Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. de Colmenar Viejo, km. 9.100, 28034 Madrid, Spain.
Deneb Medical. Paseo de Miramón, 170, 20014, San Sebastián, Spain.
Int J Epidemiol. 2021 Aug 30;50(4):1114-1123. doi: 10.1093/ije/dyab043.
BACKGROUND: There is a real possibility of successive COVID-19-epidemic waves with devastating consequences. In this context, it has become mandatory to design age-selective measures aimed at achieving an optimal balance between protecting public health and maintaining a viable economic activity. METHODS: We programmed a Susceptible, Exposed, Infected, Removed (SEIR) model in order to introduce epidemiologically relevant age classes into the outbreak-dynamics analysis. The model was fitted to the official death toll and calculated age distribution of deaths in Wuhan using a constrained linear least-squares algorithm. Subsequently, we used synthetic location-specific and age-structured contact matrices to quantify the effect of age-selective interventions both on mortality and on economic activity in Wuhan. For this purpose, we simulated four different scenarios ranging from an absence of measures to age-selective interventions with stronger physical-distancing measures for older individuals. RESULTS: An age-selective strategy could reduce the death toll by >30% compared with the non-selective measures applied during Wuhan's lockdown for the same workforce. Moreover, an alternative age-selective strategy could allow a 5-fold increase in the population working on site without a detrimental impact on the death toll compared with the Wuhan scenario. CONCLUSION: Our results suggest that age-selective-distancing measures focused on the older population could have achieved a better balance between COVID-19 mortality and economic activity during the first COVID-19 outbreak in Wuhan. However, the implications of this need to be interpreted along with considerations of the practical feasibility and potential wider benefits and drawbacks of such a strategy.
背景:新冠疫情可能会一波接一波地袭来,造成毁灭性的后果。在此背景下,必须设计针对特定年龄的措施,在保护公众健康和维持可行的经济活动之间取得最佳平衡。
方法:我们编写了一个易感者-暴露者-感染者-移除者(SEIR)模型,以便在疫情动态分析中引入具有流行病学意义的年龄类别。该模型使用受约束的线性最小二乘法算法拟合官方死亡人数和武汉的死亡年龄分布。随后,我们使用综合的特定地点和年龄结构接触矩阵来量化年龄选择干预措施对武汉死亡率和经济活动的影响。为此,我们模拟了四个不同的场景,从没有措施到对老年人实施更强有力的物理隔离措施的年龄选择干预。
结果:与武汉封锁期间实施的非选择性措施相比,年龄选择策略可使死亡人数减少 30%以上。此外,另一种替代的年龄选择策略可以使现场工作人数增加 5 倍,而与武汉的情况相比,对死亡人数没有不利影响。
结论:我们的结果表明,针对老年人的年龄选择隔离措施可能在武汉首次新冠疫情期间在新冠死亡率和经济活动之间取得了更好的平衡。然而,需要结合这种策略的实际可行性以及更广泛的潜在利益和缺点来解释其影响。
Cochrane Database Syst Rev. 2020-9-15
BMC Public Health. 2022-4-7
Epidemiol Infect. 2021-1-8
BMC Public Health. 2022-3-12
N Engl J Med. 2020-6-11
N Engl J Med. 2020-7-23