The number of new infections per day is a key quantity for effective epidemic management. It can be estimated relatively directly by testing of random population samples. Without such direct epidemiological measurement, other approaches are required to infer whether the number of new cases is likely to be increasing or decreasing: for example, estimating the pathogen effective reproduction number, R, using data gathered from the clinical response to the disease. For Covid-19 (SARS-CoV-2) such R estimation is heavily dependent on modelling assumptions, because the available clinical case data are opportunistic observational data subject to severe temporal confounding. Given this difficulty it is useful to retrospectively reconstruct the time course of infections from the least compromised available data, using minimal prior assumptions. A Bayesian inverse problem approach applied to UK data on first wave Covid-19 deaths and the disease duration distribution suggests that fatal infections were in decline before full UK lockdown (24 March 2020), and that fatal infections in Sweden started to decline only a day or two later. An analysis of UK data using the model of Flaxman et al. (2020, Nature 584) gives the same result under relaxation of its prior assumptions on R, suggesting an enhanced role for non pharmaceutical interventions (NPIs) short of full lock down in the UK context. Similar patterns appear to have occurred in the subsequent two lockdowns. Estimates from the main UK Covid statistical surveillance surveys, available since original publication, support these results. Replication code for the paper is available in the supporting information of doi/10.1111/biom.13462.
The coronavirus disease 2019 (COVID-19) global pandemic has led many countries to impose unprecedented lockdown measures in order to slow down the outbreak. Questions on whether governments have acted promptly enough, and whether lockdown measures can be lifted soon have since been central in public discourse. Data-driven models that predict COVID-19 fatalities under different lockdown policy scenarios are essential for addressing these questions and informing governments on future policy directions. To this end, this paper develops a Bayesian model for predicting the effects of COVID-19 lockd…
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 …
A widely-used model for determining the long-term health impacts of public health interventions, often called a "multistate lifetable", requires estimates of incidence, case fatality, and sometimes also remission rates, for multiple diseases by age and gender. Generally, direct data on both incidence and case fatality are not available in every disease and setting. For example, we may know population mortality and prevalence rather than case fatality and incidence. This paper presents Bayesian continuous-time multistate models for estimating transition rates between disease states based on inc…
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…
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…
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…
The case fatality ratio (CFR) for COVID-19 is difficult to estimate. One difficulty is due to ignoring or overestimating time delay between reporting and death. We claim that all of these cause large errors and artificial time dependence of the CFR. We find that for each country, there is a unique value of the time lag between reported cases and deaths versus time, that yields the optimal correlation between them is a specific sense. We find that the resulting corrected CFR (deaths shifted back by this time lag, divided by cases) is actually constant over many months, for many countries, but a…
Understanding differences in hospital case-fatality rates (HCFRs) of coronavirus disease (COVID-19) may help evaluate its severity and the capacity of the healthcare system to reduce mortality. We examined the variability in HCFRs of COVID-19 in relation to spatial inequalities in socioeconomic factors across the city of Sao Paulo, Brazil. We found that HCFRs were higher for men and for individuals aged 60 years and older. Our models identified per capita income as a significant factor that is negatively associated with the HCFRs of COVID-19, even after adjusting by age, sex and presence of ri…
This paper aims to develop a global perspective of the complexity of the relationship between the standardised per-capita growth rate of Covid-19 cases, deaths, and the OxCGRT Covid-19 Stringency Index, a measure describing a country's stringency of lockdown policies. To achieve our goal, we use a heterogeneous intrinsic dimension estimator implemented as a Bayesian mixture model, called Hidalgo. We identify that the Covid-19 dataset may project onto two low-dimensional manifolds without significant information loss. The low dimensionality suggests strong dependency among the standardised grow…
