Optimal, near-optimal, and robust epidemic control
Optimal, near-optimal, and robust epidemic control
复制标题
DOI：
10.1038/s42005-021-00570-y
复制
发表时间：
2021-04-20
影响因子：
5.5
通讯作者：
Levin, Simon A.
中科院分区：
文献类型：
--
作者：
Morris, Dylan H.;Rossine, Fernando W.;Levin, Simon A.
在缺乏药物和疫苗的情况下，政策制定者使用社会距离等非药物干预措施来降低致病接触率，目的是减少或推迟流行病高峰。这些措施会带来社会和经济成本，因此社会可能无法维持它们超过一段时间。干预政策的设计通常依赖于流行病模型的数值模拟，但比较政策和评估其稳健性需要适用于各种战略的明确原则。在经典的易感-感染-恢复流行病模型中，我们导出了理论上最优的策略，即使用有时间限制的干预措施来降低新疾病的峰值流行率。我们表明，广泛的易于实现的策略类可以执行几乎和理论上的最优策略一样好。但是，无论是最优策略还是这些接近最优策略，都不会对实施错误具有鲁棒性：干预时机上的小错误会导致患病率峰值的大幅增加。我们的研究结果揭示了非药物疾病控制的基本原理，并暴露了它们潜在的脆弱性。为了实现强有力的控制，干预必须是强有力的、早期的，最好是持续的。2019冠状病毒病大流行表明，需要非药物流行病缓解战略，即使持续时间有限，这些战略也可能有效。在这里，作者导出了在易感-感染-恢复模型中限制流行高峰的解析最优和近最优限时策略，并表明，由于此类策略对实施错误的敏感性，及时行动是非药物疾病控制的基础。
In the absence of drugs and vaccines, policymakers use non-pharmaceutical interventions such as social distancing to decrease rates of disease-causing contact, with the aim of reducing or delaying the epidemic peak. These measures carry social and economic costs, so societies may be unable to maintain them for more than a short period of time. Intervention policy design often relies on numerical simulations of epidemic models, but comparing policies and assessing their robustness demands clear principles that apply across strategies. Here we derive the theoretically optimal strategy for using a time-limited intervention to reduce the peak prevalence of a novel disease in the classic Susceptible-Infectious-Recovered epidemic model. We show that broad classes of easier-to-implement strategies can perform nearly as well as the theoretically optimal strategy. But neither the optimal strategy nor any of these near-optimal strategies is robust to implementation error: small errors in timing the intervention produce large increases in peak prevalence. Our results reveal fundamental principles of non-pharmaceutical disease control and expose their potential fragility. For robust control, an intervention must be strong, early, and ideally sustained.The COVID-19 pandemic has demonstrated the need for non-pharmaceutical epidemic mitigation strategies that can be effective even if they are limited in duration. Here, the authors derive analytically optimal and near-optimal time-limited strategies for limiting the epidemic peak in the Susceptible-Infectious-Recovered model and show that, due to the sensitivity of such strategies to implementation errors, timely action is fundamental to non-pharmaceutical disease control.