Scenario design for infectious disease projections: Integrating concepts from decision analysis and experimental design.

Across many fields, scenario modeling has become an important tool for exploring long-term projections and how they might depend on potential interventions and critical uncertainties, with relevance to both decision makers and scientists. In the past decade, and especially during the COVID-19 pandemic, the field of epidemiology has seen substantial growth in the use of scenario projections. Multiple scenarios are often projected at the same time, allowing important comparisons that can guide the choice of intervention, the prioritization of research topics, or public communication. The design of the scenarios is central to their ability to inform important questions. In this paper, we draw on the fields of decision analysis and statistical design of experiments to propose a framework for scenario design in epidemiology, with relevance also to other fields. We identify six different fundamental purposes for scenario designs (decision making, sensitivity analysis, situational awareness, horizon scanning, forecasting, and value of information) and discuss how those purposes guide the structure of scenarios. We discuss other aspects of the content and process of scenario design, broadly for all settings and specifically for multi-model ensemble projections. As an illustrative case study, we examine the first 17 rounds of scenarios from the U.S. COVID-19 Scenario Modeling Hub, then reflect on future advancements that could improve the design of scenarios in epidemiological settings.

When do we need multiple infectious disease models? Agreement between projection rank and magnitude in a multi-model setting.

Mathematical models are useful for public health planning and response to infectious disease threats. However, different models can provide differing results, which can hamper decision making if not synthesized appropriately. To address this challenge, multi-model hubs convene independent modeling groups to generate ensembles, known to provide more accurate predictions of future outcomes. Yet, these hubs are resource intensive, and how many models are sufficient in a hub is not known. Here, we compare the benefit of predictions from multiple models in different contexts: (1) decision settings that depend on predictions of quantitative outcomes (e.g., hospital capacity planning), where assessments of the benefits of multi-model ensembles have largely focused; and (2) decisions settings that require the ranking of alternative epidemic scenarios (e.g., comparing outcomes under multiple possible interventions and biological uncertainties). We develop a mathematical framework to mimic a multi-model prediction setting, and use this framework to quantify how frequently predictions from different models agree. We further explore multi-model agreement using real-world, empirical data from 14 rounds of U.S. COVID-19 Scenario Modeling Hub projections. Our results suggest that the value of multiple models could be different in different decision contexts, and if only a few models are available, focusing on the rank of alternative epidemic scenarios could be more robust than focusing on quantitative outcomes. Although additional exploration of the sufficient number of models for different contexts is still needed, our results indicate that it may be possible to identify decision contexts where it is robust to rely on fewer models, a finding that can inform the use of modeling resources during future public health crises.

Reframing wildlife disease management problems with decision analysis.

Contemporary wildlife disease management is complex because managers need to respond to a wide range of stakeholders, multiple uncertainties, and difficult trade-offs that characterize the interconnected challenges of today. Despite general acknowledgment of these complexities, managing wildlife disease tends to be framed as a scientific problem, in which the major challenge is lack of knowledge. The complex and multifactorial process of decision-making is collapsed into a scientific endeavor to reduce uncertainty. As a result, contemporary decision-making may be oversimplified, rely on simple heuristics, and fail to account for the broader legal, social, and economic context in which the decisions are made. Concurrently, scientific research on wildlife disease may be distant from this decision context, resulting in information that may not be directly relevant to the pertinent management questions. We propose reframing wildlife disease management challenges as decision problems and addressing them with decision analytical tools to divide the complex problems into more cognitively manageable elements. In particular, structured decision-making has the potential to improve the quality, rigor, and transparency of decisions about wildlife disease in a variety of systems. Examples of management of severe acute respiratory syndrome coronavirus 2, white-nose syndrome, avian influenza, and chytridiomycosis illustrate the most common impediments to decision-making, including competing objectives, risks, prediction uncertainty, and limited resources.