The determination of the infection fatality rate (IFR) for the novel SARS-CoV-2 coronavirus is a key aim for many of the field studies that are currently being undertaken in response to the pandemic. The IFR together with the basic reproduction number $R_0$, are the main epidemic parameters describing severity and transmissibility of the virus, respectively. The IFR can be also used as a basis for estimating and monitoring the number of infected individuals in a population, which may be subsequently used to inform policy decisions relating to public health interventions and lockdown strategies…
Coronavirus disease 2019 (COVID-19) is associated with a very high number of casualties in the general population. Assessing the exact magnitude of this number is a non-trivial problem, as relying only on officially reported COVID-19 associated fatalities runs the risk of incurring in several kinds of biases. One of the ways to approach the issue is to compare overall mortality during the pandemic with expected mortality computed using the observed mortality figures of previous years. In this paper, we build on existing methodology and propose two ways to compute expected as well as excess mor…
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…
The coronavirus disease (COVID-19) has spread worldwide with an unprecedented impact on society. In the Philippines, several interventions such as mobility restrictions for different age groups and vaccination prioritization programs have been implemented to reduce the risks of infections and mortality. This study aimed to identify age-sex composition with greater susceptibility, longer hospitalization and higher fatality. The COVID-19 cases from March 2020 to April 2021 provided by the Department of Health Davao Region in the Philippines were analyzed. A Chi-square test was used to determine …
The COVID-19 pandemic has caused severe public health consequences in the United States. In this study, we use a hierarchical Bayesian model to estimate the age-specific COVID-19 attributable deaths over time in the United States. The model is specified by a novel non-parametric spatial approach, a low-rank Gaussian Process (GP) projected by regularised B-splines. We show that this projection defines a new GP with attractive smoothness and computational efficiency properties, derive its kernel function, and discuss the penalty terms induced by the projected GP. Simulation analyses and benchmar…
The ongoing COVID-19 pandemic has brought science to the fore of the public discourse and considering the complexity of the issues involved, with it also the challenge of effective and informative science communication. A particularly contentious topic, in that it is both highly emotional in and of itself, as well as in that it sits at the nexus of the decision-making process regarding the handling of the pandemic, which has effected lockdowns, social behaviour measures, business closures, and others, concerns the recording and the reporting of the disease mortality. To clarify a point which h…
Widespread vaccination campaigns have changed the landscape for COVID-19, vastly altering symptoms and reducing morbidity and mortality. We estimate trends in mortality by month of admission and vaccination status among those hospitalised with COVID-19 in England between March 2020 to September 2021, controlling for demographic factors and hospital load. Among 259,727 hospitalised COVID-19 cases, 51,948 (20.0%) experienced mortality in hospital. Hospitalised fatality risk ranged from 40.3% (95% confidence interval 39.4-41.3%) in March 2020 to 8.1% (7.2-9.0%) in June 2021. Older individuals and…
F. Hoffmann-La Roche Ltd（罗氏制药公司）；Max Planck Institute for Intelligent Systems（马克斯·普朗克智能系统研究所）；ETH Zurich（苏黎世联邦理工学院）；John A. Paulson School of Engineering and Applied Sciences, Harvard University（哈佛大学约翰·A·保尔森工程与应用科学学院）；Beth Israel Deaconess Medical Center, Harvard Medical School（哈佛医学院贝斯以色列女执事医疗中心）；MIT Critical Data, Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Harvard-MIT Health Sciences & Technology（哈佛-麻省理工健康科学与技术研究所医学工程与科学研究所计算生理学实验室MIT关键数据）；University Hospital of Tübingen（蒂宾根大学医院）；Kantonsspital Winterthur（温特图尔州立医院）
Coronavirus Disease 2019 (COVID-19) is an emerging respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with rapid human-to-human transmission and a high case fatality rate particularly in older patients. Due to the exponential growth of infections, many healthcare systems across the world are under pressure to care for increasing amounts of at-risk patients. Given the high number of infected patients, identifying patients with the highest mortality risk early is critical to enable effective intervention and optimal prioritisation of care. Here, we pre…
We introduce a new probabilistic model to estimate the real spread of the novel SARS-CoV-2 virus along regions or countries. Our model simulates the behavior of each individual in a population according to a probabilistic model through an inverse problem; we estimate the real number of recovered and infected people using mortality records. In addition, the model is dynamic in the sense that it takes into account the policy measures introduced when we solve the inverse problem. The results obtained in Spain have particular practical relevance: the number of infected individuals can be $17$ time…
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…
