In India the COVID-19 infected population has not yet been accurately established. As always in the early stages of any epidemic, the need to test serious cases first has meant that the population with asymptomatic or mild sub-clinical symptoms has not yet been analyzed. Using counts of fatalities, and previously estimated parameters for the progress of the disease, we give statistical estimates of the infected population. The doubling time is a crucial unknown input parameter which affects these estimates, and may differ strongly from one geographical location to another. We suggest a method for estimating epidemiological parameters for COVID-19 in different locations within a few days, so adding to the information required for gauging the success of public health interventions
We analyzed 5,484 close contacts of COVID-19 cases from Italy, all of them tested for SARS-CoV-2 infection. We found an infection fatality ratio of 2.2% (95%CI 1.69-2.81%) and identified male sex, age >70 years, cardiovascular comorbidities, and infection early in the epidemics as risk factors for death.
The first cases of COVID-19 in France were detected on January 24, 2020. The number of screening tests carried out and the methodology used to target the patients tested do not allow for a direct computation of the real number of cases and the mortality rate.In this report, we develop a 'mechanistic-statistical' approach coupling a SIR ODE model describing the unobserved epidemiological dynamics, a probabilistic model describing the data acquisition process and a statistical inference method. The objective of this model is not to make forecasts but to estimate the real number of people infecte…
Epidemic parameters are estimated through Bayesian inference using the daily fatality counts in Mumbai during the period from March 31 to April 14. A doubling time of 5.5 days (median with 95% CrI of 4.6-6.9 days) is observed. In the SEIR model this gives the basic reproduction rate R_0 of 3.4 (median with 95% CrI of 2.4-4.8). Using as input the infection fatality rate and the interval between infection and death, the number of infections in Mumbai is inferred. It is found that the ratio of the number of test positives to the total infections is 0.13\% (median), implying that tests are current…
Different ways of calculating mortality ratios during epidemics have yielded very different results, particularly during the current COVID-19 pandemic. We formulate both a survival probability model and an associated infection duration-dependent SIR model to define individual- and population-based estimates of dynamic mortality ratios. The key parameters that affect the dynamics of the different mortality estimates are the incubation period and the time individuals were infected before confirmation of infection. We stress that none of these ratios are accurately represented by the often misint…
The infection fatality rate (IFR) of COVID-19 is one of the measures of disease impact that can be of importance for policy making. Here we show that many of the studies on which these estimates are based are scientifically flawed for reasons which include: nonsensical equations, unjustified assumptions, small sample sizes, non-representative sampling (systematic biases), incorrect definitions of symptomatic and asymptomatic cases (identified and unidentified cases), typically assuming that cases which are asymptomatic at the time of testing are the same as completely asymptomatic (never sympt…
The infection fatality rate (IFR) of the Coronavirus Disease 2019 (COVID-19) is one of the most discussed figures in the context of this pandemic. Using German COVID-19 surveillance data and age-group specific IFR estimates from multiple international studies, this work investigates time-dependent variations in effective IFR over the course of the pandemic. Three different methods for estimating (effective) IFRs are presented: (a) population-averaged IFRs based on the assumption that the infection risk is independent of age and time, (b) effective IFRs based on the assumption that the age dist…
Relevance: Laboratory diagnosis of the novel coronavirus (SARS-CoV-2) infection combined with quarantine for contacts of infected individuals affects the spread of SARS-CoV-2 infection and levels of related mortality. Practices for testing for SARS-CoV-2 infection vary geographically in Russia. For example, in the city of St. Petersburg, where mortality rate for COVID-19 is the highest in the Russian Federation on Oct. 25, 2020, every death for COVID-19 corresponds to 15.7 detected cases of COVID-19 in the population, while the corresponding number for the whole of Russia is 58.1, suggesting l…
SARS-CoV-2 has disrupted the life of billions of people around the world since the first outbreak was officially declared in China at the beginning of 2020. Yet, important questions such as how deadly it is or its degree of spread within different countries remain unanswered. In this work, we exploit the `universal' growth of the mortality rate with age observed in different countries since the beginning of their respective outbreaks, combined with the results of the antibody prevalence tests in the population of Spain, to unveil both unknowns. We validate these results with an analogous antib…
There are many hard-to-reconcile numbers circulating concerning Covid-19. Using reports from random testing, the fatality ratio per infection is evaluated and used to extract further information on the actual fraction of infections and the success of their identification for different countries.
