Diao Jiahao, Chisholm Rebecca H, Geard Nicholas, McCaw James M
School of Mathematics and Statistics, The University of Melbourne, Parkville, Victoria, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
Infect Dis Model. 2025 Jul 9;10(4):1307-1321. doi: 10.1016/j.idm.2025.07.003. eCollection 2025 Dec.
As demonstrated during the COVID-19 pandemic, non-pharmaceutical interventions, such as case isolation, are an important element of pandemic response. The overall impact of case isolation on epidemic dynamics depends on a number of factors, including the timing of isolation relative to the onset of contagiousness for each individual instructed to isolate by public health authorities. While there is an extensive literature examining the importance of minimising the delay from exposure to direction to isolate in determining the impact of case isolation policy, less is known about how underlying epidemic dynamics may also contribute to that impact. Empirical observation and modelling studies have shown that, as an epidemic progresses, the distribution of viral loads among cases changes systematically. In principle, this may allow for more targeted and efficient isolation strategies to be implemented. Here, we describe a multi-scale agent-based model developed to investigate how isolation strategies that account for cases viral loads could be incorporated into policy. We compare the impact and efficiency of isolation strategies in which all cases, regardless of their viral load, are required to isolate to strategies in which some cases may be exempt from isolation. Our findings show that, following the epidemic peak, the vast majority of cases identified with a low viral load are in the declining phase of their infection and so contribute less to overall contagiousness. This observation prompts the question about the potential public health value of discontinuing isolation for such individuals. Our numerical investigation of this 'adaptive' strategy shows that exempting individuals with low viral loads from isolation following the epidemic peak leads to a modest increase in new infections. Surprisingly, it also leads to a in efficiency, as measured by the average number of infections averted per isolated case. Our findings therefore suggest caution in adopting such flexible or adaptive isolation policies. Our multi-scale modelling framework is sufficiently flexible to enable extensive numerical evaluation of more complex isolation strategies that incorporate more disease-specific biological and epidemiological features, supporting the development and evaluation of future public health pandemic response plans.
正如在新冠疫情期间所显示的那样,非药物干预措施,如病例隔离,是应对疫情的重要组成部分。病例隔离对疫情动态的总体影响取决于许多因素,包括相对于公共卫生当局指示隔离的每个个体的传染性开始时间的隔离时机。虽然有大量文献研究了在确定病例隔离政策的影响时尽量减少从接触到指示隔离的延迟的重要性,但对于潜在的疫情动态如何也可能促成这种影响却知之甚少。实证观察和建模研究表明,随着疫情的发展,病例之间病毒载量的分布会系统性地变化。原则上,这可能允许实施更有针对性和高效的隔离策略。在这里,我们描述了一个基于多尺度主体的模型,该模型旨在研究如何将考虑病例病毒载量的隔离策略纳入政策。我们比较了要求所有病例(无论其病毒载量如何)进行隔离的策略与一些病例可能免于隔离的策略的影响和效率。我们的研究结果表明,在疫情高峰之后,绝大多数病毒载量低的病例处于感染的下降阶段,因此对总体传染性的贡献较小。这一观察结果引发了关于对这类个体停止隔离的潜在公共卫生价值的问题。我们对这种“适应性”策略的数值研究表明,在疫情高峰之后免除病毒载量低的个体的隔离会导致新感染病例略有增加。令人惊讶的是,以每个隔离病例避免的平均感染数来衡量,这也会导致效率降低。因此,我们的研究结果表明在采用这种灵活或适应性隔离政策时要谨慎。我们的多尺度建模框架足够灵活,能够对纳入更多疾病特异性生物学和流行病学特征的更复杂隔离策略进行广泛的数值评估,支持未来公共卫生疫情应对计划的制定和评估。