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Article ; Online: Impact of Vaccination and Nonpharmaceutical Interventions With Possible COVID-19 Viral Evolutions Using an Agent-Based Simulation.

Lee, Serin / Zabinsky, Zelda B / Wasserheit, Judith N / Ross, Jennifer M / Chen, Shi / Liu, Shan

AJPM focus

2023 Volume 3, Issue 1, Page(s) 100155

Abstract: Introduction: The COVID-19 pandemic continues with highly contagious variants and waning immunity. As the virus keeps evolving to be more infectious and immune evasive, some question whether the COVID-19 pandemic can be managed through sustainable ... ...

Abstract	Introduction: The COVID-19 pandemic continues with highly contagious variants and waning immunity. As the virus keeps evolving to be more infectious and immune evasive, some question whether the COVID-19 pandemic can be managed through sustainable public health measures. Methods: We developed an agent-based simulation to explore the impact of COVID-19 mutations, periodic vaccinations, and nonpharmaceutical interventions on reducing COVID-19 deaths. The model is calibrated to the greater Seattle area by observing local epidemic data. We perform scenario analyses on viral mutations that change infectiousness, disease severity, and immune evasiveness from previous infections and vaccination every 6 months. The simulation is run until the end of year 2023. Results: Variants with increased infectivity or increased immune evasion dominate previous strains. With enhanced immune protection from a pancoronavirus vaccine, the most optimistic periodic vaccination rate reduces average total deaths by 44.6% compared with the most pessimistic periodic vaccination rate. A strict threshold nonpharmaceutical intervention policy reduces average total deaths by 71.3% compared with an open society, whereas a moderate nonpharmaceutical intervention policy results in a 33.6% reduction. Conclusions: Our findings highlight the potential benefits of pancoronavirus vaccines that offer enhanced and longer-lasting immunity. We emphasize the crucial role of nonpharmaceutical interventions in reducing COVID-19 deaths regardless of virus mutation scenarios. Owing to highly immune evasive and contagious SARS-CoV-2 variants, most scenarios in this study fail to reduce the mortality of COVID-19 to the level of influenza and pneumonia. However, our findings indicate that periodic vaccinations and a threshold nonpharmaceutical intervention policy may succeed in achieving this goal. This indicates the need for caution and vigilance in managing a continuing COVID-19 epidemic.
Language	English
Publishing date	2023-10-10
Publishing country	England
Document type	Journal Article
ISSN	2773-0654
ISSN (online)	2773-0654
DOI	10.1016/j.focus.2023.100155
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Route Optimization Tool (RoOT) for distribution of vaccines and health products.

Zabinsky, Zelda B / Zameer, Mariam / Petroianu, Larissa P G / Muteia, Mamiza M / Coelho, Aida L

Gates open research

2021 Volume 5, Page(s) 34

Abstract: Ensuring the delivery and availability of health products, including temperature-sensitive vaccines, is vital to saving lives in low- and middle-income countries (LMICs). In many LMICs routes are hand drawn by logisticians and are adjusted based on ... ...

Abstract	Ensuring the delivery and availability of health products, including temperature-sensitive vaccines, is vital to saving lives in low- and middle-income countries (LMICs). In many LMICs routes are hand drawn by logisticians and are adjusted based on vehicle availability and product quantities. Easy-to-use real-time supply chain tools are needed to create or adjust routes for available vehicles and road conditions. Having more efficient and optimized distribution is especially critical for COVID-19 vaccine distribution. Route Optimization Tool (RoOT) works best for planning routes for 50 health facilities or less, in two minutes. We develop RoOT using a variant of a Vehicle Routing and Scheduling Algorithm (VeRSA) that is coded in Python but reads and writes Excel files to make data input and using outputs easier. RoOT can be used for routine operations or in emergency situations, such as delivery of new COVID-19 vaccine. The tool has a user-centric design with easy dropdown menus and the ability to optimize on time, risk, or combination of both. RoOT is an open-source tool for optimal routing of health products. It provides optimized routes faster than most commercial software and is tailored to meet the needs of government stakeholders We trained supply chain logisticians in Mozambique on using RoOT, and their feedback validates that RoOT is a practical tool to improve planning and efficient distribution of health products, especially vaccines. We also illustrate how RoOT can be adapted for an emergency situation by using a test scenario of a cyclone. Currently, RoOT does not allow multi-day routes, and is designed for trips that can be completed within twenty-four hours. Areas for future development include multi-day routing and integration with mapping software to facilitate distance calculations and visualization of routes.
Language	English
Publishing date	2021-11-15
Publishing country	United States
Document type	Journal Article
ISSN	2572-4754
ISSN (online)	2572-4754
DOI	10.12688/gatesopenres.13219.2
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Article ; Online: COVID-19 Pandemic Response Simulation in a Large City: Impact of Nonpharmaceutical Interventions on Reopening Society.

