区域因素决定消除策略的可行性
Regional factors determine the feasibility of an elimination strategy
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中文总结 AI 辅助
该研究通过数学建模分析区域特征，明确公共卫生能力、传播率等因素决定疫情消除策略的可行性，指出旅行措施可间接保护接触者追踪能力以防控疫情。
中文摘要 AI 辅助
我们对区域特征及其产生的流行病学情况进行了明确的数学刻画，以评估利用病例隔离、接触者追踪等针对性措施实现消除或抑制策略是否可行。我们推导了一个流行病模型，其中社区成员可被旅行者或其他社区成员感染，且用于支持入境旅行者和受感染社区成员隔离的公共卫生资源存在约束。我们证明最优控制策略是立即将公共卫生措施提升至最大水平。我们发现，若公共卫生能力高、传播率低或受感染旅行者的入境率低，针对性措施可实现消除或抑制策略。研究结果表明，某国在疫情期间采用缓解策略，若改为消除策略未必能取得更好结果，因为公共卫生能力低、传播率高或旅行者入境率高的国家，消除策略可能不可行。区域特征的组合决定消除、抑制或无反弹的缓解策略是否可行。我们还发现，旅行者入境率低且有能力实施并执行入境旅行者隔离或检疫的区域，超出接触者追踪和社区成员隔离能力的可能性更小。旅行措施仅通过直接作用预防少量社区感染，但间接而言，旅行措施通过保护接触者追踪能力，可防止疫情反弹，并在疫苗或疗法研发前大幅减少疫情期间的感染人数。
英文摘要
We provide an explicit mathematical characterization of regional characteristics and the resulting epidemiology to evaluate whether elimination or suppression is feasible using targeted measures, such as case isolation and contact tracing. We derive an epidemic model where community members can be infected by either travellers or other community members, and with constraints on the public health resources available to support isolation of arriving travellers and infected community members. We prove that the optimal controls are to immediately implement public health measures at their maximum levels. We find that elimination or suppression strategies are feasible with targeted measures if public health capacity is high, the transmission rate is low, or if the arrival rate of infected travellers is low. Our results illustrate that a particular country that implemented a mitigation strategy during the pandemic may not necessarily have achieved better outcomes if it had instead implemented elimination because elimination may not have been feasible in countries with low public health capacity to support control measures, high transmission rates, or high traveller arrival rates. Combinations of regional characteristics determine whether an elimination, suppression or mitigation strategy without resurgence is feasible. We find that regions with the low traveller arrival rates and the capacity to implement and enforce isolation or quarantine of arriving travellers are less likely to exceed their capacity to contact trace and isolate community members. Travel measures prevent only a small number of community infections via their direct effect, but indirectly, by protecting contact tracing capacity, travel measures can prevent epidemic resurgence and substantially reduce the number of people infected during a pandemic before a vaccine or therapy is developed.