Replanteamiento del manejo de problemas por enfermedades de fauna mediante el análisis de decisiones Resumen El manejo actual de las enfermedades de la fauna es complejo debido a que los gestores necesitan responder a una amplia gama de actores, varias incertidumbres y compensaciones difíciles que caracterizan los retos interconectados del día de hoy. A pesar de que en general se reconocen estas complejidades, el manejo de las enfermedades tiende a plantearse como un problema científico en el que el principal obstáculo es la falta de conocimiento. El proceso complejo y multifactorial de la toma decisiones está colapsado dentro de un esfuerzo científico para reducir la incertidumbre. Como resultado de esto, las decisiones contemporáneas pueden estar simplificadas en exceso, depender de métodos heurísticos simples y no considerar el contexto legal, social y económico más amplio en el que se toman las decisiones. De manera paralela, las investigaciones científicas sobre las enfermedades de la fauna pueden estar lejos de este contexto de decisiones, lo que deriva en información que puede no ser directamente relevante para las preguntas pertinentes de manejo. Proponemos replantear los obstáculos para el manejo de enfermedades de fauna como problemas de decisión y abordarlos con herramientas analíticas de decisión para dividir los problemas complejos en elementos más manejables de manera cognitiva. En particular, las decisiones estructuradas tienen el potencial de mejorar la calidad, el rigor y la transparencia de las decisiones sobre las enfermedades de la fauna en una variedad de sistemas. Ejemplos como el manejo del coronavirus del síndrome de respiración agudo tipo 2, el síndrome de nariz blanca, la influenza aviar y la quitridiomicosis ilustran los impedimentos más comunes para la toma de decisiones, incluyendo los objetivos en competencia, riesgos, incertidumbre en las predicciones y recursos limitados.

Ensemble2: Scenarios ensembling for communication and performance analysis.

Throughout the COVID-19 pandemic, scenario modeling played a crucial role in shaping the decision-making process of public health policies. Unlike forecasts, scenario projections rely on specific assumptions about the future that consider different plausible states-of-the-world that may or may not be realized and that depend on policy interventions, unpredictable changes in the epidemic outlook, etc. As a consequence, long-term scenario projections require different evaluation criteria than the ones used for traditional short-term epidemic forecasts. Here, we propose a novel ensemble procedure for assessing pandemic scenario projections using the results of the Scenario Modeling Hub (SMH) for COVID-19 in the United States (US). By defining a "scenario ensemble" for each model and the ensemble of models, termed "Ensemble2", we provide a synthesis of potential epidemic outcomes, which we use to assess projections' performance, bypassing the identification of the most plausible scenario. We find that overall the Ensemble2 models are well-calibrated and provide better performance than the scenario ensemble of individual models. The ensemble procedure accounts for the full range of plausible outcomes and highlights the importance of scenario design and effective communication. The scenario ensembling approach can be extended to any scenario design strategy, with potential refinements including weighting scenarios and allowing the ensembling process to evolve over time.

The US COVID-19 and Influenza Scenario Modeling Hubs: Delivering long-term projections to guide policy.

Between December 2020 and April 2023, the COVID-19 Scenario Modeling Hub (SMH) generated operational multi-month projections of COVID-19 burden in the US to guide pandemic planning and decision-making in the context of high uncertainty. This effort was born out of an attempt to coordinate, synthesize and effectively use the unprecedented amount of predictive modeling that emerged throughout the COVID-19 pandemic. Here we describe the history of this massive collective research effort, the process of convening and maintaining an open modeling hub active over multiple years, and attempt to provide a blueprint for future efforts. We detail the process of generating 17 rounds of scenarios and projections at different stages of the COVID-19 pandemic, and disseminating results to the public health community and lay public. We also highlight how SMH was expanded to generate influenza projections during the 2022-23 season. We identify key impacts of SMH results on public health and draw lessons to improve future collaborative modeling efforts, research on scenario projections, and the interface between models and policy.

Scenario Design for Infectious Disease Projections: Integrating Concepts from Decision Analysis and Experimental Design.

