SARS-CoV-2 surveillance by wastewater-based epidemiology is poised to provide a complementary approach to sequencing individual cases. However, robust quantification of variants and de novo detection of emerging variants remains challenging for existing strategies. We deep sequenced 3,413 wastewater samples representing 94 municipal catchments, covering >59% of the population of Austria, from December 2020 to February 2022. Our system of variant quantification in sewage pipeline designed for robustness (termed VaQuERo) enabled us to deduce the spatiotemporal abundance of predefined variants from complex wastewater samples. These results were validated against epidemiological records of >311,000 individual cases. Furthermore, we describe elevated viral genetic diversity during the Delta variant period, provide a framework to predict emerging variants and measure the reproductive advantage of variants of concern by calculating variant-specific reproduction numbers from wastewater. Together, this study demonstrates the power of national-scale WBE to support public health and promises particular value for countries without extensive individual monitoring.
The decline of active COVID-19 cases in many countries in the world has proved that lockdown policies are indeed a very effective measure to stop the exponential spread of the virus. Still, the danger of a second wave of infections is omnipresent and it is clear, that every policy of the lockdown has to be carefully evaluated and possibly replaced by a different, less restrictive policy, before it can be lifted. Tracing of contacts and consequential tracing and breaking of infection-chains is a promising and comparably straightforward strategy to help containing the disease, although its precise impact on the epidemic is unknown. In order to quantify the benefits of tracing and similar policies we developed an agent-based model that not only validly depicts the spread of the disease, but allows for exploratory analysis of containment policies. We will describe our model and perform case studies in which we use the model to quantify impact of contact tracing in different characteristics and draw valuable conclusions about contact tracing policies in general.
Background Many countries have already gone through several infection waves and mostly managed to successfully stop the exponential spread of SARS-CoV-2 through bundles of restrictive measures. Still, the danger of further waves of infections is omnipresent, and it is apparent that every containment policy must be carefully evaluated and possibly replaced by a different, less restrictive policy before it can be lifted. Tracing of contacts and consequential breaking of infection chains is a promising strategy to help contain the disease, although its precise impact on the epidemic is unknown. Objective In this work, we aim to quantify the impact of tracing on the containment of the disease and investigate the dynamic effects involved. Design We developed an agent-based model that validly depicts the spread of the disease and allows for exploratory analysis of containment policies. We applied this model to quantify the impact of different approaches of contact tracing in Austria to derive general conclusions on contract tracing. Results The study displays that strict tracing complements other intervention strategies. For the containment of the disease, the number of secondary infections must be reduced by about 75%. Implementing the proposed tracing strategy supplements measures worth about 5%. Evaluation of the number of preventively quarantined persons shows that household quarantine is the most effective in terms of avoided cases per quarantined person. Limitations The results are limited by the validity of the modeling assumptions, model parameter estimates, and the quality of the parametrization data. Conclusions The study shows that tracing is indeed an efficient measure to keep case numbers low but comes at a high price if the disease is not well contained. Therefore, contact tracing must be executed strictly, and adherence within the population must be held up to prevent uncontrolled outbreaks of the disease.
In health care the reimbursement of medical providers is an important topic and can influence the overall outcome. We present the agent-based GAP-DRG model, which allows a comparison of reimbursement schemes in outpatient care. It models patients and medical providers as agents. In the simulation patients develop medical problems (i.e., diseases) and a need for medical services. This leads to utilization of medical providers. The reimbursement system receives information on the patients' visits via its generic interface, which facilitates an easy replacement. We describe the assumptions of the model in detail and show how it makes extensive use of available Austrian routine care data for its parameterization. The model design is optimized for utilizing as much of these data as possible. However, many assumptions have to be simplifications. Further work and detailed comparisons with health care data will provide insight on which assumptions are valid descriptions of the real process.
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