Containment to outbreak tipping points in COVID-19

  1. Matías Arim
  2. Daniel Herrera-Esposito
  3. Paola Bermolen
  4. Álvaro Cabana
  5. María Inés Fariello
  6. Mauricio Lima
  7. Hector Romero

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Abstract

Non-pharmaceutical interventions (NPIs) have been a cornerstone in managing emergent diseases such as COVID-19 1–4 . However, despite their potential to contain or attenuate the epidemic, the effects of NPIs on disease dynamics are not well understood 1,5–7 . We show that saturation of NPIs with the increase in infected individuals, an expected consequence of limited contact tracing and healthcare capacities, produces a positive feedback in the disease growth rate and a threshold between two alternative states--containment and outbreak 8 . These alternative states were previously related with the strength of NPIs but not with the infection number 2,9–11 . Furthermore, the transition between these states involves an abrupt acceleration in disease dynamics, which we report here for several COVID-19 outbreaks around the world. The consequences of a positive feedback in population dynamics at low numbers is a phenomenon widely studied in ecology--the Allee effect. This effect is a determinant of extinction-outbreak states, geographic synchronization, spatial spread, and the effect of exogenous variables, as vaccination 12–15 . As countries are relaxing containing measures, recognizing an NPI-induced Allee effect may be essential for deploying containment strategies within and among countries 16 and acknowledges the need for early warning indicators of approaching epidemic tipping points 17 .

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    SciScore for 10.1101/2020.09.14.20194159: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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 10.1101/2020.09.14.20194159v1 on medRxiv