Mitigating the externality of diseases of poverty through health aid

Externality exists in healthcare when an individual benefits from others being healthy as it reduces the probability of getting sick from illness. Healthy workers are considered to be the more productive labourers leading to a country’s positive economic growth over time. Several research studies have modelled disease transmission and its economic impact on a single country in isolation. We developed a two-country diseaseeconomy model that explores disease transmission and crossborder infection of disease for its impacts. The model includes aspects of a worsening and rapid transmission of disease juxtaposed by positive impacts to the economy from tourism. We found that high friction affects the gross domestic product (GDP) of the lower-income country more than the higherincome country. Health aid from one country to another can substantially help grow the GDP of both countries due to the positive externality of disease reduction. Disease has less impact to both economies if the relative cost of treatment over an alternative (e.g. vaccination) is lower than the baseline value. Providing medical supplies to another country, adopting moderate friction between the countries, and finding treatments with lower costs result in the best scenario to preserve the GDP of both countries

Human Cultural Dimensions and Behavior during COVID-19 Can Lead to Policy Resistance and Economic Losses: A Perspective from Game Theory Analysis

The recent COVID-19 pandemic has caused significant societal impacts. Besides loss of life there were large additional costs incurred by every country including the treatment of patients and costs to implement response plans. The pandemic resulted in major economic disruptions and stalled growth worldwide due to travel bans, lockdowns, social distancing, and non-essential business closures. Public health officials in almost every country implemented and encouraged Nonpharmaceutical Interventions (NPIs) such as contact tracing, social distancing, masks, and isolation. Human behavioral decision-making concerning social isolation was a major hindrance to the success in curbing the pandemic worldwide. In many developing countries individuals’ choices were motivated by the competing risk of losing jobs, and daily income. In this chapter we focus on human behavior concerning social isolation in the context of decision-making during the pandemic. We developed a conceptual framework and deterministic model that integrated evolutionary game theory within our disease transmission model. We illustrate scenarios numerically simulating the model. This study highlights the idea that human behavior is an important component in successful disease control strategies. Economic resilience, especially in low-income countries, can improve public understanding and uptake of NPIs

Evaluation of the United States COVID-19 vaccine allocation strategy

Background: Anticipating an initial shortage of vaccines for COVID-19, the Centers for Disease Control (CDC) in the United States developed priority vaccine allocations for specific demographic groups in the population. This study evaluates the performance of the CDC vaccine allocation strategy with respect to multiple potentially competing vaccination goals (minimizing mortality, cases, infections, and years of life lost (YLL)), under the same framework as the CDC allocation: four priority vaccination groups and population demographics stratified by age, comorbidities, occupation and living condition (congested or non-congested). Methods and findings: We developed a compartmental disease model that incorporates key elements of the current pandemic including age-varying susceptibility to infection, age-varying clinical fraction, an active case-count dependent social distancing level, and time-varying infectivity (accounting for the emergence of more infectious virus strains). The CDC allocation strategy is compared to all other possibly optimal allocations that stagger vaccine roll-out in up to four phases (17.5 million strategies). The CDC allocation strategy performed well in all vaccination goals but never optimally. Under the developed model, the CDC allocation deviated from the optimal allocations by small amounts, with 0.19% more deaths, 4.0% more cases, 4.07% more infections, and 0.97% higher YLL, than the respective optimal strategies. The CDC decision to not prioritize the vaccination of individuals under the age of 16 was optimal, as was the prioritization of health-care workers and other essential workers over non-essential workers. Finally, a higher prioritization of individuals with comorbidities in all age groups improved outcomes compared to the CDC allocation. Conclusion: The developed approach can be used to inform the design of future vaccine allocation strategies in the United States, or adapted for use by other countries seeking to optimize the effectiveness of their vaccine allocation strategies

Xenotropic Murine Leukemia Virus-Related Virus as a Case Study: Using a Precautionary Risk Management Approach for Emerging Blood-Borne Pathogens in Canada

In October 2009 it was reported that 68 of 101 patients with chronic fatigue syndrome (CFS) in the United States, when tested, were infected with a novel gamma retrovirus, xenotropic murine leukemia virus-related virus (XMRV) (Lombardi et al., 2009). XMRV is a recently discovered human gammaretrovirus first described in prostate cancers that shares significant homology with murine leukemia virus (MLV) (Ursiman et al., 2006). It is known that XMRV can cause leukemias and sarcomas in several rodent, feline, and primate species but has not been shown to cause disease in humans. XMRV was detectable in the peripheral blood mononuclear cells (PBMCs) and plasma of individuals diagnosed with CFS (Lombardi et al., 2009). After this report was published there was a great deal of uncertainty surrounding this emergent virus and its involvement in the etiology of CFS. The uncertainty was, in part, due to CFS being a complex, poorly understood multi-system disorder with different disease criteria used for its diagnosis. CFS, also known as Myalgic Encephalomyelitis (ME), is a debilitating disease of unknown origin that is estimated to affect 17 million people worldwide. The initial report connecting XMRV to prostate cancers and CFS garnered significant media and scientific interest since it provided a potential Susie ElSaadany2**, Tamer Oraby1 * Daniel Krewski1, 4 and Peter R. Ganz5 1McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ontario, Canada 2Blood Safety Surveillance and Health Care Acquired Infections Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada 3Aspinall and Associates, Cleveland House, High Street, and Earth Sciences, Bristol University, Bristol, United Kingdom 4Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada 5Health Canada, Director’s Office, Ottawa, Ontario, Canada ** Corresponding Author , Marian Laderoute2 , Jun Wu2 , Willy Aspinall3 , www.intechopen.com 32 The Continuum of Health Risk Assessments explanation for the disease but also an avenue for possible therapeutic treatments since XMRV is known to be susceptible to some anti-retroviral drugs (Cohen, 2011)

