Model-based evaluation of the impact of noncompliance with public health measures on COVID-19 disease control

Abstract

The word 'pandemic' conjures dystopian images of bodies stacked in the streets and societies on the brink of collapse. Despite this frightening picture, denialism and noncompliance with public health measures are common in the historical record, for example during the 1918 Influenza pandemic or the 2015 Ebola epidemic. The unique characteristics of SARS-CoV-2 - its high reproductive number (R0), time-limited natural immunity and considerable potential for asymptomatic spread - exacerbate the public health repercussions of noncompliance with biomedical and nonpharmaceutical interventions designed to limit disease transmission. In this work, we used game theory to explore when noncompliance confers a perceived benefit to individuals, demonstrating that noncompliance is a Nash equilibrium under a broad set of conditions. We then used epidemiological modeling to explore the impact of noncompliance on short-term disease control, demonstrating that the presence of a noncompliant subpopulation prevents suppression of disease spread. Our modeling shows that the existence of a noncompliant population can also prevent any return to normalcy over the long run. For interventions that are highly effective at preventing disease spread, however, the consequences of noncompliance are borne disproportionately by noncompliant individuals. In sum, our work demonstrates the limits of free-market approaches to compliance with disease control measures during a pandemic. The act of noncompliance with disease intervention measures creates a negative externality, rendering COVID-19 disease control ineffective in the short term and making complete suppression impossible in the long term. Our work underscores the importance of developing effective strategies for prophylaxis through public health measures aimed at complete suppression and the need to focus on compliance at a population level.

Different Trends in Excess Mortality in a Central European Country Compared to Main European Regions in the Year of the COVID-19 Pandemic (2020): a Hungarian Analysis

“…Limited hospital capacity, overwhelmed intensive care units and staff shortages may also have contributed to the excess mortality [ 16 ]. Furthermore, poor adherence to Covid-19 restrictions and social distancing measures as well as loosening restrictions for economic recovery in these countries may have played a part in the further increase of excess mortality during the second wave [ 17 ]. In addition, recent data from the United Kingdom suggest that a substantial proportion of excess mortality in the second half of 2020 may have derived from long-term complications of the first wave leading to hospital readmissions and deaths [ 18 ].…”

Beyond the new normal: assessing the feasibility of vaccine-based elimination of SARS-CoV-2

“…5) were adopted independently by individuals. A full exploration of the impact of individual choices on the trajectory of the pandemic is beyond the scope of this paper, but has been explored thoroughly by us and others [61,62]. Lastly, the availability of vaccinal efficacy data limits our analysis.…”

“…For the young and healthy, once vaccinated, there may be little incentive to comply with further public health measures aimed at limiting the spread of SARS-CoV-2. If mask-wearing was difficult to incentivize in the population before the emergence of a vaccine, it stands to reason that vaccination will make it more difficult, not easier [62]. For those with limited access to the vaccine or with limited benefit from it, the pandemic will never end.…”

Beyond the new normal: Assessing the feasibility of vaccine-based suppression of SARS-CoV-2

“…We also assumed that stacking interventions (Fig 5) were adopted independently by individuals. A full exploration of the impact of individual choices on the trajectory of the pandemic is beyond the scope of this paper, but has been explored thoroughly by us and others [50,51]. Lastly, the availability of vaccinal efficacy data limits our analysis.…”

“…For the young and healthy, once vaccinated, there may be little incentive to comply with further public health measures aimed at limiting the spread of SARS-CoV-2. If mask-wearing was difficult to incentivize in the population before the deployment of a vaccine, it stands to reason that vaccination will make it more difficult, not easier [51]. For those with limited access to the vaccine or with limited benefit from it, the pandemic will never end.…”