Across many fields, scenario modeling has become an important tool for exploring long-term projections and how they might depend on potential interventions and critical uncertainties, with relevance to both decision makers and scientists. In the past decade, and especially during the COVID-19 pandemic, the field of epidemiology has seen substantial growth in the use of scenario projections. Multiple scenarios are often projected at the same time, allowing important comparisons that can guide the choice of intervention, the prioritization of research topics, or public communication. The design of the scenarios is central to their ability to inform important questions. In this paper, we draw on the fields of decision analysis and statistical design of experiments to propose a framework for scenario design in epidemiology, with relevance also to other fields. We identify six different fundamental purposes for scenario designs (decision making, sensitivity analysis, value of information, situational awareness, horizon scanning, and forecasting) and discuss how those purposes guide the structure of scenarios. We discuss other aspects of the content and process of scenario design, broadly for all settings and specifically for multi-model ensemble projections. As an illustrative case study, we examine the first 17 rounds of scenarios from the U.S. COVID-19 Scenario Modeling Hub, then reflect on future advancements that could improve the design of scenarios in epidemiological settings.

Qualitative value of information provides a transparent and repeatable method for identifying critical uncertainty.

Conservation decisions are often made in the face of uncertainty because the urgency to act can preclude delaying management while uncertainty is resolved. In this context, adaptive management is attractive, allowing simultaneous management and learning. An adaptive program design requires the identification of critical uncertainties that impede the choice of management action. Quantitative evaluation of critical uncertainty, using the expected value of information, may require more resources than are available in the early stages of conservation planning. Here, we demonstrate the use of a qualitative index to the value of information (QVoI) to prioritize which sources of uncertainty to reduce regarding the use of prescribed fire to benefit Eastern Black Rails (Laterallus jamaicensis jamaicensis), Yellow Rails (Coterminous noveboracensis), and Mottled Ducks (Anas fulvigula; hereafter, focal species) in high marshes of the U.S. Gulf of Mexico. Prescribed fire has been used as a management tool in Gulf of Mexico high marshes throughout the last 30+ years; however, effects of periodic burning on the focal species and the optimal conditions for burning marshes to improve habitat remain unknown. We followed a structured decision-making framework to develop conceptual models, which we then used to identify sources of uncertainty and articulate alternative hypotheses about prescribed fire in high marshes. We used QVoI to evaluate the sources of uncertainty based on their Magnitude, Relevance for decision-making, and Reducibility. We found that hypotheses related to the optimal fire return interval and season were the highest priorities for study, whereas hypotheses related to predation rates and interactions among management techniques were lowest. These results suggest that learning about the optimal fire frequency and season to benefit the focal species might produce the greatest management benefit. In this case study, we demonstrate that QVoI can help managers decide where to apply limited resources to learn which specific actions will result in a higher likelihood of achieving the desired management objectives. Further, we summarize the strengths and limitations of QVoI and outline recommendations for its future use for prioritizing research to reduce uncertainty about system dynamics and the effects of management actions.

Context-dependent representation of within- and between-model uncertainty: aggregating probabilistic predictions in infectious disease epidemiology.

Probabilistic predictions support public health planning and decision making, especially in infectious disease emergencies. Aggregating outputs from multiple models yields more robust predictions of outcomes and associated uncertainty. While the selection of an aggregation method can be guided by retrospective performance evaluations, this is not always possible. For example, if predictions are conditional on assumptions about how the future will unfold (e.g. possible interventions), these assumptions may never materialize, precluding any direct comparison between predictions and observations. Here, we summarize literature on aggregating probabilistic predictions, illustrate various methods for infectious disease predictions via simulation, and present a strategy for choosing an aggregation method when empirical validation cannot be used. We focus on the linear opinion pool (LOP) and Vincent average, common methods that make different assumptions about between-prediction uncertainty. We contend that assumptions of the aggregation method should align with a hypothesis about how uncertainty is expressed within and between predictions from different sources. The LOP assumes that between-prediction uncertainty is meaningful and should be retained, while the Vincent average assumes that between-prediction uncertainty is akin to sampling error and should not be preserved. We provide an R package for implementation. Given the rising importance of multi-model infectious disease hubs, our work provides useful guidance on aggregation and a deeper understanding of the benefits and risks of different approaches.

