Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany, 69120.
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 100730.
J Travel Med. 2021 Feb 23;28(2). doi: 10.1093/jtm/taaa226.
In many countries, patients with mild coronavirus disease 2019 (COVID-19) are told to self-isolate at home, but imperfect compliance and shared living space with uninfected people limit the effectiveness of home-based isolation. We examine the impact of facility-based isolation compared to self-isolation at home on the continuing epidemic in the USA.
We developed a compartment model to simulate the dynamic transmission of COVID-19 and calibrated it to key epidemic measures in the USA from March to September 2020. We simulated facility-based isolation strategies with various capacities and starting times under different diagnosis rates. Our primary model outcomes are new infections and deaths over 2 months from October 2020 onwards. In addition to national-level estimations, we explored the effects of facility-based isolation under different epidemic burdens in major US Census Regions. We performed sensitivity analyses by varying key model assumptions and parameters.
We find that facility-based isolation with moderate capacity of 5 beds per 10 000 total population could avert 4.17 (95% credible interval 1.65-7.11) million new infections and 16 000 (8000-23 000) deaths in 2 months compared with home-based isolation. These results are equivalent to relative reductions of 57% (44-61%) in new infections and 37% (27-40%) in deaths. Facility-based isolation with high capacity of 10 beds per 10 000 population could achieve reductions of 76% (62-84%) in new infections and 52% (37-64%) in deaths when supported by expanded testing with an additional 20% daily diagnosis rate. Delays in implementation would substantially reduce the impact of facility-based isolation. The effective capacity and the impact of facility-based isolation varied by epidemic stage across regions.
Timely facility-based isolation for mild COVID-19 cases could substantially reduce the number of new infections and effectively curb the continuing epidemic in the USA. Local epidemic burdens should determine the scale of facility-based isolation strategies.
在许多国家，轻症 2019 冠状病毒病（COVID-19）患者被要求在家中进行自我隔离，但不完美的遵守规定和与未感染者共享居住空间限制了基于家庭的隔离的效果。我们研究了与在家中自我隔离相比，基于设施的隔离对美国国内持续流行的影响。
我们开发了一个隔室模型来模拟 COVID-19 的动态传播，并根据 2020 年 3 月至 9 月美国的关键疫情数据对其进行了校准。我们模拟了具有不同容量和起始时间的基于设施的隔离策略，在不同的诊断率下进行。我们的主要模型结果是 2020 年 10 月以后两个月内的新增感染和死亡人数。除了国家层面的估计，我们还探索了在主要美国人口普查区不同流行负担下基于设施的隔离的效果。我们通过改变关键模型假设和参数进行了敏感性分析。
我们发现，中等容量的设施隔离（每 10000 总人口 5 个床位）可避免 417 万（95%可信区间 165 万-711 万）例新感染和 1.6 万（8000 万-2.3 万）例死亡，与在家中隔离相比。这些结果相当于新感染减少 57%（44%-61%），死亡减少 37%（27%-40%）。如果在每天额外增加 20%的检测量以扩大检测的情况下，具有 10 个床位/10000 人口的高容量设施隔离，可使新感染减少 76%（62%-84%），死亡减少 52%（37%-64%）。实施延迟将大大降低基于设施的隔离的效果。不同地区的流行阶段不同，设施隔离的有效容量和影响也不同。
及时对轻症 COVID-19 病例进行基于设施的隔离可以显著减少新感染人数，并有效遏制美国国内的持续流行。当地的流行负担应决定基于设施的隔离策略的规模。
