Early coronavirus disease 2019 (COVID-19) pandemic effects on individual-level risk for healthcare-associated infections in hospitalized patients.

OBJECTIVE: We compared the individual-level risk of hospital-onset infections with multidrug-resistant organisms (MDROs) in hospitalized patients prior to and during the coronavirus disease 2019 (COVID-19) pandemic. We also quantified the effects of COVID-19 diagnoses and intrahospital COVID-19 burden on subsequent MDRO infection risk. DESIGN: Multicenter, retrospective, cohort study. SETTING: Patient admission and clinical data were collected from 4 hospitals in the St. Louis area. PATIENTS: Data were collected for patients admitted between January 2017 and August 2020, discharged no later than September 2020, and hospitalized ≥48 hours. METHODS: Mixed-effects logistic regression models were fit to the data to estimate patients' individual-level risk of infection with MDRO pathogens of interest during hospitalization. Adjusted odds ratios were derived from regression models to quantify the effects of the COVID-19 period, COVID-19 diagnosis, and hospital-level COVID-19 burden on individual-level hospital-onset MDRO infection probabilities. RESULTS: We calculated adjusted odds ratios for COVID-19-era hospital-onset Acinetobacter spp., P. aeruginosa and Enterobacteriaceae spp infections. Probabilities increased 2.64 (95% confidence interval [CI], 1.22-5.73) times, 1.44 (95% CI, 1.03-2.02) times, and 1.25 (95% CI, 1.00-1.58) times relative to the prepandemic period, respectively. COVID-19 patients were 4.18 (95% CI, 1.98-8.81) times more likely to acquire hospital-onset MDRO S. aureus infections. CONCLUSIONS: Our results support the growing body of evidence indicating that the COVID-19 pandemic has increased hospital-onset MDRO infections.

Modelling the role of mortality-based response triggers on the effectiveness of African swine fever control strategies.

African swine fever (ASF) is considered the most impactful transboundary swine disease. In the absence of effective vaccines, control strategies are heavily dependent on mass depopulation and shipment restrictions. Here, we developed a nested multiscale model for the transmission of ASF, combining a spatially explicit network model of animal shipments with a deterministic compartmental model for the dynamics of two ASF strains within 3 km × 3 km pixels in one Brazilian state. The model outcomes are epidemic duration, number of secondary infected farms and pigs, and distance of ASF spread. The model also shows the spatial distribution of ASF epidemics. We analyzed quarantine-based control interventions in the context of mortality trigger thresholds for the deployment of control strategies. The mean epidemic duration of a moderately virulent strain was 11.2 days, assuming the first infection is detected (best-case scenario), and 15.9 days when detection is triggered at 10% mortality. For a highly virulent strain, the epidemic duration was 6.5 days and 13.1 days, respectively. The distance from the source to infected locations and the spatial distribution was not dependent on strain virulence. Under the best-case scenario, we projected an average number of infected farms of 23.77 farms and 18.8 farms for the moderate and highly virulent strains, respectively. At 10% mortality-trigger, the predicted number of infected farms was on average 46.27 farms and 42.96 farms, respectively. We also demonstrated that the establishment of ring quarantine zones regardless of size (i.e. 5 km, 15 km) was outperformed by backward animal movement tracking. The proposed modelling framework provides an evaluation of ASF epidemic potential, providing a ranking of quarantine-based control strategies that could assist animal health authorities in planning the national preparedness and response plan.

Assessing the efficacy of interventions to control indoor SARS-Cov-2 transmission: an agent-based modeling approach.

Intervention strategies for minimizing indoor SARS-CoV-2 transmission are often based on anecdotal evidence because there is little evidence-based research to support them. We developed a spatially-explicit agent-based model for simulating indoor respiratory pathogen transmission, and used it to compare effects of four interventions on reducing individual-level SARS-CoV-2 transmission risk by simulating a well-known case study. We found that imposing movement restrictions and efficacious mask usage appear to have the greatest effects on reducing infection risk, but multiple concurrent interventions are required to minimize the proportion of susceptible individuals infected. Social distancing had little effect on reducing transmission if individuals move during the gathering. Furthermore, our results suggest that there is potential for ventilation airflow to expose susceptible people to aerosolized pathogens even if they are relatively far from infectious individuals. Maximizing rates of aerosol removal is the key to successful transmission-risk reduction when using ventilation systems as intervention tools. ARTICLE SUMMARY LINE: Imposing mask usage requirements, group size restrictions, duration limits, and social distancing policies can have additive, and in some cases multiplicative protective effects on SARS-CoV-2 infection risk during indoor events.

Assessing the efficacy of interventions to control indoor SARS-Cov-2 transmission: An agent-based modeling approach.

Nonpharmaceutical interventions for minimizing indoor SARS-CoV-2 transmission continue to be critical tools for protecting susceptible individuals from infection, even as effective vaccines are produced and distributed globally. We developed a spatially-explicit agent-based model for simulating indoor respiratory pathogen transmission during discrete events taking place in a single room within a sub-day time frame, and used it to compare effects of four interventions on reducing secondary SARS-CoV-2 attack rates during a superspreading event by simulating a well-known case study. We found that preventing people from moving within the simulated room and efficacious mask usage appear to have the greatest effects on reducing infection risk, but multiple concurrent interventions are required to minimize the proportion of susceptible individuals infected. Social distancing had little effect on reducing transmission if individuals were randomly relocated within the room to simulate activity-related movements during the gathering. Furthermore, our results suggest that there is potential for ventilation airflow to expose susceptible people to aerosolized pathogens even if they are relatively far from infectious individuals. Maximizing the vertical aerosol removal rate is paramount to successful transmission-risk reduction when using ventilation systems as intervention tools.

