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Deaths from undetected COVID-19 infections as a fraction of COVID-19 deaths can be used for early detection of an upcoming epidemic wave

With countries across the world facing repeated epidemic waves, it becomes critical to monitor, mitigate and prevent subsequent waves. Common indicators like active case numbers may not be sensitive enough in the presence of systemic inefficiencies like insufficient testing or contact tracing. Test...

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Autores principales: Rangayyan, Yashaswini Mandayam, Kidambi, Sriram, Raghavan, Mohan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022783/
https://www.ncbi.nlm.nih.gov/pubmed/36930586
http://dx.doi.org/10.1371/journal.pone.0283081
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author Rangayyan, Yashaswini Mandayam
Kidambi, Sriram
Raghavan, Mohan
author_facet Rangayyan, Yashaswini Mandayam
Kidambi, Sriram
Raghavan, Mohan
author_sort Rangayyan, Yashaswini Mandayam
collection PubMed
description With countries across the world facing repeated epidemic waves, it becomes critical to monitor, mitigate and prevent subsequent waves. Common indicators like active case numbers may not be sensitive enough in the presence of systemic inefficiencies like insufficient testing or contact tracing. Test positivity rates are sensitive to testing strategies and cannot estimate the extent of undetected cases. Reproductive numbers estimated from logarithms of new incidences are inaccurate in dynamic scenarios and not sensitive enough to capture changes in efficiencies. Systemic fatigue results in lower testing, inefficient tracing and quarantining thereby precipitating the onset of the epidemic wave. We propose a novel indicator for detecting the slippage of test-trace efficiency based on the number of deaths/hospitalizations resulting from known and hitherto unknown infections. This can also be used to forecast an epidemic wave that is advanced or exacerbated due to a drop in efficiency in situations where the testing has come down drastically and contact tracing is virtually nil as is prevalent currently. Using a modified SEIRD epidemic simulator we show that (i) Ratio of deaths/hospitalizations from an undetected infection to total deaths converges to a measure of systemic test-trace inefficiency. (ii) This index forecasts the slippage in efficiency earlier than other known metrics. (iii) Mitigation triggered by this index helps reduce peak active caseload and eventual deaths. Deaths/hospitalizations accurately track the systemic inefficiencies and detect latent cases. Based on these results we make a strong case that administrations use this metric in the ensemble of indicators. Further, hospitals may need to be mandated to distinctly register deaths/hospitalizations due to previously undetected infections. Thus the proposed metric is an ideal indicator of an epidemic wave that poses the least socio-economic cost while keeping the surveillance robust during periods of pandemic fatigue.
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spelling pubmed-100227832023-03-18 Deaths from undetected COVID-19 infections as a fraction of COVID-19 deaths can be used for early detection of an upcoming epidemic wave Rangayyan, Yashaswini Mandayam Kidambi, Sriram Raghavan, Mohan PLoS One Research Article With countries across the world facing repeated epidemic waves, it becomes critical to monitor, mitigate and prevent subsequent waves. Common indicators like active case numbers may not be sensitive enough in the presence of systemic inefficiencies like insufficient testing or contact tracing. Test positivity rates are sensitive to testing strategies and cannot estimate the extent of undetected cases. Reproductive numbers estimated from logarithms of new incidences are inaccurate in dynamic scenarios and not sensitive enough to capture changes in efficiencies. Systemic fatigue results in lower testing, inefficient tracing and quarantining thereby precipitating the onset of the epidemic wave. We propose a novel indicator for detecting the slippage of test-trace efficiency based on the number of deaths/hospitalizations resulting from known and hitherto unknown infections. This can also be used to forecast an epidemic wave that is advanced or exacerbated due to a drop in efficiency in situations where the testing has come down drastically and contact tracing is virtually nil as is prevalent currently. Using a modified SEIRD epidemic simulator we show that (i) Ratio of deaths/hospitalizations from an undetected infection to total deaths converges to a measure of systemic test-trace inefficiency. (ii) This index forecasts the slippage in efficiency earlier than other known metrics. (iii) Mitigation triggered by this index helps reduce peak active caseload and eventual deaths. Deaths/hospitalizations accurately track the systemic inefficiencies and detect latent cases. Based on these results we make a strong case that administrations use this metric in the ensemble of indicators. Further, hospitals may need to be mandated to distinctly register deaths/hospitalizations due to previously undetected infections. Thus the proposed metric is an ideal indicator of an epidemic wave that poses the least socio-economic cost while keeping the surveillance robust during periods of pandemic fatigue. Public Library of Science 2023-03-17 /pmc/articles/PMC10022783/ /pubmed/36930586 http://dx.doi.org/10.1371/journal.pone.0283081 Text en © 2023 Rangayyan et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rangayyan, Yashaswini Mandayam
Kidambi, Sriram
Raghavan, Mohan
Deaths from undetected COVID-19 infections as a fraction of COVID-19 deaths can be used for early detection of an upcoming epidemic wave
title Deaths from undetected COVID-19 infections as a fraction of COVID-19 deaths can be used for early detection of an upcoming epidemic wave
title_full Deaths from undetected COVID-19 infections as a fraction of COVID-19 deaths can be used for early detection of an upcoming epidemic wave
title_fullStr Deaths from undetected COVID-19 infections as a fraction of COVID-19 deaths can be used for early detection of an upcoming epidemic wave
title_full_unstemmed Deaths from undetected COVID-19 infections as a fraction of COVID-19 deaths can be used for early detection of an upcoming epidemic wave
title_short Deaths from undetected COVID-19 infections as a fraction of COVID-19 deaths can be used for early detection of an upcoming epidemic wave
title_sort deaths from undetected covid-19 infections as a fraction of covid-19 deaths can be used for early detection of an upcoming epidemic wave
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022783/
https://www.ncbi.nlm.nih.gov/pubmed/36930586
http://dx.doi.org/10.1371/journal.pone.0283081
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