Understanding Covid-19 lethality and its variation from country to country is essential for supporting governments in the choice of appropriate strategies. Adopting correct indicators to monitor the lethality of the infection in the course of the outbreak is a crucial issue. This works highlights how far the time-dependent case fatality rate is a misleading indicator for estimating the fatality in the course of the outbreak, even if our attention is only restricted to the subset of confirmed cases. Our analysis proves that the final case fatality ratio for several major European countries is b…
Background: Recent work showed that the temporal growth of the novel coronavirus disease (COVID-19) follows a sub-exponential power-law scaling whenever effective control interventions are in place. Taking this into consideration, we present a new phenomenological logistic model that is well-suited for such power-law epidemic growth. Methods: We empirically develop the logistic growth model using simple scaling arguments, known boundary conditions and a comparison with available data from four countries, Belgium, China, Denmark and Germany, where (arguably) effective containment measures were …
The effective reproduction number is a key figure to monitor the course of the COVID-19 pandemic. In this study we consider a retrospective modelling approach for estimating the effective reproduction number based on death counts during the first year of the pandemic in Germany. The proposed Bayesian hierarchical model incorporates splines to estimate reproduction numbers flexibly over time while adjusting for varying effective infection fatality rates. The approach also provides estimates of dark figures regarding undetected infections over time. Results for Germany illustrate that estimated …
We analyse the temporal and regional structure in mortality rates related to COVID-19 infections. We relate the fatality date of each deceased patient to the corresponding day of registration of the infection, leading to a nowcasting model which allows us to estimate the number of present-day infections that will, at a later date, prove to be fatal. The numbers are broken down to the district level in Germany. Given that death counts generally provide more reliable information on the spread of the disease compared to infection counts, which inevitably depend on testing strategy and capacity, t…
Solid estimates describing the clinical course of SARS-CoV-2 infections are still lacking due to under-ascertainment of asymptomatic and mild-disease cases. In this work, we quantify age-specific probabilities of transitions between stages defining the natural history of SARS-CoV-2 infection from 1,965 SARS-CoV-2 positive individuals identified in Italy between March and April 2020 among contacts of confirmed cases. Infected contacts of cases were confirmed via RT-PCR tests as part of contact tracing activities or retrospectively via IgG serological tests and followed-up for symptoms and clini…
Determinants of COVID-19 clinical severity are commonly assessed by transverse or longitudinal studies of the fatality counts. However, the fatality counts depend both on disease clinical severity and transmissibility, as more infected also lead to more deaths. Moreover, fatality counts (and related measures such as Case Fatality Rate) are dynamic quantities, as they appear with a delay to infections, while different geographic regions generally belong to different points on the epidemics curve. Instead, we use epidemiological modeling to propose a disease severity measure, which accounts for …
We comparatively analyzed the spatiotemporal fluctuations of the 2019-novel coronavirus (COVID-19) and SARS outbreaks to understand their epidemiological characteristics. Methodologically, we introduced TPL (Taylor power law) to characterize their spatiotemporal heterogeneity/stability and Hubbell (2001) unified neutral theory of biodiversity (UNTB) [specifically Harris et al. (2015) HDP-MSN model (hierarchical Dirichlet process multi-site neutral model)] to approximate the metapopulation of coronavirus infections. First, TPL analysis suggested that the coronaviruses appear to have a specific …
The fatality rate of Covid-19 escalates with age and is larger in men than women. I show that these variations correlate strongly with the level of the viral receptor protein ACE2 in rat lungs, which is consistent with the still limited and apparently contradictory data on human ACE2. Surprisingly, lower levels of the receptor correlate with higher fatality. However, a previous mathematical model predicts that the speed of viral progression in the organism has a maximum and then declines with the receptor level. Moreover, many manifestations of severe CoViD-19, such as severe lung injury, exac…
Understanding how widely COVID-19 has spread is critical for examining the pandemic's progression. Despite efforts to carefully monitor the pandemic, the number of confirmed cases may underestimate the total number of infections. We introduce a demographic scaling model to estimate COVID-19 infections using an broadly applicable approach that is based on minimal data requirements: COVID-19 related deaths, infection fatality rates (IFRs), and life tables. As many countries lack reliable estimates of age-specific IFRs, we scale IFRs between countries using remaining life expectancy as a marker t…
An epidemic disease caused by a new coronavirus has spread in Northern Italy with a strong contagion rate. We implement an SEIR model to compute the infected population and number of casualties of this epidemic. The example may ideally regard the situation in the Italian Region of Lombardy, where the epidemic started on February 25. We calibrate the model with the number of dead individuals to date (May 5, 2020) and constraint the parameters on the basis of values reported in the literature. The peak occurs at day 37 (March 31) approximately, when there is a rapid decrease, with a reproduction…