When can we stop wearing masks? Agent-based modeling to identify when vaccine coverage makes nonpharmaceutical interventions for reducing SARS-CoV-2 infections redundant in indoor gatherings.

As vaccination efforts to combat the COVID-19 pandemic are ramping up worldwide, there are rising concerns that individuals will begin to eschew nonpharmaceutical interventions for preventing SARS-CoV-2 transmission and attempt to return to pre-pandemic normalcy before vaccine coverage levels effectively mitigate transmission risk. In the U.S.A., some governing bodies have already weakened or repealed guidelines for nonpharmaceutical intervention use, despite a recent spike in national COVID-19 cases and majority population of unvaccinated individuals. Recent modeling suggests that repealing nonpharmaceutical intervention guidelines too early into vaccine rollouts will lead to localized increases in COVID-19 cases, but the magnitude of nonpharmaceutical intervention effects on individual-level SARS-CoV-2 infection risk in fully- and partially-vaccinated populations is unclear. We use a previously-published agent-based model to simulate SARS-CoV-2 transmission in indoor gatherings of varying durations, population densities, and vaccination coverage levels. By simulating nonpharmaceutical interventions in some gatherings but not others, we were able to quantify the difference in SARS-CoV-2 infection risk when nonpharmaceutical interventions were used, relative to scenarios with no nonpharmaceutical interventions. We found that nonpharmaceutical interventions will often reduce secondary attack rates, especially during brief interactions, and therefore there is no definitive vaccination coverage level that makes nonpharmaceutical interventions completely redundant. However, the reduction effect on absolute SARS-CoV-2 infection risk conferred by nonpharmaceutical interventions is likely proportional to COVID-19 prevalence. Therefore, if COVID-19 prevalence decreases in the future, nonpharmaceutical interventions will likely still confer protective effects but potential benefits may be small enough to remain within "effectively negligible" risk thresholds.

Combining epidemiological and ecological methods to quantify social effects on Escherichia coli transmission.

Enteric microparasites like Escherichia coli use multiple transmission pathways to propagate within and between host populations. Characterizing the relative transmission risk attributable to host social relationships and direct physical contact between individuals is paramount for understanding how microparasites like E. coli spread within affected communities and estimating colonization rates. To measure these effects, we carried out commensal E. coli transmission experiments in two cattle (Bos taurus) herds, wherein all individuals were equipped with real-time location tracking devices. Following transmission experiments in this model system, we derived temporally dynamic social and contact networks from location data. Estimated social affiliations and dyadic contact frequencies during transmission experiments informed pairwise accelerated failure time models that we used to quantify effects of these sociobehavioural variables on weekly E. coli colonization risk in these populations. We found that sociobehavioural variables alone were ultimately poor predictors of E. coli colonization in feedlot cattle, but can have significant effects on colonization hazard rates (p ≤ 0.05). We show, however, that observed effects were not consistent between similar populations. This work demonstrates that transmission experiments can be combined with real-time location data collection and processing procedures to create an effective framework for quantifying sociobehavioural effects on microparasite transmission.

Accounting for space and uncertainty in real-time location system-derived contact networks.

Point data obtained from real-time location systems (RTLSs) can be processed into animal contact networks, describing instances of interaction between tracked individuals. Proximity-based definitions of interanimal "contact," however, may be inadequate for describing epidemiologically and sociologically relevant interactions involving body parts or other physical spaces relatively far from tracking devices. This weakness can be overcome by using polygons, rather than points, to represent tracked individuals and defining "contact" as polygon intersections.We present novel procedures for deriving polygons from RTLS point data while maintaining distances and orientations associated with individuals' relocation events. We demonstrate the versatility of this methodology for network modeling using two contact network creation examples, wherein we use this procedure to create (a) interanimal physical contact networks and (b) a visual contact network. Additionally, in creating our networks, we establish another procedure to adjust definitions of "contact" to account for RTLS positional accuracy, ensuring all true contacts are likely captured and represented in our networks.Using the methods described herein and the associated R package we have developed, called contact, researchers can derive polygons from RTLS points. Furthermore, we show that these polygons are highly versatile for contact network creation and can be used to answer a wide variety of epidemiological, ethological, and sociological research questions.By introducing these methodologies and providing the means to easily apply them through the contact R package, we hope to vastly improve network-model realism and researchers' ability to draw inferences from RTLS data.

Transmission on empirical dynamic contact networks is influenced by data processing decisions.

Dynamic contact data can be used to inform disease transmission models, providing insight into the dynamics of infectious diseases. Such data often requires extensive processing for use in models or analysis. Therefore, processing decisions can potentially influence the topology of the contact network and the simulated disease transmission dynamics on the network. In this study, we examine how four processing decisions, including temporal sampling window (TSW), spatial threshold of contact (SpTh), minimum contact duration (MCD), and temporal aggregation (daily or hourly) influence the information content of contact data (indicated by changes in entropy) as well as disease transmission model dynamics. We found that changes made to information content by processing decisions translated to significant impacts to the transmission dynamics of disease models using the contact data. In particular, we found that SpTh had the largest independent influence on information content, and that some output metrics (R0, time to peak infection) were more sensitive to changes in information than others (epidemic extent). These findings suggest that insights gained from transmission modeling using dynamic contact data can be influenced by processing decisions alone, emphasizing the need to carefully consideration them prior to using contact-based models to conduct analyses, compare different datasets, or inform policy decisions.