Shut and re-open: the role of schools in the spread of COVID-19 in Europe.

Funder: Department for Health and Social CareWe investigate the effect of school closure and subsequent reopening on the transmission of COVID-19, by considering Denmark, Norway, Sweden and German states as case studies. By comparing the growth rates in daily hospitalizations or confirmed cases under different interventions, we provide evidence that school closures contribute to a reduction in the growth rate approximately 7 days after implementation. Limited school attendance, such as older students sitting exams or the partial return of younger year groups, does not appear to significantly affect community transmission. In countries where community transmission is generally low, such as Denmark or Norway, a large-scale reopening of schools while controlling or suppressing the epidemic appears feasible. However, school reopening can contribute to statistically significant increases in the growth rate in countries like Germany, where community transmission is relatively high. In all regions, a combination of low classroom occupancy and robust test-and-trace measures were in place. Our findings underscore the need for a cautious evaluation of reopening strategies. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'

Shut and re-open: the role of schools in the spread of COVID-19 in Europe

From The Royal Society via Jisc Publications RouterHistory: accepted 2020-12-02, pub-electronic 2021-05-31, pub-print 2021-07-19Article version: VoRPublication status: PublishedFunder: Wellcome Trust; Id: http://dx.doi.org/10.13039/100004440; Grant(s): 202562/Z/16/ZFunder: Royal Society; Id: http://dx.doi.org/10.13039/501100000288; Grant(s): 202562/Z/16/ZFunder: Department for Health and Social CareFunder: Canadian Institutes of Health Research; Id: http://dx.doi.org/10.13039/501100000024; Grant(s): 2019 Novel Coronavirus (COVID-19) rapid researchFunder: Medical Research Council; Id: http://dx.doi.org/10.13039/501100000265; Grant(s): MC UU 00002/11We investigate the effect of school closure and subsequent reopening on the transmission of COVID-19, by considering Denmark, Norway, Sweden and German states as case studies. By comparing the growth rates in daily hospitalizations or confirmed cases under different interventions, we provide evidence that school closures contribute to a reduction in the growth rate approximately 7 days after implementation. Limited school attendance, such as older students sitting exams or the partial return of younger year groups, does not appear to significantly affect community transmission. In countries where community transmission is generally low, such as Denmark or Norway, a large-scale reopening of schools while controlling or suppressing the epidemic appears feasible. However, school reopening can contribute to statistically significant increases in the growth rate in countries like Germany, where community transmission is relatively high. In all regions, a combination of low classroom occupancy and robust test-and-trace measures were in place. Our findings underscore the need for a cautious evaluation of reopening strategies. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’

Challenges in control of COVID-19: short doubling time and long delay to effect of interventions

Early assessments of the growth rate of COVID-19 were subject to significant uncertainty, as expected with limited data and difficulties in case ascertainment, but as cases were recorded in multiple countries, more robust inferences could be made. Using multiple countries, data streams and methods, we estimated that, when unconstrained, European COVID-19 confirmed cases doubled on average every 3 days (range 2.2-4.3 days) and Italian hospital and intensive care unit admissions every 2-3 days; values that are significantly lower than the 5-7 days dominating the early published literature. Furthermore, we showed that the impact of physical distancing interventions was typically not seen until at least 9 days after implementation, during which time confirmed cases could grow eightfold. We argue that such temporal patterns are more critical than precise estimates of the time-insensitive basic reproduction number R0 for initiating interventions, and that the combination of fast growth and long detection delays explains the struggle in countries' outbreak response better than large values of R0 alone. One year on from first reporting these results, reproduction numbers continue to dominate the media and public discourse, but robust estimates of unconstrained growth remain essential for planning worst-case scenarios, and detection delays are still key in informing the relaxation and re-implementation of interventions. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'

