Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus
Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus
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DOI：
10.1016/j.mbs.2020.108364
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发表时间：
2020-07-01
影响因子：
4.3
通讯作者：
Gumel, Abba B.
中科院分区：
文献类型：
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作者：
Ngonghala, Calistus N.;Iboi, Enahoro;Gumel, Abba B.
新型冠状病毒（COVID-19）于二零一九年十二月爆发，对全球公共卫生造成毁灭性影响。在缺乏安全有效的疫苗或抗病毒药物的情况下，控制和减轻大流行负担的战略侧重于非药物干预措施，如社交距离、接触者追踪、检疫、隔离和在公共场所使用口罩。我们开发了一个新的数学模型，用于评估上述控制和缓解策略对人口水平的影响。严格的分析表明，无病平衡是局部渐近稳定的，如果一个特定的流行病学阈值，称为再生数（表示为R-c），小于1。该模型使用美国纽约州和整个美国的COVID-19传播动态相关数据进行模拟，显示大流行负担将分别在4月中旬和下旬达到峰值。如果实施的严格社交距离措施持续到2020年5月底或6月底，最坏情况下的累积死亡率预测（基于研究中考虑的抗COVID非药物干预措施的基线水平）将分别大幅下降80%和64%。放宽或终止严格社交距离措施的持续时间及时间对确定COVID-19疫情的未来发展轨迹至关重要。这项研究表明，提前终止严格的社交距离措施可能会引发毁灭性的第二波负担类似于严格的社交距离措施开始实施之前的预测。如果纽约州至少有70%的居民在公共场合持续使用有效的口罩（如外科口罩，估计功效>= 70%），则在公共场合使用这种口罩可能导致消除大流行（在全国范围内，使用这种口罩的依从性至少为80%）。使用低效能口罩，例如布口罩（估计效能低于30%），亦可能大幅减少COVID-19负担（尽管无法消除）。将低效口罩与提高其他抗COVID-19干预策略水平相结合，可以消除大流行。这项研究强调了社交距离在减少COVID 19负担方面的重要作用。社交距离协议的遵守程度提高，令疫情的负担大幅减轻，而美国多个州及时实施社交距离措施，可能已避免COVID-19带来的灾难性后果。在公共场所使用口罩（包括低效能的布口罩）对减少COVID-19的社区传播和负担非常有用，前提是其覆盖率较高。如果将基于口罩的干预措施与严格的社交距离策略相结合，消除COVID-19所需的口罩覆盖率就会下降。
A pandemic of a novel Coronavirus emerged in December of 2019 (COVID-19), causing devastating public health impact across the world. In the absence of a safe and effective vaccine or antivirals, strategies for controlling and mitigating the burden of the pandemic are focused on non-pharmaceutical interventions, such as social-distancing, contact-tracing, quarantine, isolation, and the use of face-masks in public. We develop a new mathematical model for assessing the population-level impact of the aforementioned control and mitigation strategies. Rigorous analysis of the model shows that the disease-free equilibrium is locally-asymptotically stable if a certain epidemiological threshold, known as the reproduction number (denoted by R-c), is less than unity. Simulations of the model, using data relevant to COVID-19 transmission dynamics in the US state of New York and the entire US, show that the pandemic burden will peak in mid and late April, respectively. The worst-case scenario projections for cumulative mortality (based on the baseline levels of anti-COVID non-pharmaceutical interventions considered in the study) decrease dramatically by 80% and 64%, respectively, if the strict social-distancing measures implemented are maintained until the end of May or June, 2020. The duration and timing of the relaxation or termination of the strict social-distancing measures are crucially-important in determining the future trajectory of the COVID-19 pandemic. This study shows that early termination of the strict social-distancing measures could trigger a devastating second wave with burden similar to those projected before the onset of the strict social-distancing measures were implemented. The use of efficacious face-masks (such as surgical masks, with estimated efficacy >= 70%) in public could lead to the elimination of the pandemic if at least 70% of the residents of New York state use such masks in public consistently (nationwide, a compliance of at least 80% will be required using such masks). The use of low efficacy masks, such as cloth masks (of estimated efficacy less than 30%), could also lead to significant reduction of COVID-19 burden (albeit, they are not able to lead to elimination). Combining low efficacy masks with improved levels of the other anti-COVID-19 intervention strategies can lead to the elimination of the pandemic. This study emphasizes the important role social-distancing plays in curtailing the burden of COVID19. Increases in the adherence level of social-distancing protocols result in dramatic reduction of the burden of the pandemic, and the timely implementation of social-distancing measures in numerous states of the US may have averted a catastrophic outcome with respect to the burden of COVID-19. Using face-masks in public (including the low efficacy cloth masks) is very useful in minimizing community transmission and burden of COVID-19, provided their coverage level is high. The masks coverage needed to eliminate COVID-19 decreases if the masks-based intervention is combined with the strict social-distancing strategy.