Modelling testing and response strategies for COVID-19 outbreaks in remote Australian Aboriginal communities
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Background
Remote Australian Aboriginal and Torres Strait Islander communities have potential to be severely impacted by COVID-19, with multiple factors predisposing to increased transmission and disease severity. Our modelling aims to inform optimal public health responses.
Methods
An individual-based simulation model represented SARS-CoV2 transmission in communities ranging from 100 to 3500 people, comprised of large, interconnected households. A range of strategies for case finding, quarantining of contacts, testing, and lockdown were examined, following the silent introduction of a case.
Results
Multiple secondary infections are likely present by the time the first case is identified. Quarantine of close contacts, defined by extended household membership, can reduce peak infection prevalence from 60 to 70% to around 10%, but subsequent waves may occur when community mixing resumes. Exit testing significantly reduces ongoing transmission. Concurrent lockdown of non-quarantined households for 14 days is highly effective for epidemic control and reduces overall testing requirements; peak prevalence of the initial outbreak can be constrained to less than 5%, and the final community attack rate to less than 10% in modelled scenarios. Lockdown also mitigates the effect of a delay in the initial response. Compliance with lockdown must be at least 80–90%, however, or epidemic control will be lost.
Conclusions
A SARS-CoV-2 outbreak will spread rapidly in remote communities. Prompt case detection with quarantining of extended-household contacts and a 14 day lockdown for all other residents, combined with exit testing for all, is the most effective strategy for rapid containment. Compliance is crucial, underscoring the need for community supported, culturally sensitive responses.
Article activity feed
-
-
SciScore for 10.1101/2020.10.07.20208819: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization The remaining 2% is spent at a randomly allocated dwelling. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: Our model is informed by simplifying assumptions derived from observational data regarding population structure and mixing. Other ‘real world’ mixing opportunities (e.g. schools and workplaces) have not been explicitly included. Assumptions regarding transmission …
SciScore for 10.1101/2020.10.07.20208819: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization The remaining 2% is spent at a randomly allocated dwelling. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: Our model is informed by simplifying assumptions derived from observational data regarding population structure and mixing. Other ‘real world’ mixing opportunities (e.g. schools and workplaces) have not been explicitly included. Assumptions regarding transmission dynamics are derived from non-Aboriginal populations, but where possible we have erred on the side of caution. The high R0 to which the model is calibrated is based on early estimates from Wuhan and amplified to reflect the propensity for intense transmission in remote households. We assume perfect sensitivity and specificity of testing throughout the infectious period. Morbidity and mortality outcomes have not been estimated in this model, or the anticipated demand on health resources (testing requirements aside). We assume that cases in isolation and contacts in quarantine will have no contact with others (i.e. will not transmit SARS-CoV-2). This may not be possible to achieve, but by representing this ideal we assess the maximum effectiveness of these measures and demonstrate the added value of lockdown.
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.
- No funding statement was detected.
- No protocol registration statement was detected.
-
-