Vote-processing rules for combining control recommendations from multiple models.

Mathematical modelling is used during disease outbreaks to compare control interventions. Using multiple models, the best method to combine model recommendations is unclear. Existing methods weight model projections, then rank control interventions using the combined projections, presuming model outputs are directly comparable. However, the way each model represents the epidemiological system will vary. We apply electoral vote-processing rules to combine model-generated rankings of interventions. Combining rankings of interventions, instead of combining model projections, avoids assuming that projections are comparable as all comparisons of projections are made within each model. We investigate four rules: First-past-the-post, Alternative Vote (AV), Coombs Method and Borda Count. We investigate rule sensitivity by including models that favour only one action or including those that rank interventions randomly. We investigate two case studies: the 2014 Ebola outbreak in West Africa (37 compartmental models) and a hypothetical foot-and-mouth disease outbreak in UK (four individual-based models). The Coombs Method was least susceptible to adding models that favoured a single action, Borda Count and AV were most susceptible to adding models that ranked interventions randomly. Each rule chose the same intervention as when ranking interventions by mean projections, suggesting that combining rankings provides similar recommendations with fewer assumptions about model comparability. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Optimizing management of invasions in an uncertain world using dynamic spatial models.

Dispersal drives invasion dynamics of nonnative species and pathogens. Applying knowledge of dispersal to optimize the management of invasions can mean the difference between a failed and a successful control program and dramatically improve the return on investment of control efforts. A common approach to identifying optimal management solutions for invasions is to optimize dynamic spatial models that incorporate dispersal. Optimizing these spatial models can be very challenging because the interaction of time, space, and uncertainty rapidly amplifies the number of dimensions being considered. Addressing such problems requires advances in and the integration of techniques from multiple fields, including ecology, decision analysis, bioeconomics, natural resource management, and optimization. By synthesizing recent advances from these diverse fields, we provide a workflow for applying ecological theory to advance optimal management science and highlight priorities for optimizing the control of invasions. One of the striking gaps we identify is the extremely limited consideration of dispersal uncertainty in optimal management frameworks, even though dispersal estimates are highly uncertain and greatly influence invasion outcomes. In addition, optimization frameworks rarely consider multiple types of uncertainty (we describe five major types) and their interrelationships. Thus, feedbacks from management or other sources that could magnify uncertainty in dispersal are rarely considered. Incorporating uncertainty is crucial for improving transparency in decision risks and identifying optimal management strategies. We discuss gaps and solutions to the challenges of optimization using dynamic spatial models to increase the practical application of these important tools and improve the consistency and robustness of management recommendations for invasions.

An introduction to decision science for conservation.

Biodiversity conservation decisions are difficult, especially when they involve differing values, complex multidimensional objectives, scarce resources, urgency, and considerable uncertainty. Decision science embodies a theory about how to make difficult decisions and an extensive array of frameworks and tools that make that theory practical. We sought to improve conceptual clarity and practical application of decision science to help decision makers apply decision science to conservation problems. We addressed barriers to the uptake of decision science, including a lack of training and awareness of decision science; confusion over common terminology and which tools and frameworks to apply; and the mistaken impression that applying decision science must be time consuming, expensive, and complex. To aid in navigating the extensive and disparate decision science literature, we clarify meaning of common terms: decision science, decision theory, decision analysis, structured decision-making, and decision-support tools. Applying decision science does not have to be complex or time consuming; rather, it begins with knowing how to think through the components of a decision utilizing decision analysis (i.e., define the problem, elicit objectives, develop alternatives, estimate consequences, and perform trade-offs). This is best achieved by applying a rapid-prototyping approach. At each step, decision-support tools can provide additional insight and clarity, whereas decision-support frameworks (e.g., priority threat management and systematic conservation planning) can aid navigation of multiple steps of a decision analysis for particular contexts. We summarize key decision-support frameworks and tools and describe to which step of a decision analysis, and to which contexts, each is most useful to apply. Our introduction to decision science will aid in contextualizing current approaches and new developments, and help decision makers begin to apply decision science to conservation problems.

