6 research outputs found
Key epidemiological drivers and impact of interventions in the 2020 SARS-CoV-2 epidemic in England.
We fitted a model of SARS-CoV-2 transmission in care homes and the community to regional surveillance data for England. Compared with other approaches, our model provides a synthesis of multiple surveillance data streams into a single coherent modeling framework, allowing transmission and severity to be disentangled from features of the surveillance system. Of the control measures implemented, only national lockdown brought the reproduction number (Rt eff) below 1 consistently; if introduced 1 week earlier, it could have reduced deaths in the first wave from an estimated 48,600 to 25,600 [95% credible interval (CrI): 15,900 to 38,400]. The infection fatality ratio decreased from 1.00% (95% CrI: 0.85 to 1.21%) to 0.79% (95% CrI: 0.63 to 0.99%), suggesting improved clinical care. The infection fatality ratio was higher in the elderly residing in care homes (23.3%, 95% CrI: 14.7 to 35.2%) than those residing in the community (7.9%, 95% CrI: 5.9 to 10.3%). On 2 December 2020, England was still far from herd immunity, with regional cumulative infection incidence between 7.6% (95% CrI: 5.4 to 10.2%) and 22.3% (95% CrI: 19.4 to 25.4%) of the population. Therefore, any vaccination campaign will need to achieve high coverage and a high degree of protection in vaccinated individuals to allow nonpharmaceutical interventions to be lifted without a resurgence of transmission
Understanding the potential impact of different drug properties on SARS-CoV-2 transmission and disease burden : a modelling analysis
Q1Q1Background
The unprecedented public health impact of the COVID-19 pandemic has motivated a rapid
search for potential therapeutics, with some key successes. However, the potential impact of
different treatments, and consequently research and procurement priorities, have not been clear.
Methods and Findings
develop a mathematical model of SARS-CoV-2 transmission, COVID-19 disease and
clinical care to explore the potential public-health impact of a range of different potential
therapeutics, under a range of different scenarios varying: i) healthcare capacity, ii) epidemic
trajectories; and iii) drug efficacy in the absence of supportive care. In each case, the outcome
of interest was the number of COVID-19 deaths averted in scenarios with the therapeutic
compared to scenarios without. We find the impact of drugs like dexamethasone (which are
delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to
depend on the availability of supportive care such as oxygen and mechanical ventilation) is
likely to be limited in settings where healthcare capacity is lowest or where uncontrolled
epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in highincome countries but only 8% in low-income countries (assuming R=1.35). Therapeutics for
different patient populations (those not in hospital, early in the course of infection) and types
of benefit (reducing disease severity or infectiousness, preventing hospitalisation) could have
much greater benefits, particularly in resource-poor settings facing large epidemics.
Conclusions
There is a global asymmetry in who is likely to benefit from advances in the treatment of
COVID-19 to date, which have been focussed on hospitalised-patients and predicated on an
assumption of adequate access to supportive care. Therapeutics that can feasibly be delivered
to those earlier in the course of infection that reduce the need for healthcare or reduce
infectiousness could have significant impact, and research into their efficacy and means of
delivery should be a priorityRevista Internacional - Indexad
Leveraging community mortality indicators to infer COVID-19 mortality and transmission dynamics in Damascus, Syria
10.1038/s41467-021-22474-9NATURE COMMUNICATIONS12