Optimal time to return to normality: parallel use of COVID-19 vaccines and circuit breakers

  1. Michael B. Bonsall
  2. Chris Huntingford
  3. Thomas Rawson

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Abstract

By January 2020, the COVID-19 illness has caused over two million deaths. Countries have restricted disease spread through non-pharmaceutical interventions (e.g., social distancing). More severe “lockdowns” have also been required. Although lockdowns keep people safer from the virus, they substantially disrupt economies and individual well-being. Fortunately, vaccines are becoming available. Yet, vaccination programs may take several months to implement, requiring further time for individuals to develop immunity following inoculation. To prevent health services being overwhelmed it may be necessary to implement further lockdowns in conjunction with vaccination. Here, we investigate optimal approaches for vaccination under varying lockdown lengths and/or severities to prevent COVID-19-related deaths exceeding critical thresholds. We find increases in vaccination rate cause a disproportionately larger decrease in lockdowns: with vaccination, severe lockdowns can reduce infections by up to 89%. Notably, we include demographics, modelling three groups: vulnerable, front-line workers, and non-vulnerable. We investigate the sequence of vaccination. One counter-intuitive finding is that even though the vulnerable group is high risk, demographically, this is a small group (per person, vaccination occurs more slowly) so vaccinating this group first achieves limited gains in overall disease control. Better disease control occurs by vaccinating the non-vulnerable group with longer and/or more severe lockdowns.

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    SciScore for 10.1101/2021.02.01.21250877: (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 data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Their use of an inequality constraint is used to model limitations related to vaccine availability and production. With the choice of linear terms in the objective functional, the optimal solutions are on-off (bang-bang) control with variable time between delivery of vaccines to minimize the number of infections. Our results contrast with this bang-bang control. This highlights the effects of different uses of cost structures. Here, we use quadratic increasing costs to capture difficulties in achieving vaccination target as the number of vaccinated individuals increases, as well as the application of the optimal control problem to a structured (rather than unstructured) population. In our key result, the sequence of vaccine delivery to different groups is critical to achieving disease control and minimizing the public health burden of disease-induced deaths. As noted, neither of these previous studies consider population structure and the interaction between vaccines and NPIs as concomitant approaches to disease control and minimizing disease induced deaths. We argue that these sort of optimal control approaches provide a ‘weight of evidence’ for more pluralistic approaches to controlling the infection, and especially as appropriate constraints can be included in solving numerical optimal models of the epidemiological dynamics. In conclusion, although vaccinations for COVID-19 are starting to be approved for use, and countries are thereby implementing mass inoculation program...

    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.

    About SciScore

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  2. Version published to 10.1101/2021.02.01.21250877 on medRxiv