Las decisiones sobre la conservación de la biodiversidad son difíciles de tomar, especialmente cuando involucran diferentes valores, objetivos multidimensionales complejos, recursos limitados, urgencia y una incertidumbre considerable. Las ciencias de la decisión incorporan una teoría sobre cómo tomar decisiones difíciles y una variedad extensa de marcos de trabajo y herramientas que transforman esa teoría en práctica. Buscamos mejorar la claridad conceptual y la aplicación práctica de las ciencias de la decisión para ayudar al órgano decisorio a aplicar estas ciencias a los problemas de conservación. Nos enfocamos en las barreras para la aceptación de las ciencias de la decisión, incluyendo la falta de capacitación y de conciencia por estas ciencias; la confusión por la terminología común y cuáles herramientas y marcos de trabajo aplicar; y la impresión errónea de que la aplicación de estas ciencias consume tiempo y debe ser costosa y compleja. Para asistir en la navegación de la literatura extensa y dispar de las ciencias de la decisión, aclaramos el significado de varios términos comunes: ciencias de la decisión, teoría de la decisión, análisis de decisiones, toma estructurada de decisiones y herramientas de apoyo para las decisiones. La aplicación de las ciencias de la decisión no tiene que ser compleja ni debe llevar mucho tiempo; de hecho, todo comienza con saber cómo pensar detenidamente en los componentes de una decisión mediante el análisis de decisiones (es decir, definir el problema, producir objetivos, desarrollar alternativas, estimar consecuencias y realizar compensaciones). Lo anterior se logra de mejor manera mediante la aplicación de una estrategia prototipos rápidos. En cada paso, las herramientas de apoyo para las decisiones pueden proporcionar visión y claridad adicionales, mientras que los marcos de apoyo para las decisiones (p.ej.: gestión de amenazas prioritarias y planeación sistemática de la conservación) pueden asistir en la navegación de los diferentes pasos de un análisis de decisiones para contextos particulares. Resumimos los marcos de trabajo y las herramientas más importantes de apoyo para las decisiones y describimos el paso, y el contexto, del análisis de decisiones para el que es más útil aplicarlos. Nuestra introducción a las ciencias de la decisión apoyará en la contextualización de las estrategias actuales y los nuevos desarrollos, y ayudarán al órgano decisorio a comenzar a aplicar estas ciencias en los problemas de conservación.

Synergistic interventions to control COVID-19: Mass testing and isolation mitigates reliance on distancing.

Stay-at-home orders and shutdowns of non-essential businesses are powerful, but socially costly, tools to control the pandemic spread of SARS-CoV-2. Mass testing strategies, which rely on widely administered frequent and rapid diagnostics to identify and isolate infected individuals, could be a potentially less disruptive management strategy, particularly where vaccine access is limited. In this paper, we assess the extent to which mass testing and isolation strategies can reduce reliance on socially costly non-pharmaceutical interventions, such as distancing and shutdowns. We develop a multi-compartmental model of SARS-CoV-2 transmission incorporating both preventative non-pharmaceutical interventions (NPIs) and testing and isolation to evaluate their combined effect on public health outcomes. Our model is designed to be a policy-guiding tool that captures important realities of the testing system, including constraints on test administration and non-random testing allocation. We show how strategic changes in the characteristics of the testing system, including test administration, test delays, and test sensitivity, can reduce reliance on preventative NPIs without compromising public health outcomes in the future. The lowest NPI levels are possible only when many tests are administered and test delays are short, given limited immunity in the population. Reducing reliance on NPIs is highly dependent on the ability of a testing program to identify and isolate unreported, asymptomatic infections. Changes in NPIs, including the intensity of lockdowns and stay at home orders, should be coordinated with increases in testing to ensure epidemic control; otherwise small additional lifting of these NPIs can lead to dramatic increases in infections, hospitalizations and deaths. Importantly, our results can be used to guide ramp-up of testing capacity in outbreak settings, allow for the flexible design of combined interventions based on social context, and inform future cost-benefit analyses to identify efficient pandemic management strategies.

