concurrent community-based voluntary SI of symptomatic COVID-19 cases was assessed. Results SC reduced attack rates in the range of 7.2-12.7% when the duration of SC increased from 3 to 16 weeks, when contacts among school children were restricted by 60-80%, and in the absence of SI by mildly symptomatic persons. Depending on the scenario, the overall reduction in ICU admissions attributed to SC throughout the outbreak ranged from 3.3 to 6.7%. When SI of mildly symptomatic persons was included and practiced by 20%, the reduction of attack rate and ICU admissions exceeded 6.3% and 9.1% (on average), respectively, in the corresponding scenarios. Conclusion Our results indicate that SC may have limited impact on reducing the burden of COVID-19 without measures to interrupt the chain of transmission during both pre-symptomatic and symptomatic stages. While highlighting the importance of SI, our findings indicate the need for better understanding of the epidemiologic characteristics of emerging diseases on the effectiveness of social distancing measures.