Evaluation of effects of public health interventions on COVID-19 transmission for Pakistan: A mathematical simulation study

  1. Zulfiqar A Bhutta
  2. Ofir Harari
  3. Jay JH Park
  4. Noor-E Zannat
  5. Michael Zoratti
  6. Tim Churches
  7. Kristian Thorlund
  8. Edward J Mills

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Abstract

Background

In an effort to contain the COVID-19 epidemic, many governments across the world have enforced lockdown or social distancing measures. Several outbreak models have been developed to investigate the effects of different public health strategies for COVID-19, but they have not been developed for Pakistan and other South East Asian countries, where a large proportion of global population resides.

Methods

We developed a stochastic individual contact model by extending the widely-used Susceptible-Infectious-Recovered (SIR) compartment model with additional compartments to model both anticipated mitigating effects of public health intervention strategies for Pakistan. We estimated the projected spread, number of hospitalizations, and case fatalities under no intervention and four increasingly stringent public health strategies of social distancing and self-isolation at the national and provincial levels of Pakistan.

Results

Our analysis shows that without any public health interventions the expected number of cumulative case fatalities is 671,596 in Pakistan with the virus is expected to peak in terms of the number of required ICU-hospitalizations at 198,593 persons by the end of the June 2020. The estimated total numbers of cumulative case fatalities are lower for other public health strategies with strict social distancing showing the lowest number of deaths at 1,588 (Self-isolation: n=341,359; Flexible social distancing strategy: n=3,995; and Exit strategy: n=28,214). The lowest number of required ICU-hospitalization is also estimated for strict social distancing strategy (n=266 persons at the end of May 2020). Generally, the simulated effects of the different public health strategies at the provincial-level were similar to the national-level with strict social distancing showing the fewest number of case fatalities and ICU-hospitalizations.

Conclusion

Our results indicate that case fatalities and ICU-hospitalizations for Pakistan will be high without any public health interventions. While strict social distancing can potentially prevent a large number of deaths and ICU-hospitalizations, the government faces an important dilemma of potentially severe economic downfall. Consideration of a temporary strict social distancing strategy with gradual return of the lower-risk Pakistani population, as simulated in our exit strategy scenario, may an effective compromise between public health and economy of Pakistani population.

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    SciScore for 10.1101/2020.04.30.20086447: (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:
    Our model and analyses are not without limitations. COVID-19 is a new disease caused by a novel virus, and thus there are inevitable uncertainties in the data inputs that were utilized for this modelling study. In this regard, our prediction of the epidemic duration and size should be interpreted as applicable to the confirmed cases based on the testing method implemented in Pakistan. While we took into account the impact estimates of social distancing on regular activities from Google, the model also assumes homogenous mixing (contacts) between members of the population, without taking age group, fine-scale geography or other social factors into account. Additional work is required to add these aspects to such models. These figures largely represent people with smart phones and exclude the rural poor and slum dwellers. The network structure of each individual’s social circles also was not taken into consideration for this study, and there is also little information available on periodic clustering of people in mosques etc. Regardless of these limitations, to our knowledge, this extended stochastic ICM model is the first to examine the effects of self-isolation and social distancing on the number of ICU hospitalizations required and case fatalities in South Asia. While there has been other modeling studies for COVID-19, these other studies have focused on regions such as Wuhan, China, and high-income countries such as Italy, Japan, South Korea, United States etc.5,7,13,19,20 ...

    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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  2. Version published to 10.1101/2020.04.30.20086447v1 on medRxiv