Weighing the unknowns: Value of Information for biological and operational uncertainty in invasion management.

The management of biological invasions is a worldwide conservation priority. Unfortunately, decision-making on optimal invasion management can be impeded by lack of information about the biological processes that determine invader success (i.e. biological uncertainty) or by uncertainty about the effectiveness of candidate interventions (i.e. operational uncertainty). Concurrent assessment of both sources of uncertainty within the same framework can help to optimize control decisions.Here, we present a Value of Information (VoI) framework to simultaneously analyse the effects of biological and operational uncertainties on management outcomes. We demonstrate this approach with a case study: minimizing the long-term population growth of musk thistle Carduus nutans, a widespread invasive plant, using several insects as biological control agents, including Trichosirocalus horridus, Rhinocyllus conicus and Urophora solstitialis.The ranking of biocontrol agents was sensitive to differences in the target weed's demography and also to differences in the effectiveness of the different biocontrol agents. This finding suggests that accounting for both biological and operational uncertainties is valuable when making management recommendations for invasion control. Furthermore, our VoI analyses show that reduction of all uncertainties across all combinations of demographic model and biocontrol effectiveness explored in the current study would lead, on average, to a 15.6% reduction in musk thistle population growth rate. The specific growth reduction that would be observed in any instance would depend on how the uncertainties actually resolve. Resolving biological uncertainty (across demographic model combinations) or operational uncertainty (across biocontrol effectiveness combinations) alone would reduce expected population growth rate by 8.5% and 10.5% respectively.Synthesis and applications. Our study demonstrates that intervention rank is determined both by biological processes in the targeted invasive populations and by intervention effectiveness. Ignoring either biological uncertainty or operational uncertainty may result in a suboptimal recommendation. Therefore, it is important to simultaneously acknowledge both sources of uncertainty during the decision-making process in invasion management. The framework presented here can accommodate diverse data sources and modelling approaches, and has wide applicability to guide invasive species management and conservation efforts.

Demographic risk assessment for a harvested species threatened by climate change: polar bears in the Chukchi Sea.

Climate change threatens global biodiversity. Many species vulnerable to climate change are important to humans for nutritional, cultural, and economic reasons. Polar bears Ursus maritimus are threatened by sea-ice loss and represent a subsistence resource for Indigenous people. We applied a novel population modeling-management framework that is based on species life history and accounts for habitat loss to evaluate subsistence harvest for the Chukchi Sea (CS) polar bear subpopulation. Harvest strategies followed a state-dependent approach under which new data were used to update the harvest on a predetermined management interval. We found that a harvest strategy with a starting total harvest rate of 2.7% (˜85 bears/yr at current abundance), a 2:1 male-to-female ratio, and a 10-yr management interval would likely maintain subpopulation abundance above maximum net productivity level for the next 35 yr (approximately three polar bear generations), our primary criterion for sustainability. Plausible bounds on starting total harvest rate were 1.7-3.9%, where the range reflects uncertainty due to sampling variation, environmental variation, model selection, and differing levels of risk tolerance. The risk of undesired demographic outcomes (e.g., overharvest) was positively related to harvest rate, management interval, and projected declines in environmental carrying capacity; and negatively related to precision in population data. Results reflect several lines of evidence that the CS subpopulation has been productive in recent years, although it is uncertain how long this will last as sea-ice loss continues. Our methods provide a template for balancing trade-offs among protection, use, research investment, and other factors. Demographic risk assessment and state-dependent management will become increasingly important for harvested species, like polar bears, that exhibit spatiotemporal variation in their response to climate change.

Risks posed by SARS-CoV-2 to North American bats during winter fieldwork.

