COVID-19 pandemics modeling with modified determinist SEIR, social distancing, and age stratification. The effect of vertical confinement and release in Brazil.

Autor: Lyra W; Department of Astronomy, New Mexico State University, Las Cruces, New Mexico, United States of America., do Nascimento JD Jr; Departamento de Física Teórica e Experimental, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.; Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts, United States of America., Belkhiria J; One Health Institute, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America.; Center for Animal Disease Modeling and Surveillance, Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, California, United States of America., de Almeida L; Departamento de Física Teórica e Experimental, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil., Chrispim PPM; Instituto Alicerce Ensino Pesquisa e Inovação em Saúde, Rio de Janeiro, Rio de Janeiro, Brazil.; Hospital do Coração, Laboratório de Implementação do Conhecimento em Saúde, Paraíso, São Paulo, Brazil., de Andrade I; Secretaria de Estado da Saúde Pública/SESAP/Cefope - Escola Técnica do SUS - ETSUS, Natal, Rio Grande do Norte, Brazil.; Laboratório de Inovação Tecnológica em Saúde, Natal, Rio Grande do Norte, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Sep 02; Vol. 15 (9), pp. e0237627. Date of Electronic Publication: 2020 Sep 02 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0237627
Abstrakt: The ongoing COVID-19 epidemics poses a particular challenge to low and middle income countries, making some of them consider the strategy of "vertical confinement". In this strategy, contact is reduced only to specific groups (e.g. age groups) that are at increased risk of severe disease following SARS-CoV-2 infection. We aim to assess the feasibility of this scenario as an exit strategy for the current lockdown in terms of its ability to keep the number of cases under the health care system capacity. We developed a modified SEIR model, including confinement, asymptomatic transmission, quarantine and hospitalization. The population is subdivided into 9 age groups, resulting in a system of 72 coupled nonlinear differential equations. The rate of transmission is dynamic and derived from the observed delayed fatality rate; the parameters of the epidemics are derived with a Markov chain Monte Carlo algorithm. We used Brazil as an example of middle income country, but the results are easily generalizable to other countries considering a similar strategy. We find that starting from 60% horizontal confinement, an exit strategy on May 1st of confinement of individuals older than 60 years old and full release of the younger population results in 400 000 hospitalizations, 50 000 ICU cases, and 120 000 deaths in the 50-60 years old age group alone. Sensitivity analysis shows the 95% confidence interval brackets a order of magnitude in cases or three weeks in time. The health care system avoids collapse if the 50-60 years old are also confined, but our model assumes an idealized lockdown where the confined are perfectly insulated from contamination, so our numbers are a conservative lower bound. Our results discourage confinement by age as an exit strategy.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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