Objectives Movement restriction policies (MRPs) are effective in preventing/delaying COVID-19 transmission but are associated with high societal cost. This study aims to estimate the health burden of the first wave of COVID-19 in China and the cost-effectiveness of early versus late implementation of MRPs to inform preparation for future waves. Methods The SEIR (susceptible, exposed, infectious, and recovered) modeling framework was adapted to simulate the health and cost outcomes of initiating MRPs at different times: rapid implementation (January 23, the real-world scenario), delayed by 1 week, delayed by 2 weeks, and delayed by 4 weeks. The end point was set as the day when newly confirmed cases reached zero. Two costing perspectives were adopted: healthcare and societal. Input data were obtained from official statistics and published literature. The primary outcomes were disability-adjusted life-years, cost, and net monetary benefit. Costs were reported in both Chinese renminbi (RMB) and US dollars (USD) at 2019 values. Results The first wave of COVID-19 in China resulted in 38 348 disability adjusted life-years lost (95% CI 19 417-64 130) and 2639 billion RMB losses (95% CI 1347-4688). The rapid implementation strategy dominated all other delayed strategies. This conclusion was robust to all scenarios tested. At a willingness-to-pay threshold of 70 892 RMB (the national annual GDP per capita) per disability-adjusted life-year saved, the probability for the rapid implementation to be the optimal strategy was 96%. Conclusions Early implementation of MRPs in response to COVID-19 reduced both the health burden and societal cost and thus should be used for future waves of COVID-19.
Purpose: It is unclear how and to what extent various infection prevention and control (IPC) policies affect the spread of an epidemic during work resumption. In order to assess the impact of IPC policies, this research addresses the results of a policy simulation in Shanghai, China, which estimates the transmission dynamics of COVID-19 under various IPC policies and offers evidence-based outcomes of work resumption policies for the world. Materials and Methods: This simulation research is based on a system dynamics (SD) model that integrates IPC work resumption policies implemented in Shanghai into the classical susceptible-exposed-infected-removed (SEIR) epidemiological model. Input data were obtained from official websites, the Baidu migration index and published literature. The SD model was validated by comparing results with real-world data. Results: The simulations show that a non-quarantined and non-staged approach to work resumption (Policy 1) would bring a small secondary outbreak of COVID-19. The quarantined but non-staged approach (Policy 2) and the non-quarantined but staged approach (Policy 3) would not bring a secondary outbreak of COVID-19. However, they both would generate more newly confirmed cases than the staged and quarantined approach (Policy 4). Moreover, the 14-day quarantine policy alone appears to be more effective in reducing transmission risk than the staged work resumption policy alone. The combined staged and quarantined IPC policy led to the fewest confirmed cases caused by work resumption in Shanghai, and the spread of COVID-19 stopped (ie, the number of newly confirmed cases reduced to zero) at the earliest date. Conclusion: Conservative IPC policies can prevent a second outbreak of COVID-19 during work resumption. The dynamic systems model designed in this study can serve as a tool to test various IPC work resumption policies, facilitating decision-making in responses to combating the COVID-19 pandemic.
Background Lockdown policies were widely adopted during the coronavirus disease 2019 (COVID-19) pandemic to control the spread of the virus before vaccines became available. These policies had significant economic impacts and caused social disruptions. Early re-opening is preferable, but it introduces the risk of a resurgence of the epidemic. Although the World Health Organization has outlined criteria for re-opening, decisions on re-opening are mainly based on epidemiologic criteria. To date, the effectiveness of re-opening policies remains unclear. Methods A system dynamics COVID-19 model, SEIHR(Q), was constructed by integrating infection prevention and control measures implemented in Wuhan into the classic SEIR epidemiological model and was validated with real-world data. The input data were obtained from official websites and the published literature. Results The simulation results showed that track-and-trace measures had significant effects on the level of risk associated with re-opening. In the case of Wuhan, where comprehensive contact tracing was implemented, there would have been almost no risk associated with re-opening. With partial contact tracing, re-opening would have led to a minor second wave of the epidemic. However, if only limited contact tracing had been implemented, a more severe second outbreak of the epidemic would have occurred, overwhelming the available medical resources. If the ability to implement a track-trace-quarantine policy is fixed, the epidemiological criteria need to be further taken into account. The model simulation revealed different levels of risk associated with re-opening under different levels of track-and-trace ability and various epidemiological criteria. A matrix was developed to evaluate the effectiveness of the re-opening policies. Conclusions The SEIHR(Q) model designed in this study can quantify the impact of various re-opening policies on the spread of COVID-19. Integrating epidemiologic criteria, the contact tracing policy, and medical resources, the model simulation predicts whether the re-opening policy is likely to lead to a further outbreak of the epidemic and provides evidence-based support for decisions regarding safe re-opening during an ongoing epidemic. Keyords COVID-19; Risk of re-opening; Effectiveness of re-opening policies; IPC measures; SD modelling.
This paper proposes Health Drive, a novel mobile healthcare platform with context-aware multiplesensor integration to promote safe driving. Health Drive employs a multi-tier vehicular social network (M-VSN) architecture that consists of three tiers: network tier, mobile device tier and cloud tier. The network tier provides communication supports, and the mobile device tier works in parallel with the cloud tier to integrate and interpret diverse sensing data. The three tiers work together to provide a seamless solution that can efficiently collect and interpret diverse sensing data in the heterogeneous environments found in vehicular networks, to deliver personalized service to drivers for safety improvement in real-time. We evaluate the system performance of Health Drive and provide results of practical experiments to show the desired functionality and feasibility of Health Drive in the real-world for safety improvement in transportation.
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