Outbreaks in care homes may lead to substantial disease burden if not mitigated.

The number of COVID-19 outbreaks reported in UK care homes rose rapidly in early March of 2020. Owing to the increased co-morbidities and therefore worse COVID-19 outcomes for care home residents, it is important that we understand this increase and its future implications. We demonstrate the use of an SIS model where each nursing home is an infective unit capable of either being susceptible to an outbreak (S) or in an active outbreak (I). We use a generalized additive model to approximate the trend in growth rate of outbreaks in care homes and find the fit to be improved in a model where the growth rate is proportional to the number of current care home outbreaks compared with a model with a constant growth rate. Using parameters found from the outbreak-dependent growth rate, we predict a 73% prevalence of outbreaks in UK care homes without intervention as a reasonable worst-case planning assumption. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'.

Canada needs to rapidly escalate public health interventions for its COVID-19 mitigation strategies.

BACKGROUND: After the declaration of COVID-19 pandemic on March 11th, 2020, local transmission chains starting in different countries including Canada are forcing governments to take decisions on public health interventions to mitigate the spread of the epidemic. METHODS: We conduct data-driven and model-free estimations for the growth rates of the COVID-19 epidemics in Italy and Canada, by fitting an exponential curve to the daily reported cases. We use these estimates to predict epidemic trends in Canada under different scenarios of public health interventions. RESULTS: In Italy, the initial growth rate (0.22) has reduced to 0.1 two weeks after the lockdown of the country on March 8th, 2020. This corresponds to an increase of the doubling time from about 3.15 to almost 7 days. In comparison, the growth rate in Canada has increased from 0.13 between March 1st and 13th, to 0.25 between March 13th to 22nd. This current growth rate corresponds to a doubling time of 2.7 days, and therefore, unless further public health interventions are escalated in Canada, we project 15,000 cases by March 31st. However, the case number may be reduced to 4000 if escalated public health interventions could instantly reduce the growth rate to 0.1, the same level achieved in Italy. INTERPRETATION: Prompt and farsighted interventions are critical to counteract the very rapid initial growth of the COVID-19 epidemic in Canada. Mitigation plans must take into account the delayed effect of interventions by up to 2-weeks and the short doubling time of 3-4 days.

Exact and approximate moment closures for non-Markovian network epidemics.

Moment-closure techniques are commonly used to generate low-dimensional deterministic models to approximate the average dynamics of stochastic systems on networks. The quality of such closures is usually difficult to asses and furthermore the relationship between model assumptions and closure accuracy are often difficult, if not impossible, to quantify. Here we carefully examine some commonly used moment closures, in particular a new one based on the concept of maximum entropy, for approximating the spread of epidemics on networks by reconstructing the probability distributions over triplets based on those over pairs. We consider various models (SI, SIR, SEIR and Reed-Frost-type) under Markovian and non-Markovian assumption characterising the latent and infectious periods. We initially study with care two special networks, namely the open triplet and closed triangle, for which we can obtain analytical results. We then explore numerically the exactness of moment closures for a wide range of larger motifs, thus gaining understanding of the factors that introduce errors in the approximations, in particular the presence of a random duration of the infectious period and the presence of overlapping triangles in a network. We also derive a simpler and more intuitive proof than previously available concerning the known result that pair-based moment closure is exact for the Markovian SIR model on tree-like networks under pure initial conditions. We also extend such a result to all infectious models, Markovian and non-Markovian, in which susceptibles escape infection independently from each infected neighbour and for which infectives cannot regain susceptible status, provided the network is tree-like and initial conditions are pure. This works represent a valuable step in enriching intuition and deepening understanding of the assumptions behind moment closure approximations and for putting them on a more rigorous mathematical footing.

Epidemic growth rate and household reproduction number in communities of households, schools and workplaces.

In this paper we present a novel and coherent modelling framework for the characterisation of the real-time growth rate in SIR models of epidemic spread in populations with social structures of increasing complexity. Known results about homogeneous mixing and multitype models are included in the framework, which is then extended to models with households and models with households and schools/workplaces. Efficient methods for the exact computation of the real-time growth rate are presented for the standard SIR model with constant infection and recovery rates (Markovian case). Approximate methods are described for a large class of models with time-varying infection rates (non-Markovian case). The quality of the approximation is assessed via comparison with results from individual-based stochastic simulations. The methodology is then applied to the case of influenza in models with households and schools/workplaces, to provide an estimate of a household-to-household reproduction number and thus asses the effort required to prevent an outbreak by targeting control policies at the level of households. The results highlight the risk of underestimating such effort when the additional presence of schools/workplaces is neglected. Our framework increases the applicability of models of epidemic spread in socially structured population by linking earlier theoretical results, mainly focused on time-independent key epidemiological parameters (e.g. reproduction numbers, critical vaccination coverage, epidemic final size) to new results on the epidemic dynamics.