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      Effect of vaccination, border testing, and quarantine requirements on the risk of COVID-19 in New Zealand: A modelling study

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          Abstract

          We couple a simple model of quarantine and testing strategies for international travellers with a model for transmission of SARS-CoV-2 in a partly vaccinated population. We use this model to estimate the risk of an infectious traveller causing a community outbreak under various border control strategies and different levels of vaccine coverage in the population. Results are calculated from N = 100,000 independent realisations of the stochastic model. We find that strategies that rely on home isolation are significantly higher risk than the current mandatory 14-day stay in government-managed isolation. Nevertheless, combinations of testing and home isolation can still reduce the risk of a community outbreak to around one outbreak per 100 infected travellers. We also find that, under some circumstances, using daily lateral flow tests or a combination of lateral flow tests and polymerase chain reaction (PCR) tests can reduce risk to a comparable or lower level than using PCR tests alone. Combined with controls on the number of travellers from countries with high prevalence of COVID-19, our results allow different options for managing the risk of COVID-19 at the border to be compared. This can be used to inform strategies for relaxing border controls in a phased way, while limiting the risk of community outbreaks as vaccine coverage increases.

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          The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

          Stephen A. Lauer, Kyra Grantz, Qifang Bi … (2020)
          Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID-19 and describe its public health implications. Design: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases. Primary Funding Source: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.
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            Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing

            Luca Ferretti, Chris Wymant, Michelle L. Kendall … (2020)
            The newly emergent human virus SARS-CoV-2 is resulting in high fatality rates and incapacitated health systems. Preventing further transmission is a priority. We analyzed key parameters of epidemic spread to estimate the contribution of different transmission routes and determine requirements for case isolation and contact-tracing needed to stop the epidemic. We conclude that viral spread is too fast to be contained by manual contact tracing, but could be controlled if this process was faster, more efficient and happened at scale. A contact-tracing App which builds a memory of proximity contacts and immediately notifies contacts of positive cases can achieve epidemic control if used by enough people. By targeting recommendations to only those at risk, epidemics could be contained without need for mass quarantines (‘lock-downs’) that are harmful to society. We discuss the ethical requirements for an intervention of this kind.
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              Age-dependent effects in the transmission and control of COVID-19 epidemics

              Nicholas Davies, Petra Klepac, Yang Liu … (2020)
              The COVID-19 pandemic has shown a markedly low proportion of cases among children1-4. Age disparities in observed cases could be explained by children having lower susceptibility to infection, lower propensity to show clinical symptoms or both. We evaluate these possibilities by fitting an age-structured mathematical model to epidemic data from China, Italy, Japan, Singapore, Canada and South Korea. We estimate that susceptibility to infection in individuals under 20 years of age is approximately half that of adults aged over 20 years, and that clinical symptoms manifest in 21% (95% credible interval: 12-31%) of infections in 10- to 19-year-olds, rising to 69% (57-82%) of infections in people aged over 70 years. Accordingly, we find that interventions aimed at children might have a relatively small impact on reducing SARS-CoV-2 transmission, particularly if the transmissibility of subclinical infections is low. Our age-specific clinical fraction and susceptibility estimates have implications for the expected global burden of COVID-19, as a result of demographic differences across settings. In countries with younger population structures-such as many low-income countries-the expected per capita incidence of clinical cases would be lower than in countries with older population structures, although it is likely that comorbidities in low-income countries will also influence disease severity. Without effective control measures, regions with relatively older populations could see disproportionally more cases of COVID-19, particularly in the later stages of an unmitigated epidemic.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Dis Model
                Journal ID (iso-abbrev): Infect Dis Model
                Title: Infectious Disease Modelling
                Publisher: The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.
                ISSN (Print): 2468-2152
                ISSN (Electronic): 2468-0427
                Publication date PMC-release: 28 December 2021
                Publication date (Electronic): 28 December 2021
                Affiliations
                [a ]Department of Physics, University of Auckland, New Zealand
                [b ]School of Mathematics and Statistics, University of Canterbury, New Zealand
                [c ]Te Pūnaha Matatini, Centre of Research Excellence in Complex Systems, New Zealand
                [d ]Manaaki Whenua, Lincoln, New Zealand
                Author notes
                [∗ ]Corresponding author. School of Mathematics and Statistics, University of Canterbury, New Zealand.
                Article
                Publisher Item ID: S2468-0427(21)00087-7
                DOI: 10.1016/j.idm.2021.12.006
                PMC ID: 8712670
                PubMed ID: 34977439
                SO-VID: df06810c-fc54-4f6b-b415-b9f955ead619
                Copyright © © 2021 The Authors
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 17 November 2021
                Date revision received : 23 December 2021
                Date accepted : 23 December 2021
                Categories
                Subject: Article

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