Modeling the effect of lockdown timing as a COVID‑19 control measure in countries with differing social contacts

The application, timing, and duration of lockdown strategies during a pandemic remain poorly quantified with regards to expected public health outcomes. Previous projection models have reached conflicting conclusions about the effect of complete lockdowns on COVID-19 outcomes. We developed a stochastic continuous-time Markov chain (CTMC) model with eight states including the environment (SEAMHQRD-V), and derived a formula for the basic reproduction number, R0, for that model. Applying the R 0 formula as a function in previously-published social contact matrices from 152 countries, we produced the distribution and four categories of possible R 0 for the 152 countries and chose one country from each quarter as a representative for four social contact categories (Canada, China, Mexico, and Niger). The model was then used to predict the effects of lockdown timing in those four categories through the representative countries. The analysis for the effect of a lockdown was performed without the influence of the other control measures, like social distancing and mask wearing, to quantify its absolute effect. Hypothetical lockdown timing was shown to be the critical parameter in ameliorating pandemic peak incidence. More importantly, we found that well-timed lockdowns can split the peak of hospitalizations into two smaller distant peaks while extending the overall pandemic duration. The timing of lockdowns reveals that a “tunneling” effect on incidence can be achieved to bypass the peak and prevent pandemic caseloads from exceeding hospital capacity

Analysis of intervention effectiveness using early outbreak transmission dynamics to guide future pandemic management and decision-making in Kuwait

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a World Health Organization designated pandemic that can result in severe symptoms and death that disproportionately affects older patients or those with comorbidities. Kuwait reported its first imported cases of COVID-19 on February 24, 2020. Analysis of data from the first three months of community transmission of the COVID-19 outbreak in Kuwait can provide important guidance for decision-making when dealing with future SARS-CoV-2 epidemic wave management. The analysis of intervention scenarios can help to evaluate the possible impacts of various outbreak control measures going forward which aim to reduce the effective reproduction number during the initial outbreak wave. Herein we use a modified susceptible-exposed-asymptomatic-infectious-removed (SEAIR) transmission model to estimate the outbreak dynamics of SARS-CoV-2 transmission in Kuwait. We fit case data from the first 96 days in the model to estimate the effective reproduction number and used Google mobility data to refine community contact matrices. The SEAIR modelled scenarios allow for the analysis of various interventions to determine their effectiveness. The model can help inform future pandemic wave management, not only in Kuwait but for other countries as well

Using a stochastic continuous-time Markov chain model to examine alternative timing and duration of the COVID-19 lockdown in Kuwait: what can be done now?

Background Kuwait had its first COVID-19 in late February, and until October 6, 2020 it recorded 108,268 cases and 632 deaths. Despite implementing one of the strictest control measures-including a three-week complete lockdown, there was no sign of a declining epidemic curve. The objective of the current analyses is to determine, hypothetically, the optimal timing and duration of a full lockdown in Kuwait that would result in controlling new infections and lead to a substantial reduction in case hospitalizations. Methods The analysis was conducted using a stochastic Continuous-Time Markov Chain (CTMC), eight state model that depicts the disease transmission and spread of SARS-CoV 2. Transmission of infection occurs between individuals through social contacts at home, in schools, at work, and during other communal activities. Results The model shows that a lockdown 10 days before the epidemic peak for 90 days is optimal but a more realistic duration of 45 days can achieve about a 45% reduction in both new infections and case hospitalizations. Conclusions In the view of the forthcoming waves of the COVID19 pandemic anticipated in Kuwait using a correctly-timed and sufficiently long lockdown represents a workable management strategy that encompasses the most stringent form of social distancing with the ability to significantly reduce transmissions and hospitalizations

Analysis of the Healthcare MERS-CoV Outbreak in King Abdulaziz Medical Center, Riyadh, Saudi Arabia, June–August 2015 Using a SEIR Ward Transmission Model

Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging zoonotic coronavirus that has a tendency to cause significant healthcare outbreaks among patients with serious comorbidities. We analyzed hospital data from the MERS-CoV outbreak in King Abdulaziz Medical Center, Riyadh, Saudi Arabia, June–August 2015 using the susceptible-exposed-infectious-recovered (SEIR) ward transmission model. The SEIR compartmental model considers several areas within the hospital where transmission occurred. We use a system of ordinary differential equations that incorporates the following units: emergency department (ED), out-patient clinic, intensive care unit, and hospital wards, where each area has its own carrying capacity and distinguishes the transmission by three individuals in the hospital: patients, health care workers (HCW), or mobile health care workers. The emergency department, as parameterized has a large influence over the epidemic size for both patients and health care workers. Trend of the basic reproduction number (R0), which reached a maximum of 1.39 at the peak of the epidemic and declined to 0.92 towards the end, shows that until added hospital controls are introduced, the outbreak would continue with sustained transmission between wards. Transmission rates where highest in the ED, and mobile HCWs were responsible for large part of the outbreak