Modeling shield immunity to reduce COVID-19 transmission in long-term care facilities
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Abstract
Nursing homes and other long-term care facilities in the United States have experienced severe COVID-19 outbreaks and elevated mortality rates, often following upon the inadvertent introduction of SARS-CoV-2. Following FDA emergency use approval, widespread distribution of vaccines has resulted in rapid reduction in COVID-19 cases in vulnerable, older populations. Yet, vaccination coverage remains incomplete amongst residents and healthcare workers. As such, mitigation and prevention strategies are needed to reduce the ongoing risk of transmission and mortality amongst vulnerable, nursing home populations. One such strategy is that of ‘shield immunity’, in which recovered individuals increase their contact rates and therefore shield individuals who remain susceptible to infection. Here, we adapt recent population-scale shield immunity models to a network context. To do so, we evaluate network-based shield immunity by evaluating how restructured interactions in a bipartite network (e.g., between healthcare workers and long-term care residents) affects SARS-CoV-2 epidemic dynamics. First, we identify a series of rewiring principles that leverage viral testing, antibody testing, and vaccination information to reassign immunized healthcare workers to care for infected residents while retaining workload balance amidst an outbreak. We find a significant reduction in outbreak size when using infection and immune-based cohorting as a weekly intervention. Second, we also identify a preventative strategy using shield-immunity rewiring principles, by assigning susceptible healthcare workers to care for cohorts of immunized residents; this strategy reduces the risk that an inadvertent introduction of SARS-CoV-2 into the facility via a healthcare worker spreads to susceptible residents. Network-based epidemic modeling reveals that preventative rewiring can control the size of outbreaks at levels similar to that of isolation of infectious healthcare workers. Overall, this assessment of shield immunity provides further support for leveraging infection and immune status in network-based interventions to control and prevent the spread of COVID-19.
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SciScore for 10.1101/2021.07.16.21260657: (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: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Indeed, our network-based intervention model comes with caveats. Our focus on interventions to reduce risk of SARS-CoV-2 does not consider risks for other infections like influenza, norovirus, and antibiotic resistant pathogens, particularly if the infection risk factors for these other diseases do not coincide with those associated with SARS-CoV-2. In addition, network-based interventions require changes in staff care and availability, …
SciScore for 10.1101/2021.07.16.21260657: (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: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Indeed, our network-based intervention model comes with caveats. Our focus on interventions to reduce risk of SARS-CoV-2 does not consider risks for other infections like influenza, norovirus, and antibiotic resistant pathogens, particularly if the infection risk factors for these other diseases do not coincide with those associated with SARS-CoV-2. In addition, network-based interventions require changes in staff care and availability, exploration of feasibility will require extending the current framework to reflect constraints in staff expertise, numbers, and supply. Moreover, we have assumed that recovered individuals and vaccinated individuals have protective immunity from onward transmission over the period of the epidemic outbreak (here modeled as 100 days). The duration of effective immunity has been estimated to be at least 6-8 months [35]; however, the rise of variants and heterogeneous variation in immune protection reinforce the need to use PPE in nursing home facilities until levels are substantially reduced (in contrast to some proposals that recovered individuals not use PPE, perhaps because of a concern on levels of PPE availability [34]). Applications of dynamic rewiring informed by immune shielding concepts should be evaluated and adjusted in light of the ongoing spread of variants of concern. In summary, we have developed a network-based approach to cohort both residents and healthcare workers in light of their infection and immune status as a means to redu...
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.
Results from scite Reference Check: We found no unreliable references.
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