Design of COVID-19 staged alert systems to ensure healthcare capacity with minimal closures
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Abstract
Community mitigation strategies to combat COVID-19, ranging from healthy hygiene to shelter-in-place orders, exact substantial socioeconomic costs. Judicious implementation and relaxation of restrictions amplify their public health benefits while reducing costs. We derive optimal strategies for toggling between mitigation stages using daily COVID-19 hospital admissions. With public compliance, the policy triggers ensure adequate intensive care unit capacity with high probability while minimizing the duration of strict mitigation measures. In comparison, we show that other sensible COVID-19 staging policies, including France’s ICU-based thresholds and a widely adopted indicator for reopening schools and businesses, require overly restrictive measures or trigger strict stages too late to avert catastrophic surges. As proof-of-concept, we describe the optimization and maintenance of the staged alert system that has guided COVID-19 policy in a large US city (Austin, Texas) since May 2020. As cities worldwide face future pandemic waves, our findings provide a robust strategy for tracking COVID-19 hospital admissions as an early indicator of hospital surges and enacting staged measures to ensure integrity of the health system, safety of the health workforce, and public confidence.
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SciScore for 10.1101/2020.11.26.20152520: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Designing policies to achieve concise and widely acceptable objectives, like these, allows policymakers to anticipate potential limitations and provide transparent and intuitive justifications for the public. Cities, states and countries worldwide have enacted staged COVID-19 mitigation policies. However, few provide detailed rationales …
SciScore for 10.1101/2020.11.26.20152520: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Designing policies to achieve concise and widely acceptable objectives, like these, allows policymakers to anticipate potential limitations and provide transparent and intuitive justifications for the public. Cities, states and countries worldwide have enacted staged COVID-19 mitigation policies. However, few provide detailed rationales for the choice of data indicators or the trigger conditions for changing stages. They may, in fact, be grounded in rigorous assessments of both data reliability and probability of achieving explicit policy goals. However, our comparative evaluation of two examples—France’s ICU-capacity-based triggers and the Harvard Global Health Institute’s incidence-based triggers—suggest that such systems may be sensible but sub-optimal. They may err in the direction of either failing to prevent overwhelming surges of COVID-19 hospitalizations or imposing unnecessarily early or long restrictions. There are important limitations to our approach. If the reporting of hospitalization data is delayed, biased, or inconsistent, the system may be prone to false or delayed alarms (37). Second, our analyses make strong assumptions about the reduction in transmission under various alert stages. Although these are directly estimated from data during various pandemic periods in Austin, the future impact of staged restrictions may change with public willingness to comply with guidelines on distancing, face coverings, and hygiene. If future restrictions lead to greater re...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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