In the absence of other tools, monitoring the effects of protective measures, including social distancing and forecasting the outcome of outbreaks is of immense interest. Real-time data is noisy and very often hampered by systematic errors in reporting. Detailed epidemic models may contain a large number of empirical parameters, which cannot be determined with sufficient accuracy. In this paper, we show that the cumulative number of deaths can be regarded as a master variable, and the parameters of the epidemic such as the basic reproduction number, the size of the susceptible population, and …
In this short note we model the region-wise trends of the evolution to COVID-19 infections using a stochastic SIR model. The SIR dynamics are expressed using \textit{Itô-stochastic differential equations}. We first derive the parameters of the model from the available daily data from European regions based on a 24-day history of infections, recoveries and deaths. The derived parameters have been aggregated to project future trends for the Indian subcontinent, which is currently at an early stage in the infection cycle. The projections are meant to serve as a guideline for strategizing the soci…
There are many sources of data giving information about the number of SARS-CoV-2 infections in the population, but all have major drawbacks, including biases and delayed reporting. For example, the number of confirmed cases largely underestimates the number of infections, deaths lag infections substantially, while test positivity rates tend to greatly overestimate prevalence. Representative random prevalence surveys, the only putatively unbiased source, are sparse in time and space, and the results come with a big delay. Reliable estimates of population prevalence are necessary for understandi…
Indian Institute of Technology, Delhi（印度理工学院德里分校）；AFMC, Pune（武装部队医学院，浦那）；CMC Ludhiana（卢迪亚纳基督教医学院）
As the second wave in India mitigates, COVID-19 has now infected about 29 million patients countrywide, leading to more than 350 thousand people dead. As the infections surged, the strain on the medical infrastructure in the country became apparent. While the country vaccinates its population, opening up the economy may lead to an increase in infection rates. In this scenario, it is essential to effectively utilize the limited hospital resources by an informed patient triaging system based on clinical parameters. Here, we present two interpretable machine learning models predicting the clinica…
The second wave of Covid-19 that started in mid-February 2021 in Mumbai is now subsiding. Increasingly the focus amongst the policy makers and general public is on the potential third wave. Due to uncertainties regarding emergence of new variants and reinfections, instead of projecting our best guess scenario, in this report we conduct an extensive scenario analysis for Mumbai and track peak fatalities in the coming months in each of these scenarios. Our key conclusions are - As per our model, about 80% of Mumbai population has been exposed to Covid-19 by June 1, 2021. Under the assumption tha…
Using a simple economic model in which social-distancing reduces contagion, we study the implications of waning immunity for the epidemiological dynamics and social activity. If immunity wanes, we find that COVID-19 likely becomes endemic and that social-distancing is here to stay until the discovery of a vaccine or cure. But waning immunity does not necessarily change optimal actions on the onset of the pandemic. Decentralized equilibria are virtually independent of waning immunity until close to peak infections. For centralized equilibria, the relevance of waning immunity decreases in the pr…
I use a very simple deterministic model for the spread of Covid-19 in a large population. Using this to compare the relative decay of the number of deaths per day between different regions in Italy, Spain and England, each applying in principle the same social distancing procedures across the whole country, I obtain an estimate of the total fraction of the population which had already become infected by April 10th. In the most heavily affected regions, Lombardy, Madrid and London, this fraction is higher than expected, i.e. $\approx 0.3$. This result can then be converted to a determination of…
A pandemic caused by a new coronavirus (COVID-19) has spread worldwide, inducing an epidemic still active in Argentina. In this chapter, we present a case study using an SEIR (Susceptible-Exposed-Infected-Recovered) diffusion model of fractional order in time to analyze the evolution of the epidemic in Buenos Aires and neighboring areas (Región Metropolitana de Buenos Aires, (RMBA)) comprising about 15 million inhabitants. In the SEIR model, individuals are divided into four classes, namely, susceptible (S), exposed (E), infected (I) and recovered (R). The SEIR model of fractional order allows…
Recent analysis of early COVID-19 data from China showed that the number of confirmed cases followed a subexponential power-law increase, with a growth exponent of around 2.2 [B.\,F.~Maier, D.~Brockmann, {\it Science} {\bf 368}, 742 (2020)]. The power-law behavior was attributed to a combination of effective containment and mitigation measures employed as well as behavioral changes by the population. In this work, we report a random walk Monte Carlo simulation study of proximity-based infection spread. Control interventions such as lockdown measures and mobility restrictions are incorporated i…
