Timing social distancing to avert unmanageable COVID-19 hospital surges
Timing social distancing to avert unmanageable COVID-19 hospital surges
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DOI：
10.1073/pnas.2009033117
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发表时间：
2020-08-18
影响因子：
11.1
通讯作者：
Meyers, Lauren Ancel
中科院分区：
文献类型：
--
作者：
Duque, Daniel;Morton, David P.;Meyers, Lauren Ancel
继2020年4月16日发布放宽2019冠状病毒病（COVID-19）社交距离政策的《再次开放美国指南》后，当地领导人担心未来的大流行浪潮，缺乏追踪和抑制传播的有力策略。在这里，我们提出了一个策略，当入院人数超过阈值时，触发短期就地庇护令。我们使用随机优化来获得触发器，以确保医院激增不会超过当地的容量，并且封锁时间尽可能短。例如，德克萨斯州奥斯汀--美国发展最快的大城市--采用了基于这种方法的COVID-19应对策略。假设放宽社交距离会使感染风险增加6倍，那么最优策略将总共触发135 d（90%预测区间：126天至141天）的庇护，允许学校在秋季开学，预计将导致2,929人死亡（90%预测区间：2，837至3，026），为年死亡率的29%。在未来几个月，决策者可能面临艰难的选择，公共克制和弱势群体的保护程度可能挽救或牺牲数千人的生命。
Following the April 16, 2020 release of the Opening Up America Again guidelines for relaxing coronavirus disease 2019 (COVID-19) social distancing policies, local leaders are concerned about future pandemic waves and lack robust strategies for tracking and suppressing transmission. Here, we present a strategy for triggering short-term shelter-in-place orders when hospital admissions surpass a threshold. We use stochastic optimization to derive triggers that ensure hospital surges will not exceed local capacity and lockdowns are as short as possible. For example, Austin, Texas- the fastest-growing large city in the United States-has adopted a COVID-19 response strategy based on this method. Assuming that the relaxation of social distancing increases the risk of infection sixfold, the optimal strategy will trigger a total of 135 d (90% prediction interval: 126 d to 141 d) of sheltering, allow schools to open in the fall, and result in an expected 2,929 deaths (90% prediction interval: 2,837 to 3,026) by September 2021, which is 29% of the annual mortality rate. In the months ahead, policy makers are likely to face difficult choices, and the extent of public restraint and cocooning of vulnerable populations may save or cost thousands of lives.