Density is destiny

There’s no simple, one-size-fits-all protocol for reopening the economy, said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia. Rubin is developing a model to forecast how reopening 260 large U.S. counties on May 15 would play out if residents maintained only half the social distancing measures now in place.

The good news, Rubin said, is that modest-size, relatively spread-out cities will probably have room to make adjustments. But if restrictions ease too much, New York and similarly dense cities will rapidly see infections spike again.

“It comes back really quick, and the peaks are much higher than what you’re seeing right now,” Rubin said. “It was sobering. I was more optimistic before we did our models.”

This is why epidemiologists are cautioning state leaders to inch toward reopening with tentative, staggered steps.

SOURCE: Washington Post

Modeling to Inform Infectious Disease Control

Mathematical modeling is used in the management of infectious disease control as a way to assess interventions relatively quickly, cheaply, and safely. Modeling to Inform Infectious Disease Control shows readers how to take advantage of these models when developing strategies to mitigate infectious disease transmission.

The book presents a way of modeling as well as modeling results that help to guide the effective management of infectious disease transmission and outbreak response. It discusses the requirements for preventing epidemics and ways to quantify the impact of preventative public health interventions on the size and dynamics of an epidemic. The book also illustrates how data are used to inform model choice.

Accessible to readers with diverse backgrounds, this book explains how to gain insight into the management of infectious diseases through statistical modeling. With end-of-chapter exercises and glossaries of infectious disease terminology and notation, the text is suitable for a graduate-level public health course. Supplementary technical material is provided at the end of each chapter for readers with a stronger background in mathematics and an interest in the art of modeling. 


Why is the UK responding differently to most other countries?


The UK has taken a very different approach than most other countries to combating coronavirus. LBC explains the thinking behind the Prime Minister’s strategy.

Boris Johnson’s plan is to create a “herd immunity” to coronavirus, meaning that if a wide number of low-risk people get the virus, it will be harder to spread further later down the line. So what is the difference between the UK’s approach and other European countries, who have closed schools and put in travel restrictions.

LBC’s Ben Kentish explains the science behind the UK’s coronavirus strategy:

“Boris Johnson was adamant yesterday that he is confident he has taken the right approach -- as was the Chief Medical Officer and the Chief Scientific Adviser. It’s a very different approach to almost all the UK’s allies, with other western democracies going for stricter measures immediately. But they are confident that their modelling and their science shows that ultimately a lot of those measures are pointless. It’s a risky decision, because it does put the UK out on a limb, but it’s based on two fundamental predictions.”


Biosecurity Dilemmas : Dreaded Diseases, Ethical Responses, and the Health of Nations


It is worth noting that the experience of TB patients’ interests being subordinated to national interest has sometimes been a distressing one. In 2007, for example, thirteen multi-drug resistant-TB patients in South Africa who had forced their way out of a hospital and demanded to be treated as outpatients were ordered back to their beds by an interim court order. Against the argument of provincial health authorities in favor of forced isolation, the patients claimed (to no avail) that this would result in them losing their jobs and welfare benefits. Following this incident a protest by MDR- and XDR-TB patients at a Johannesburg hospital, who were calling for an end to “prison-like” conditions there, became violent, and one patient was shot. By 2008, when twenty MDR-TB patients being confined at another South African hospital attacked a nurse and security guards, uprisings of this kind were becoming commonplace in that country. Afterward, the doctor in charge of Port Elizabeth’s Jose Pearson Hospital, which has guarded gates and a perimeter fence topped with razor wire, told a BBC journalist that forced isolation was the only option: “MDR and XDR, if not controlled, are almost like biological warfare against the population.”

Although such dramatic framing of the issue can serve to legitimize strict social distancing as a biosecurity practice, there is also the risk that the perceived severity of those measures might be counterproductive to disease control. Long-term isolation might well be regarded as an effective and inexpensive response to the grave risk posed by drug-resistant TB. However, any immediate good that is achieved is probably outweighed by the long-term harmfulness of such an extreme measure. The horrific prospect of forced isolation works to drive symptomatic TB sufferers underground, away from the attention of clinical caregivers and public health practitioners, because of a “loss of community trust.” Inasmuch as those distrustful patients opt for inadequate TB drug treatment through unofficial channels, the result is likely to be an exacerbation of the very conditions that occasioned the development of drug resistance in the first place.

BOOK: Amazon

Enemark, Christian. Biosecurity Dilemmas : Dreaded Diseases, Ethical Responses, and the Health of Nations. Georgetown University Press, 2017.

Editor’s note: ‘social distancing’, as used here, is closer to the term ‘quarantine’ in common usage during the coronavirus outbreak. The prospect of quarantine is possibly leading to under-reporting, at least when it comes to self-reporting.