COVID-19 control strategies and intervention effects in resource limited settings: A modeling study
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Abstract
Many countries with weaker health systems are struggling to put together a coherent strategy against the COVID-19 epidemic. We explored COVID-19 control strategies that could offer the greatest benefit in resource limited settings.
Methods
Using an age-structured SEIR model, we explored the effects of COVID-19 control interventions–a lockdown, physical distancing measures, and active case finding (testing and isolation, contact tracing and quarantine)–implemented individually and in combination to control a hypothetical COVID-19 epidemic in Kathmandu (population 2.6 million), Nepal.
Results
A month-long lockdown will delay peak demand for hospital beds by 36 days, as compared to a base scenario of no intervention (peak demand at 108 days (IQR 97-119); a 2 month long lockdown will delay it by 74 days, without any difference in annual mortality, or healthcare demand volume. Year-long physical distancing measures will reduce peak demand to 36% (IQR 23%-46%) and annual morality to 67% (IQR 48%-77%) of base scenario. Following a month long lockdown with ongoing physical distancing measures and an active case finding intervention that detects 5% of the daily infection burden could reduce projected morality and peak demand by more than 99%.
Conclusion
Limited resource settings are best served by a combination of early and aggressive case finding with ongoing physical distancing measures to control the COVID-19 epidemic. A lockdown may be helpful until combination interventions can be put in place but is unlikely to reduce annual mortality or healthcare demand.
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SciScore for 10.1101/2020.04.26.20079673: (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:We overcame this limitation by assuming that there already were about 185 infected individuals and that local transmission was under way when we began our model simulation. Our study offers important insights on mounting an effective response against the COVID-19 epidemic in a resource limited setting. As we have outlined above, an …
SciScore for 10.1101/2020.04.26.20079673: (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:We overcame this limitation by assuming that there already were about 185 infected individuals and that local transmission was under way when we began our model simulation. Our study offers important insights on mounting an effective response against the COVID-19 epidemic in a resource limited setting. As we have outlined above, an unmitigated COVID-19 epidemic has the potential to cause significant mortality that will be exacerbated by the unmet demand for health services. Our findings suggest that the best control strategy against the epidemic is a combination of interventions that aim to identify and isolate infected individuals and reduce contact between individuals by means of ongoing physical distancing measures. A lockdown can prevent the escalation of the epidemic, but is likely to be of limited value if no additional control measures are put in place.
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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