Challenges for modelling interventions for future pandemics

Funding: This work was supported by the Isaac Newton Institute (EPSRC grant no. EP/R014604/1). MEK was supported by grants from The Netherlands Organisation for Health Research and Development (ZonMw), grant number 10430022010001, and grant number 91216062, and by the H2020 Project 101003480 (CORESMA). RNT was supported by the UKRI, grant number EP/V053507/1. GR was supported by Fundação para a Ciência e a Tecnologia (FCT) project reference 131_596787873. and by the VERDI project 101045989 funded by the European Union. LP and CO are funded by the Wellcome Trust and the Royal Society (grant 202562/Z/16/Z). LP is also supported by the UKRI through the JUNIPER modelling consortium (grant number MR/V038613/1) and by The Alan Turing Institute for Data Science and Artificial Intelligence. HBS is funded by the Wellcome Trust and Royal Society (202562/Z/16/Z), and the Alexander von Humboldt Foundation. DV had support from the National Council for Scientific and Technological Development of Brazil (CNPq - Refs. 441057/2020-9, 424141/2018-3, 309569/2019-2). FS is supported by the UKRI through the JUNIPER modelling consortium (grant number MR/V038613/1). EF is supported by UKRI (Medical Research Council)/Department of Health and Social Care (National Insitute of Health Research) MR/V028618/1. JPG's work was supported by funding from the UK Health Security Agency and the UK Department of Health and Social Care.Mathematical modelling and statistical inference provide a framework to evaluate different non-pharmaceutical and pharmaceutical interventions for the control of epidemics that has been widely used during the COVID-19 pandemic. In this paper, lessons learned from this and previous epidemics are used to highlight the challenges for future pandemic control. We consider the availability and use of data, as well as the need for correct parameterisation and calibration for different model frameworks. We discuss challenges that arise in describing and distinguishing between different interventions, within different modelling structures, and allowing both within and between host dynamics. We also highlight challenges in modelling the health economic and political aspects of interventions. Given the diversity of these challenges, a broad variety of interdisciplinary expertise is needed to address them, combining mathematical knowledge with biological and social insights, and including health economics and communication skills. Addressing these challenges for the future requires strong cross-disciplinary collaboration together with close communication between scientists and policy makers.Publisher PDFPeer reviewe

Challenges in control of COVID-19: short doubling time and long delay to effect of interventions

From The Royal Society via Jisc Publications RouterHistory: accepted 2021-04-21, pub-electronic 2021-05-31, pub-print 2021-07-19Article version: VoRPublication status: PublishedFunder: Wellcome Trust; Id: http://dx.doi.org/10.13039/100004440; Grant(s): 107652/Z/15/Z, 202562/Z/16/ZFunder: Institute of Population and Public Health; Id: http://dx.doi.org/10.13039/501100000036; Grant(s): CIHR 2019 Novel Coronavirus (COVID-19) rapid reseaFunder: National Institute for Health Research; Id: http://dx.doi.org/10.13039/501100000272Funder: Medical Research Council; Id: http://dx.doi.org/10.13039/501100000265; Grant(s): MR/S020462/1, MR/V038613/1Funder: Public Health Research Programme; Id: http://dx.doi.org/10.13039/501100001921Funder: Biotechnology and Biological Sciences Research Council; Id: http://dx.doi.org/10.13039/501100000268; Grant(s): BB/R009236/1Funder: Royal Society; Id: http://dx.doi.org/10.13039/501100000288; Grant(s): INF\R2\180067Funder: Alan Turing Institute; Id: http://dx.doi.org/10.13039/100012338Early assessments of the growth rate of COVID-19 were subject to significant uncertainty, as expected with limited data and difficulties in case ascertainment, but as cases were recorded in multiple countries, more robust inferences could be made. Using multiple countries, data streams and methods, we estimated that, when unconstrained, European COVID-19 confirmed cases doubled on average every 3 days (range 2.2–4.3 days) and Italian hospital and intensive care unit admissions every 2–3 days; values that are significantly lower than the 5–7 days dominating the early published literature. Furthermore, we showed that the impact of physical distancing interventions was typically not seen until at least 9 days after implementation, during which time confirmed cases could grow eightfold. We argue that such temporal patterns are more critical than precise estimates of the time-insensitive basic reproduction number R0 for initiating interventions, and that the combination of fast growth and long detection delays explains the struggle in countries' outbreak response better than large values of R0 alone. One year on from first reporting these results, reproduction numbers continue to dominate the media and public discourse, but robust estimates of unconstrained growth remain essential for planning worst-case scenarios, and detection delays are still key in informing the relaxation and re-implementation of interventions. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’

SARS-CoV-2 infection in UK university students: lessons from September-December 2020 and modelling insights for future student return.