The virus that causes COVID-19 likely evolved in a mammalian host, possibly Old-World bats, before adapting to humans, raising the question of whether reverse zoonotic transmission to bats is possible. Wildlife management agencies in North America are concerned that the activities they authorize could lead to transmission of SARS-CoV-2 to bats from humans. A rapid risk assessment conducted in April 2020 suggested that there was a small but significant possibility that SARS-CoV-2 could be transmitted from humans to bats during summer fieldwork, absent precautions. Subsequent challenge studies in a laboratory setting have shed new information on these risks, as has more detailed information on human epidemiology and transmission. This inquiry focuses on the risk to bats from winter fieldwork, specifically surveys of winter roosts and handling of bats to test for white-nose syndrome or other research needs. We use an aerosol transmission model, with parameter estimates both from the literature and from formal expert judgment, to estimate the risk to three species of North American bats, as a function of several factors. We find that risks of transmission are lower than in the previous assessment and are notably affected by chamber volume and local prevalence of COVID-19. Use of facemasks with high filtration efficiency or a negative COVID-19 test before field surveys can reduce zoonotic risk by 65 to 88%.

Strategic testing approaches for targeted disease monitoring can be used to inform pandemic decision-making.

More than 1.6 million Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) tests were administered daily in the United States at the peak of the epidemic, with a significant focus on individual treatment. Here, we show that objective-driven, strategic sampling designs and analyses can maximize information gain at the population level, which is necessary to increase situational awareness and predict, prepare for, and respond to a pandemic, while also continuing to inform individual treatment. By focusing on specific objectives such as individual treatment or disease prediction and control (e.g., via the collection of population-level statistics to inform lockdown measures or vaccine rollout) and drawing from the literature on capture-recapture methods to deal with nonrandom sampling and testing errors, we illustrate how public health objectives can be achieved even with limited test availability when testing programs are designed a priori to meet those objectives.

Modeling of Future COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Rates and Nonpharmaceutical Intervention Scenarios - United States, April-September 2021.

After a period of rapidly declining U.S. COVID-19 incidence during January-March 2021, increases occurred in several jurisdictions (1,2) despite the rapid rollout of a large-scale vaccination program. This increase coincided with the spread of more transmissible variants of SARS-CoV-2, the virus that causes COVID-19, including B.1.1.7 (1,3) and relaxation of COVID-19 prevention strategies such as those for businesses, large-scale gatherings, and educational activities. To provide long-term projections of potential trends in COVID-19 cases, hospitalizations, and deaths, COVID-19 Scenario Modeling Hub teams used a multiple-model approach comprising six models to assess the potential course of COVID-19 in the United States across four scenarios with different vaccination coverage rates and effectiveness estimates and strength and implementation of nonpharmaceutical interventions (NPIs) (public health policies, such as physical distancing and masking) over a 6-month period (April-September 2021) using data available through March 27, 2021 (4). Among the four scenarios, an accelerated decline in NPI adherence (which encapsulates NPI mandates and population behavior) was shown to undermine vaccination-related gains over the subsequent 2-3 months and, in combination with increased transmissibility of new variants, could lead to surges in cases, hospitalizations, and deaths. A sharp decline in cases was projected by July 2021, with a faster decline in the high-vaccination scenarios. High vaccination rates and compliance with public health prevention measures are essential to control the COVID-19 pandemic and to prevent surges in hospitalizations and deaths in the coming months.

A framework for allocating conservation resources among multiple threats and actions.

Land managers decide how to allocate resources among multiple threats that can be addressed through multiple possible actions. Additionally, these actions vary in feasibility, effectiveness, and cost. We sought to provide a way to optimize resource allocation to address multiple threats when multiple management options are available, including mutually exclusive options. Formulating the decision as a combinatorial optimization problem, our framework takes as inputs the expected impact and cost of each threat for each action (including do nothing) and for each overall budget identifies the optimal action to take for each threat. We compared the optimal solution to an easy to calculate greedy algorithm approximation and a variety of plausible ranking schemes. We applied the framework to management of multiple introduced plant species in Australian alpine areas. We developed a model of invasion to predict the expected impact in 50 years for each species-action combination that accounted for each species' current invasion state (absent, localized, widespread); arrival probability; spread rate; impact, if present, of each species; and management effectiveness of each species-action combination. We found that the recommended action for a threat changed with budget; there was no single optimal management action for each species; and considering more than one candidate action can substantially increase the management plan's overall efficiency. The approximate solution (solution ranked by marginal cost-effectiveness) performed well when the budget matched the cost of the prioritized actions, indicating that this approach would be effective if the budget was set as part of the prioritization process. The ranking schemes varied in performance, and achieving a close to optimal solution was not guaranteed. Global sensitivity analysis revealed a threat's expected impact and, to a lesser extent, management effectiveness were the most influential parameters, emphasizing the need to focus research and monitoring efforts on their quantification.