Large scale virological testing of SARS-Cov2 is implemented since May 2020 in France. We assume that the positivity of asymptomatic people not being contact cases (ANBC) is representative of the positivity of the whole French population, which allows estimating the real incidence. We estimate, using Santé Public France reports, that the incidence at the beginning of August was about 0.8% and rose to about 2.4% of the total population at the beginning of September. This corresponds to about 1.6 million people simultaneously infected and 230.000 new infections each day. These evaluations allow t…
A number of models in mathematical epidemiology have been developed to account for control measures such as vaccination or quarantine. However, COVID-19 has brought unprecedented social distancing measures, with a challenge on how to include these in a manner that can explain the data but avoid overfitting in parameter inference. We here develop a simple time-dependent model, where social distancing effects are introduced analogous to coarse-grained models of gene expression control in systems biology. We apply our approach to understand drastic differences in COVID-19 infection and fatality c…
Following the emergence of a novel coronavirus (SARS-CoV-2) and its spread outside of China, Europe has experienced large epidemics. In response, many European countries have implemented unprecedented non-pharmaceutical interventions including case isolation, the closure of schools and universities, banning of mass gatherings and/or public events, and most recently, wide-scale social distancing including local and national lockdowns. In this technical update, we extend a semi-mechanistic Bayesian hierarchical model that infers the impact of these interventions and estimates the number of infec…
A pandemic caused by a new coronavirus has spread worldwide, affecting Argentina. We implement an SEIR model to analyze the disease evolution in Buenos Aires and neighbouring cities. The model parameters are calibrated using the number of casualties officially reported. Since infinite solutions honour the data, we show different cases. In all of them the reproduction ratio $R_0$ decreases after early lockdown, but then raises, probably due to an increase in contagion in highly populated slums. Therefore it is mandatory to reverse this growing trend in $R_0$ by applying control strategies to av…
Knowing the infection fatality ratio (IFR) is of crucial importance for evidence-based epidemic management: for immediate planning; for balancing the life years saved against the life years lost due to the consequences of management; and for evaluating the ethical issues associated with the tacit willingness to pay substantially more for life years lost to the epidemic, than for those to other diseases. Against this background Verity et al. (2020, Lancet Infections Diseases) have rapidly assembled case data and used statistical modelling to infer the IFR for COVID-19. We have attempted an in-d…
The 2019-Novel-Coronavirus (COVID-19) has affected 116 countries (By March 12) and out of more than 118,000 confirmed cases. Understanding the transmission dynamics of the infection in each country which affected on a daily basis and evaluating the effectiveness of control policies is critical for our further actions. To date, the statistics of COVID-19 reported cases show more than 80 percent of infected had a mild case of disease, while around 14 percent of infected experienced a severe one and about 5 percent are categorized as critical disease victims. Today's report (2020-03-12; daily upd…
Mechanistic models fit to streaming surveillance data are critical to understanding the transmission dynamics of an outbreak as it unfolds in real-time. However, transmission model parameter estimation can be imprecise, and sometimes even impossible, because surveillance data are noisy and not informative about all aspects of the mechanistic model. To partially overcome this obstacle, Bayesian models have been proposed to integrate multiple surveillance data streams. We devised a modeling framework for integrating SARS-CoV-2 diagnostics test and mortality time series data, as well as seropreva…
Coronavirus outbreak is one of the most challenging pandemics for the entire human population of the planet Earth. Techniques such as the isolation of infected persons and maintaining social distancing are the only preventive measures against the epidemic COVID-19. The actual estimation of the number of infected persons with limited data is an indeterminate problem faced by data scientists. There are a large number of techniques in the existing literature, including reproduction number, the case fatality rate, etc., for predicting the duration of an epidemic and infectious population. This pap…
The SIR evolutionary model predicts too sharp a decrease of the fractions of people infected with COVID-19 in France after the start of the national lockdown, compared to what is observed. I fit the daily hospital data: arrivals in regular and critical care units, releases and deaths, using extended SEIR models. These involve ratios of evolutionary timescales to branching fractions, assumed uniform throughout a country, and the basic reproduction number, $R_0$, before and during the national lockdown, for each region of France. The joint-region Bayesian analysis allows precise evaluations of t…
Non-pharmacologic interventions (NPIs) are one method to mitigate the spread and effects of the COVID-19 pandemic in the United States. NPIs promote protective actions to reduce exposure risk and can reduce mobility patterns within communities. Growing research literature suggests that socially vulnerable populations are disproportionately impacted with higher infection and higher fatality rates of COVID-19, though there is limited understanding of the underlying mechanisms to this health disparity. Thus, the research examines two distinct and complimentary datasets at a granular scale for fiv…
