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      Forecasting hospital-level COVID-19 admissions using real-time mobility data

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          Abstract

          Background

          For each of the COVID-19 pandemic waves, hospitals have had to plan for deploying surge capacity and resources to manage large but transient increases in COVID-19 admissions. While a lot of effort has gone into predicting regional trends in COVID-19 cases and hospitalizations, there are far fewer successful tools for creating accurate hospital-level forecasts.

          Methods

          Large-scale, anonymized mobile phone data has been shown to correlate with regional case counts during the first two waves of the pandemic (spring 2020, and fall/winter 2021). Building off this success, we developed a multi-step, recursive forecasting model to predict individual hospital admissions; this model incorporates the following data: (i) hospital-level COVID-19 admissions, (ii) statewide test positivity data, and (iii) aggregate measures of large-scale human mobility, contact patterns, and commuting volume.

          Results

          Incorporating large-scale, aggregate mobility data as exogenous variables in prediction models allows us to make hospital-specific COVID-19 admission forecasts 21 days ahead. We show this through highly accurate predictions of hospital admissions for five hospitals in Massachusetts during the first year of the COVID-19 pandemic.

          Conclusions

          The high predictive capability of the model was achieved by combining anonymized, aggregated mobile device data about users’ contact patterns, commuting volume, and mobility range with COVID hospitalizations and test-positivity data. Mobility-informed forecasting models can increase the lead-time of accurate predictions for individual hospitals, giving managers valuable time to strategize how best to allocate resources to manage forthcoming surges.

          Plain language summary

          During the COVID-19 pandemic, hospitals have needed to make challenging decisions around staffing and preparedness based on estimates of the number of admissions multiple weeks ahead. Forecasting techniques using methods from machine learning have been successfully applied to predict hospital admissions statewide, but the ability to accurately predict individual hospital admissions has proved elusive. Here, we incorporate details of the movement of people obtained from mobile phone data into a model that makes accurate predictions of the number of people who will be hospitalized 21 days ahead. This model will be useful for administrators and healthcare workers to plan staffing and discharge of patients to ensure adequate capacity to deal with forthcoming hospital admissions.

          Abstract

          Klein et al. use mobility data to forecast COVID-19 admissions for five Massachusetts hospitals. Combining aggregated mobile device data about users’ contact patterns, commuting volume, and mobility range with COVID hospitalizations and test-positivity data increases the lead-time of accurate predictions for individual hospitals.

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          Most cited references27

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          The effect of human mobility and control measures on the COVID-19 epidemic in China

          The ongoing COVID-19 outbreak expanded rapidly throughout China. Major behavioral, clinical, and state interventions have been undertaken to mitigate the epidemic and prevent the persistence of the virus in human populations in China and worldwide. It remains unclear how these unprecedented interventions, including travel restrictions, affected COVID-19 spread in China. We use real-time mobility data from Wuhan and detailed case data including travel history to elucidate the role of case importation on transmission in cities across China and ascertain the impact of control measures. Early on, the spatial distribution of COVID-19 cases in China was explained well by human mobility data. Following the implementation of control measures, this correlation dropped and growth rates became negative in most locations, although shifts in the demographics of reported cases were still indicative of local chains of transmission outside Wuhan. This study shows that the drastic control measures implemented in China substantially mitigated the spread of COVID-19.
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            Clinical Characteristics of Covid-19 in New York City

            To the Editor: The world is in the midst of the coronavirus disease 2019 (Covid-19) pandemic, 1,2 and New York City has emerged as an epicenter. Here, we characterize the first 393 consecutive patients with Covid-19 who were admitted to two hospitals in New York City. This retrospective case series includes adults 18 years of age or older with confirmed Covid-19 who were consecutively admitted between March 3 (date of the first positive case) and March 27, 2020, at an 862-bed quaternary referral center and an affiliated 180-bed nonteaching community hospital in Manhattan. Both hospitals adopted an early-intubation strategy with limited use of high-flow nasal cannulae during this period. Cases were confirmed through reverse-transcriptase–polymerase-chain-reaction assays performed on nasopharyngeal swab specimens. Data were manually abstracted from electronic health records with the use of a quality-controlled protocol and structured abstraction tool (details are provided in the Methods section in the Supplementary Appendix, available with the full text of this letter at NEJM.org). Among the 393 patients, the median age was 62.2 years, 60.6% were male, and 35.8% had obesity (Table 1). The most common presenting symptoms were cough (79.4%), fever (77.1%), dyspnea (56.5%), myalgias (23.8%), diarrhea (23.7%), and nausea and vomiting (19.1%) (Table S1 in the Supplementary Appendix). Most of the patients (90.0%) had lymphopenia, 27% had thrombocytopenia, and many had elevated liver-function values and inflammatory markers. Between March 3 and April 10, respiratory failure leading to invasive mechanical ventilation developed in 130 patients (33.1%); to date, only 43 of these patients (33.1%) have been extubated. In total, 40 of the patients (10.2%) have died, and 260 (66.2%) have been discharged from the hospital; outcome data are incomplete for the remaining 93 patients (23.7%). Patients who received invasive mechanical ventilation were more likely to be male, to have obesity, and to have elevated liver-function values and inflammatory markers (ferritin, d-dimer, C-reactive protein, and procalcitonin) than were patients who did not receive invasive mechanical ventilation. Of the patients who received invasive mechanical ventilation, 40 (30.8%) did not need supplemental oxygen during the first 3 hours after presenting to the emergency department. Patients who received invasive mechanical ventilation were more likely to need vasopressor support (95.4% vs. 1.5%) and to have other complications, including atrial arrhythmias (17.7% vs. 1.9%) and new renal replacement therapy (13.3% vs. 0.4%). Among these 393 patients with Covid-19 who were hospitalized in two New York City hospitals, the manifestations of the disease at presentation were generally similar to those in a large case series from China 1 ; however, gastrointestinal symptoms appeared to be more common than in China (where these symptoms occurred in 4 to 5% of patients). This difference could reflect geographic variation or differential reporting. Obesity was common and may be a risk factor for respiratory failure leading to invasive mechanical ventilation. 3 The percentage of patients in our case series who received invasive mechanical ventilation was more than 10 times as high as that in China; potential contributors include the more severe disease in our cohort (since testing and hospitalization in the United States is largely limited to patients with more severe disease) and the early-intubation strategy used in our hospitals. Regardless, the high demand for invasive mechanical ventilation has the potential to overwhelm hospital resources. Deterioration occurred in many patients whose condition had previously been stable; almost a third of patients who received invasive mechanical ventilation did not need supplemental oxygen at presentation. The observations that the patients who received invasive mechanical ventilation almost universally received vasopressor support and that many also received new renal replacement therapy suggest that there is also a need to strengthen stockpiles and supply chains for these resources.
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              Mobility network models of COVID-19 explain inequities and inform reopening