Un Marco de Referencia para Asignar Recursos para la Conservación entre Múltiples Amenazas y Acciones Resumen Los administradores de tierras deciden cómo asignar recursos entre múltiples amenazas que pueden abordarse por medio de múltiples acciones. Adicionalmente, estas acciones varían en viabilidad, efectividad y costo. Buscamos proporcionar una manera para optimizar la asignación de recursos para abordar varias amenazas cuando están disponibles muchas opciones de manejo, incluyendo opciones mutuamente excluyentes. Con una formulación de la decisión como un problema combinatorio de optimización, nuestro marco de referencia toma como entradas el impacto esperado y el costo de cada amenaza para cada acción (incluyendo hacer nada) y para cada presupuesto generalizado identifica la acción óptima a realizar ante cada amenaza. Comparamos la solución óptima con una aproximación de un algoritmo avaricioso fácil de calcular y una variedad de esquemas plausibles de clasificación. Aplicamos el marco de trabajo al manejo de múltiples especies de plantas introducidas en las áreas alpinas de Australia. Desarrollamos un modelo de invasión para predecir el impacto esperado en 50 años para cada combinación de especie-acción que consideró el estado actual de invasión para cada especie (ausente, localizada, ampliamente distribuida), la probabilidad de invasión, la tasa de esparcimiento, el impacto, cuando abundante, de cada especie y la efectividad de manejo de cada combinación especie-acción. Descubrimos que la acción recomendada para una amenaza cambia con el presupuesto, que no existe una acción única de manejo óptimo para cada especie y que considerar más de una acción candidata puede incrementar sustancialmente la eficiencia general del plan de manejo. La solución aproximada (solución clasificada por rentabilidad) tuvo un buen desempeño cuando el presupuesto fue igual al costo de las acciones prioritarias, lo que indica que esta estrategia sería efectiva si el presupuesto está fijado como parte del proceso de priorización. Los esquemas de clasificación variaron en cuanto a desempeño, y lograr una solución cercana a lo óptimo no estuvo garantizado. El análisis de sensibilidad global reveló que el impacto esperado de una amenaza y, a menor grado, la efectividad del manejo no fueron los parámetros con mayor influencia, lo que enfatiza la necesidad de enfocar la investigación y los esfuerzos de monitoreo en la cuantificación del impacto esperado y la efectividad del manejo.

Causes of delayed outbreak responses and their impacts on epidemic spread.

Livestock diseases have devastating consequences economically, socially and politically across the globe. In certain systems, pathogens remain viable after host death, which enables residual transmissions from infected carcasses. Rapid culling and carcass disposal are well-established strategies for stamping out an outbreak and limiting its impact; however, wait-times for these procedures, i.e. response delays, are typically farm-specific and time-varying due to logistical constraints. Failing to incorporate variable response delays in epidemiological models may understate outbreak projections and mislead management decisions. We revisited the 2001 foot-and-mouth epidemic in the United Kingdom and sought to understand how misrepresented response delays can influence model predictions. Survival analysis identified farm size and control demand as key factors that impeded timely culling and disposal activities on individual farms. Using these factors in the context of an existing policy to predict local variation in response times significantly affected predictions at the national scale. Models that assumed fixed, timely responses grossly underestimated epidemic severity and its long-term consequences. As a result, this study demonstrates how general inclusion of response dynamics and recognition of partial controllability of interventions can help inform management priorities during epidemics of livestock diseases.