Effectiveness of isolation, testing, contact tracing, and physical distancing on reducing transmission of SARS-CoV-2 in different settings: a mathematical modelling study

BACKGROUND: The isolation of symptomatic cases and tracing of contacts has been used as an early COVID-19 containment measure in many countries, with additional physical distancing measures also introduced as outbreaks have grown. To maintain control of infection while also reducing disruption to populations, there is a need to understand what combination of measures-including novel digital tracing approaches and less intensive physical distancing-might be required to reduce transmission. We aimed to estimate the reduction in transmission under different control measures across settings and how many contacts would be quarantined per day in different strategies for a given level of symptomatic case incidence. METHODS: For this mathematical modelling study, we used a model of individual-level transmission stratified by setting (household, work, school, or other) based on BBC Pandemic data from 40 162 UK participants. We simulated the effect of a range of different testing, isolation, tracing, and physical distancing scenarios. Under optimistic but plausible assumptions, we estimated reduction in the effective reproduction number and the number of contacts that would be newly quarantined each day under different strategies. RESULTS: We estimated that combined isolation and tracing strategies would reduce transmission more than mass testing or self-isolation alone: mean transmission reduction of 2% for mass random testing of 5% of the population each week, 29% for self-isolation alone of symptomatic cases within the household, 35% for self-isolation alone outside the household, 37% for self-isolation plus household quarantine, 64% for self-isolation and household quarantine with the addition of manual contact tracing of all contacts, 57% with the addition of manual tracing of acquaintances only, and 47% with the addition of app-based tracing only. If limits were placed on gatherings outside of home, school, or work, then manual contact tracing of acquaintances alone could have an effect on transmission reduction similar to that of detailed contact tracing. In a scenario where 1000 new symptomatic cases that met the definition to trigger contact tracing occurred per day, we estimated that, in most contact tracing strategies, 15 000-41 000 contacts would be newly quarantined each day. INTERPRETATION: Consistent with previous modelling studies and country-specific COVID-19 responses to date, our analysis estimated that a high proportion of cases would need to self-isolate and a high proportion of their contacts to be successfully traced to ensure an effective reproduction number lower than 1 in the absence of other measures. If combined with moderate physical distancing measures, self-isolation and contact tracing would be more likely to achieve control of severe acute respiratory syndrome coronavirus 2 transmission. FUNDING: Wellcome Trust, UK Engineering and Physical Sciences Research Council, European Commission, Royal Society, Medical Research Council

COVID-19: time to rethink palliative care strategy in resource-poor settings

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Infection kinetics of Covid-19 and containment strategy

The devastating trail of Covid-19 is characterized by one of the highest mortality-to-infected ratio for a pandemic. Restricted therapeutic and early-stage vaccination still renders social exclusion through lockdown as the key containment mode.To understand the dynamics, we propose PHIRVD, a mechanistic infection propagation model that Machine Learns (Bayesian Markov Chain Monte Carlo) the evolution of six infection stages, namely healthy susceptible (H), predisposed comorbid susceptible (P), infected (I), recovered (R), herd immunized (V) and mortality (D), providing a highly reliable mortality prediction profile for 18 countries at varying stages of lockdown. Training data between 10 February to 29 June 2020, PHIRVD can accurately predict mortality profile up to November 2020, including the second wave kinetics. The model also suggests mortality-to-infection ratio as a more dynamic pandemic descriptor, substituting reproduction number. PHIRVD establishes the importance of early and prolonged but strategic lockdown to contain future relapse, complementing futuristic vaccine impact

On the Origin of S0 Galaxies

I will review the basic properties of S0 galaxies in the local Universe in relation to both elliptical and spiral galaxies, their neighbours on the Hubble sequence, and also in relation to dwarf spheroidal (dSph) galaxies. This will include colours, luminosities, spectral features, information about the age and metallicity composition of their stellar populations and globular clusters, about their ISM content, as well as kinematic signatures and their implications for central black hole masses and past interaction events, and the number ratios of S0s to other galaxy types in relation to environmental galaxy density. I will point out some caveats as to their morphological discrimination against other classes of galaxies, discuss the role of dust and the wavelength dependence of bulge/disk light ratios. These effects are of importance for investigations into the redshift evolution of S0 galaxies -- both as individual objects and as a population. The various formation and transformation scenarios for S0 and dSph galaxies will be presented and confronted with the available observations.Comment: Invited Review, 18 pages, ``BARS 2004'' Conference, South Africa, June 2004, eds.: K. C. Freeman, D. L. Block, I. Puerari, R. Groess, Kluwer, in pres

Characterizing SARS-CoV-2 viral clearance kinetics to improve the design of antiviral pharmacometric studies

A consensus methodology for the pharmacometric assessment of candidate SARS-CoV-2 antiviral drugs would be useful for comparing trial results and improving trial design. The time to viral clearance, assessed by serial qPCR of nasopharyngeal swab samples, has been the most widely reported measure of virological response in clinical trials, but it has not been compared formally with other metrics, notably model-based estimates of the rate of viral clearance. We analyzed prospectively gathered viral clearance profiles from 280 infection episodes in vaccinated and unvaccinated individuals. We fitted different phenomenological pharmacodynamic models (single exponential decay, bi-exponential, penalized splines) and found that the clearance rate, estimated from a mixed effects single exponential decay model, is a robust pharmacodynamic summary of viral clearance. The rate of viral clearance, estimated from viral densities during the first week following peak viral load, provides increased statistical power (reduced type 2 error) compared with time to clearance. Antiviral effects approximately equivalent to those with currently used and recommended SARS-CoV-2 antiviral treatments, notably nirmatrelvir and molnupiravir, can be detected from randomized trials with sample sizes of only 35 to 65 patients per arm. We recommend that pharmacometric antiviral assessments should be conducted in early COVID-19 illness with serial qPCR samples taken over 1 week