              The coronavirus disease 2019 (COVID-19) pandemic markedly changed human mobility patterns, necessitating epidemiological models that can capture the effects of these changes in mobility on the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)1. Here we introduce a metapopulation susceptible-exposed-infectious-removed (SEIR) model that integrates fine-grained, dynamic mobility networks to simulate the spread of SARS-CoV-2 in ten of the largest US metropolitan areas. Our mobility networks are derived from mobile phone data and map the hourly movements of 98 million people from neighbourhoods (or census block groups) to points of interest such as restaurants and religious establishments, connecting 56,945 census block groups to 552,758 points of interest with 5.4 billion hourly edges. We show that by integrating these networks, a relatively simple SEIR model can accurately fit the real case trajectory, despite substantial changes in the behaviour of the population over time. Our model predicts that a small minority of 'superspreader' points of interest account for a large majority of the infections, and that restricting the maximum occupancy at each point of interest is more effective than uniformly reducing mobility. Our model also correctly predicts higher infection rates among disadvantaged racial and socioeconomic groups2-8 solely as the result of differences in mobility: we find that disadvantaged groups have not been able to reduce their mobility as sharply, and that the points of interest that they visit are more crowded and are therefore associated with higher risk. By capturing who is infected at which locations, our model supports detailed analyses that can inform more-effective and equitable policy responses to COVID-19.
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                Author and article information

                Contributors
                b.klein@northeastern.edu
                azentenolangle@mgh.harvard.edu
                scarpino@santafe.edu
                hsalmasian@bwh.harvard.edu
                Journal
                Commun Med (Lond)
                Commun Med (Lond)
                Communications Medicine
                Nature Publishing Group UK (London )
                2730-664X
                14 February 2023
                14 February 2023
                2023
                : 3
                : 25
                Affiliations
                [1 ]GRID grid.261112.7, ISNI 0000 0001 2173 3359, Network Science Institute, , Northeastern University, ; Boston, MA USA
                [2 ]GRID grid.261112.7, ISNI 0000 0001 2173 3359, Laboratory for the Modeling of Biological and Socio-Technical Systems, , Northeastern University, ; Boston, MA USA
                [3 ]GRID grid.32224.35, ISNI 0000 0004 0386 9924, Massachusetts General Hospital, ; Boston, MA USA
                [4 ]GRID grid.261112.7, ISNI 0000 0001 2173 3359, Department of Physics, , Northeastern University, ; Boston, MA USA
                [5 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Department of Zoology, , University of Oxford, ; Oxford, UK
                [6 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Pandemic Sciences Institute, , University of Oxford, ; Oxford, UK
                [7 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Population Medicine, , Harvard Medical School, ; Boston, MA USA
                [8 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, Brigham and Women’s Hospital, ; Boston, MA USA
                [9 ]GRID grid.67104.34, ISNI 0000 0004 0415 0102, Harvard Pilgrim Health Care Institute, ; Boston, MA USA
                [10 ]GRID grid.209665.e, ISNI 0000 0001 1941 1940, Santa Fe Institute, ; Santa Fe, NM USA
                [11 ]GRID grid.59062.38, ISNI 0000 0004 1936 7689, Vermont Complex Systems Center, , University of Vermont, ; Burlington, VT USA
                [12 ]GRID grid.32224.35, ISNI 0000 0004 0386 9924, Mass General Brigham, ; Somerville, MA USA
                Author information
                http://orcid.org/0000-0001-8326-5044
                http://orcid.org/0000-0002-9988-260X
                Article
                253
                10.1038/s43856-023-00253-5
                9927044
                36788347
                68775634-0f40-4589-a503-42e3d6bcb0f3
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 29 August 2022
                : 31 January 2023
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                © The Author(s) 2023

                epidemiology,health services,computational biology and bioinformatics

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