Lee, Serin / Zabinsky, Zelda B / Wasserheit, Judith N / Kofsky, Stephen M / Liu, Shan

Medical decision making : an international journal of the Society for Medical Decision Making

2021 Volume 41, Issue 4, Page(s) 419–429

Abstract: As the novel coronavirus (COVID-19) pandemic continues to expand, policymakers are striving to balance the combinations of nonpharmaceutical interventions (NPIs) to keep people safe and minimize social disruptions. We developed and calibrated an agent- ... ...

Abstract	As the novel coronavirus (COVID-19) pandemic continues to expand, policymakers are striving to balance the combinations of nonpharmaceutical interventions (NPIs) to keep people safe and minimize social disruptions. We developed and calibrated an agent-based simulation to model COVID-19 outbreaks in the greater Seattle area. The model simulated NPIs, including social distancing, face mask use, school closure, testing, and contact tracing with variable compliance and effectiveness to identify optimal NPI combinations that can control the spread of the virus in a large urban area. Results highlight the importance of at least 75% face mask use to relax social distancing and school closure measures while keeping infections low. It is important to relax NPIs cautiously during vaccine rollout in 2021.
MeSH term(s)	COVID-19/prevention & control ; Communicable Disease Control/methods ; Computer Simulation ; Contact Tracing ; Disease Outbreaks ; Humans ; Masks ; Pandemics ; Physical Distancing ; SARS-CoV-2 ; Social Conditions ; Urban Population ; Washington
Language	English
Publishing date	2021-03-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	604497-9
ISSN	1552-681X ; 0272-989X
ISSN (online)	1552-681X
ISSN	0272-989X
DOI	10.1177/0272989X211003081
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Book ; Online: Optimal control of COVID-19 infection rate with social costs

Palmer, Aaron Z. / Zabinsky, Zelda B. / Liu, Shan

2020

Abstract: The COVID-19 pandemic has posed a policy making crisis where efforts to slow down or end the pandemic conflict with economic priorities. This paper provides mathematical analysis of optimal disease control policies with idealized compartmental models for ...

Abstract	The COVID-19 pandemic has posed a policy making crisis where efforts to slow down or end the pandemic conflict with economic priorities. This paper provides mathematical analysis of optimal disease control policies with idealized compartmental models for disease propagation and simplistic models of social and economic costs. The optimal control strategies are categorized as 'suppression' and 'mitigation' strategies and are analyzed in both deterministic and stochastic models. In the stochastic model, vaccination at an uncertain time is taken into account. Comment: Substantial Revisions
Keywords	Mathematics - Optimization and Control ; Physics - Physics and Society ; Quantitative Biology - Populations and Evolution ; 92D30 ; 93C95 ; 90C90 ; covid19
Publishing date	2020-07-27
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Optimal control of COVID-19 infection rate with social costs

Palmer, Aaron Z. / Zabinsky, Zelda B. / Liu, Shan

Abstract	The COVID-19 pandemic has posed a policy making crisis where efforts to slow down or end the pandemic conflict with economic priorities. This paper provides mathematical analysis of optimal disease control policies with idealized compartmental models for disease propagation and simplistic models of social and economic costs. The optimal control strategies are categorized as 'suppression' and 'mitigation' strategies and are analyzed in both deterministic and stochastic models. In the stochastic model, vaccination at an uncertain time is taken into account.
Keywords	covid19
Publisher	ArXiv
Document type	Article
Database	COVID19

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Article: A Multi-Fidelity Rollout Algorithm for Dynamic Resource Allocation in Population Disease Management.

Ho, Ting-Yu / Liu, Shan / Zabinsky, Zelda B

Health care management science

2018 Volume 22, Issue 4, Page(s) 727–755

Abstract: Dynamic resource allocation for prevention, screening, and treatment interventions in population disease management has received much attention in recent years due to excessive healthcare costs. In this paper, our goal is to design a model and an ... ...

