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BACKGROUND: Thousands of school systems have struggled with the decisions about how to deliver education safely and effectively amid the COVID19 pandemic. This study evaluates the public health impact of various school reopening scenarios (when, and how to return to in-person instruction) on the spread of COVID19. METHODS: An agent-based simulation model was adapted and used to project the impact of various school reopening strategies on the number of infections, hospitalizations, and deaths in the state of Georgia during the study period, i.e., February 18th-November 24th, 2020. The tested strategies include (i) schools closed, i.e., all students receive online instruction, (ii) alternating school day, i.e., half of the students receive in-person instruction on Mondays and Wednesdays and the other half on Tuesdays and Thursdays, (iii) alternating school day for children, i.e., half of the children (ages 0-9) receive in-person instruction on Mondays and Wednesdays and the other half on Tuesdays and Thursdays, (iv) children only, i.e., only children receive in-person instruction, (v) regular, i.e., all students return to in-person instruction. We also tested the impact of universal masking in schools. RESULTS: Across all scenarios, the number of COVID19-related deaths ranged from approximately 8.8 to 9.9 thousand, the number of cumulative infections ranged from 1.76 to 1.96 million for adults and 625 to 771 thousand for children and youth, and the number of COVID19-related hospitalizations ranged from approximately 71 to 80 thousand during the study period. Compared to schools reopening August 10 with a regular reopening strategy, the percentage of the population infected reduced by 13%, 11%, 9%, and 6% in the schools closed, alternating school day for children, children only, and alternating school day reopening strategies, respectively. Universal masking in schools for all students further reduced outcome measures. CONCLUSIONS: Reopening schools following a regular reopening strategy would lead to higher deaths, hospitalizations, and infections. Hybrid in-person and online reopening strategies, especially if offered as an option to families and teachers who prefer to opt-in, provide a good balance in reducing the infection spread compared to the regular reopening strategy, while ensuring access to in-person education.
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COVID-19 , Adolescente , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , Niño , Preescolar , Simulación por Computador , Humanos , Lactante , Recién Nacido , Pandemias/prevención & control , Instituciones Académicas , EstudiantesRESUMEN
BACKGROUND: Recent research has been conducted by various countries and regions on the impact of non-pharmaceutical interventions (NPIs) on reducing the spread of COVID19. This study evaluates the tradeoffs between potential benefits (e.g., reduction in infection spread and deaths) of NPIs for COVID19 and being homebound (i.e., refraining from interactions outside of the household). METHODS: An agent-based simulation model, which captures the natural history of the disease at the individual level, and the infection spread via a contact network assuming heterogeneous population mixing in households, peer groups (workplaces, schools), and communities, is adapted to project the disease spread and estimate the number of homebound people and person-days under multiple scenarios, including combinations of shelter-in-place, voluntary quarantine, and school closure in Georgia from March 1 to September 1, 2020. RESULTS: Compared to no intervention, under voluntary quarantine, voluntary quarantine with school closure, and shelter-in-place with school closure scenarios 4.5, 23.1, and 200+ homebound adult-days were required to prevent one infection, with the maximum number of adults homebound on a given day in the range of 119 K-248 K, 465 K-499 K, 5388 K-5389 K, respectively. Compared to no intervention, school closure only reduced the percentage of the population infected by less than 16% while more than doubling the peak number of adults homebound. CONCLUSIONS: Voluntary quarantine combined with school closure significantly reduced the number of infections and deaths with a considerably smaller number of homebound person-days compared to shelter-in-place.
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COVID-19 , Personas Imposibilitadas , Adulto , Anciano , Georgia , Humanos , Cuarentena , SARS-CoV-2RESUMEN
Objectives: To evaluate the effectiveness of widespread adoption of masks or face coverings to reduce community transmission of the SARS-CoV-2 virus that causes COVID-19. Methods: We created an agent-based stochastic network simulation using a variant of the standard SEIR dynamic infectious disease model. We considered a mask order that was initiated 3.5 months after the first confirmed COVID-19 case. We varied the likelihood of individuals wearing masks from 0-100% in steps of 20% (mask adherence) and considered 25% to 90% mask-related reduction in viral transmission (mask efficacy). Sensitivity analyses assessed early (by week 13) versus late (by week 42) adoption of masks and geographic differences in adherence (highest in urban and lowest in rural areas). Results: Introduction of mask use with 50% efficacy worn by 50% of individuals reduces the cumulative infection attack rate (IAR) by 27%, the peak prevalence by 49%, and population-wide mortality by 29%. If 90% of individuals wear 50% efficacious masks, this decreases IAR by 54%, peak prevalence by 75%, and population-wide mortality by 55%; similar improvements hold if 70% of individuals wear 75% efficacious masks. Late adoption reduces IAR and deaths by 18% or more compared to no adoption. Lower adoption in rural areas than urban would lead to rural areas having the highest IAR. Conclusions: Even after community transmission of SARS-CoV-2 has been established, adoption of mask-wearing by a majority of community-dwelling individuals can meaningfully reduce the number and outcome of COVID-19 infections over and above physical distancing interventions.
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As the spread of COVID19 in the US continues to grow, local and state officials face difficult decisions about when and how to transition to a "new normal." The goal of this study is to project the number of COVID19 infections and resulting severe outcomes, and the need for hospital capacity under social distancing, particularly, shelter-in-place and voluntary quarantine for the State of Georgia. We developed an agent-based simulation model to project the infection spread. The model utilizes COVID19-specific parameters and data from Georgia on population interactions and demographics. The simulation study covered a seven and a half-month period, testing different social distancing scenarios, including baselines (no-intervention or school closure only) and combinations of shelter-in-place and voluntary quarantine with different timelines and compliance levels. The following outcomes are compared at the state and community levels: the number and percentage of cumulative and daily new symptomatic and asymptomatic infections, hospitalizations, and deaths; COVID19-related demand for hospital beds, ICU beds, and ventilators. The results suggest that shelter-in-place followed by voluntary quarantine reduced peak infections from approximately 180K under no intervention and 113K under school closure, respectively, to below 53K, and delayed the peak from April to July or later. Increasing shelter-in-place duration from four to five weeks yielded 2-9% and 3-11% decrease in cumulative infection and deaths, respectively. Regardless of the shelter-in-place duration, increasing voluntary quarantine compliance decreased daily new infections from almost 53K to 25K, and decreased cumulative infections by about 50%. The cumulative number of deaths ranged from 6,660 to 19,430 under different scenarios. Peak infection date varied across scenarios and counties; on average, increasing shelter-in-place duration delayed the peak day by 6 days. Overall, shelter-in-place followed by voluntary quarantine substantially reduced COVID19 infections, healthcare resource needs, and severe outcomes.