Funder: Isaac Newton Institute for Mathematical Sciences; Id: http://dx.doi.org/10.13039/501100005347Funder: Wellcome Trust; Id: http://dx.doi.org/10.13039/100004440Funder: Medical Research Council; Id: http://dx.doi.org/10.13039/501100000265Funder: UKRIFunder: University of Nottingham; Id: http://dx.doi.org/10.13039/501100000837In this paper, we present work on SARS-CoV-2 transmission in UK higher education settings using multiple approaches to assess the extent of university outbreaks, how much those outbreaks may have led to spillover in the community, and the expected effects of control measures. Firstly, we found that the distribution of outbreaks in universities in late 2020 was consistent with the expected importation of infection from arriving students. Considering outbreaks at one university, larger halls of residence posed higher risks for transmission. The dynamics of transmission from university outbreaks to wider communities is complex, and while sometimes spillover does occur, occasionally even large outbreaks do not give any detectable signal of spillover to the local population. Secondly, we explored proposed control measures for reopening and keeping open universities. We found the proposal of staggering the return of students to university residence is of limited value in terms of reducing transmission. We show that student adherence to testing and self-isolation is likely to be much more important for reducing transmission during term time. Finally, we explored strategies for testing students in the context of a more transmissible variant and found that frequent testing would be necessary to prevent a major outbreak.This work was supported by EPSRC grant no EP/R014604/1. The authors would also like to thank the Virtual Forum for Knowledge Exchange in Mathematical Sciences (V-KEMS) for the support during the workshop Unlocking higher education Spaces – What Might Mathematics Tell Us? where work on this paper was undertaken. K.J.B. acknowledges support from a University of Nottingham Anne McLaren Fellowship. E.L.F. acknowledges support via K.J.B.’s fellowship and the Nottingham BBSRC Doctoral Training Partnership. M.L.T. was supported by the UK Engineering and Physical Sciences Research Council (grant no. EP/N509620/1). E.B.-P., E.J.N., L.D., J.R.G. and M.J.T. were supported by UKRI through the JUNIPER modelling consortium (grant no. MR/V038613/1). E.M.H., L.D. and M.J.T. were supported by the Medical Research Council through the COVID-19 Rapid Response Rolling Call (grant no. MR/V009761/1). H.B.S. is funded by the Wellcome Trust and the Royal Society (grant no. 202562/Z/16/Z). J.E. is partially funded by the UK Engineering and Physical Sciences Research Council (grant no. EP/T004878/1)

EpiBeds:Data informed modelling of the COVID-19 hospital burden in England

The first year of the COVID-19 pandemic put considerable strain on healthcare systems worldwide. In order to predict the effect of the local epidemic on hospital capacity in England, we used a variety of data streams to inform the construction and parameterisation of a hospital progression model, EpiBeds, which was coupled to a model of the generalised epidemic. In this model, individuals progress through different pathways (e.g. may recover, die, or progress to intensive care and recover or die) and data from a partially complete patient-pathway line-list was used to provide initial estimates of the mean duration that individuals spend in the different hospital compartments. We then fitted EpiBeds using complete data on hospital occupancy and hospital deaths, enabling estimation of the proportion of individuals that follow the different clinical pathways, the reproduction number of the generalised epidemic, and to make short-term predictions of hospital bed demand. The construction of EpiBeds makes it straightforward to adapt to different patient pathways and settings beyond England. As part of the UK response to the pandemic, EpiBeds provided weekly forecasts to the NHS for hospital bed occupancy and admissions in England, Wales, Scotland, and Northern Ireland at national and regional scales

EpiBeds:Data informed modelling of the COVID-19 hospital burden in England

The first year of the COVID-19 pandemic put considerable strain on healthcare systems worldwide. In order to predict the effect of the local epidemic on hospital capacity in England, we used a variety of data streams to inform the construction and parameterisation of a hospital progression model, EpiBeds, which was coupled to a model of the generalised epidemic. In this model, individuals progress through different pathways (e.g. may recover, die, or progress to intensive care and recover or die) and data from a partially complete patient-pathway line-list was used to provide initial estimates of the mean duration that individuals spend in the different hospital compartments. We then fitted EpiBeds using complete data on hospital occupancy and hospital deaths, enabling estimation of the proportion of individuals that follow the different clinical pathways, the reproduction number of the generalised epidemic, and to make short-term predictions of hospital bed demand. The construction of EpiBeds makes it straightforward to adapt to different patient pathways and settings beyond England. As part of the UK response to the pandemic, EpiBeds provided weekly forecasts to the NHS for hospital bed occupancy and admissions in England, Wales, Scotland, and Northern Ireland at national and regional scales

EpiBeds:Data informed modelling of the COVID-19 hospital burden in England

The first year of the COVID-19 pandemic put considerable strain on healthcare systems worldwide. In order to predict the effect of the local epidemic on hospital capacity in England, we used a variety of data streams to inform the construction and parameterisation of a hospital progression model, EpiBeds, which was coupled to a model of the generalised epidemic. In this model, individuals progress through different pathways (e.g. may recover, die, or progress to intensive care and recover or die) and data from a partially complete patient-pathway line-list was used to provide initial estimates of the mean duration that individuals spend in the different hospital compartments. We then fitted EpiBeds using complete data on hospital occupancy and hospital deaths, enabling estimation of the proportion of individuals that follow the different clinical pathways, the reproduction number of the generalised epidemic, and to make short-term predictions of hospital bed demand. The construction of EpiBeds makes it straightforward to adapt to different patient pathways and settings beyond England. As part of the UK response to the pandemic, EpiBeds provided weekly forecasts to the NHS for hospital bed occupancy and admissions in England, Wales, Scotland, and Northern Ireland at national and regional scales