Abstract	Dynamic resource allocation for prevention, screening, and treatment interventions in population disease management has received much attention in recent years due to excessive healthcare costs. In this paper, our goal is to design a model and an efficient algorithm to optimize sequential intervention policies under resource constraints to improve population health outcomes. We consider a discrete-time finite-horizon budget allocation problem with disease progression within a closed birth-cohort population. To address the computational challenges associated with large-state and multiple-period dynamic decision-making problems, we propose a low-fidelity approximation that preserves the population dynamics under a stationary policy. To improve the healthcare interventions in terms of population health outcomes, we then embed the low-fidelity approximation into a high-fidelity optimization model to efficiently identify a good non-stationary sequential intervention policy. Our approach is illustrated by a numerical example of screening and treatment policy implementation for chronic hepatitis C virus (HCV) infection over a budget planning period. We numerically compare our Multi-Fidelity Rollout Algorithm (MF-RA) to a grid search approach and demonstrate the similarity of sequential policy trends and closeness of overall health outcomes measured by quality-adjusted life-years (QALYs) and the total number of individuals that undergo screening and treatment for different annual budgets and birth-cohorts. We also show how our approach scales well to problems with high dimensionality due to many decision periods by studying time to elimination of HCV.
MeSH term(s)	Aged ; Algorithms ; Budgets ; Cost-Benefit Analysis/methods ; Decision Making ; Disease Management ; Disease Progression ; Female ; Hepatitis C, Chronic/diagnosis ; Hepatitis C, Chronic/economics ; Hepatitis C, Chronic/therapy ; Humans ; Male ; Markov Chains ; Middle Aged ; Quality-Adjusted Life Years ; Resource Allocation/methods ; United States
Language	English
Publishing date	2018-09-07
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1469148-6
ISSN	1572-9389 ; 1386-9620
ISSN (online)	1572-9389
ISSN	1386-9620
DOI	10.1007/s10729-018-9454-6
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Article ; Online: COVID-19 Endemic Plan: Impact of Vaccination and Non-pharmaceutical Interventions with Viral Variants and Waning Immunity Using an Agent-Based Simulation

Lee, Serin / Zabinsky, Zelda B. / Wasserheit, Judith N. / Ross, Jennifer M. / Chen, Shi / Liu, Shan

medRxiv

Abstract: Backgrounds: Despite the widespread distribution of SARS-CoV-2 vaccines, the COVID-19 pandemic continues with highly contagious variants and waning immunity. Low disease severity of the Omicron variant gives society hope that the COVID-19 pandemic could ... ...

Abstract	Backgrounds: Despite the widespread distribution of SARS-CoV-2 vaccines, the COVID-19 pandemic continues with highly contagious variants and waning immunity. Low disease severity of the Omicron variant gives society hope that the COVID-19 pandemic could end. Methods: We develop an agent-based simulation to explore the impact of COVID-19 vaccine willingness, booster vaccination schedule, vaccine effectiveness, and non-pharmaceutical interventions (NPIs) on reducing COVID-19 deaths while considering immunity duration and disease severity against the Omicron variant. The model is calibrated to the greater Seattle area in year 2020 by observing local epidemic data. The simulation is run to the end of year 2024 to observe long-term effects. Results: Results show that an NPI policy that maintains low levels of NPIs can reduce mortality by 35.1% compared to fully opening the society. A threshold NPI policy is especially helpful when the disease severity of the Omicron variant is high, or booster vaccines are not scheduled. A periodic booster schedule is needed to achieve the goal of lowering the number of deaths from COVID-19 to the level of influenza and pneumonia. Except for one scenario, 80% or more vaccine willingness is also needed to achieve this goal. Conclusions: We find that a periodic booster vaccination schedule and mild disease severity of the Omicron variant play a crucial role in reducing deaths by the end of year 2024. If a booster schedule is not planned and the Omicron variant is not mild, NPI policies that limit society from fully opening are required to control the outbreak.
Keywords	covid19
Language	English
Publishing date	2022-06-04
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2022.06.03.22275834
Database	COVID19

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Article: Preventing tuberculosis with community-based care in an HIV-endemic setting: a modeling analysis.

Ross, Jennifer M / Greene, Chelsea / Bayer, Cara J / Dowdy, David W / van Heerden, Alastair / Heitner, Jesse / Rao, Darcy W / Roberts, D Allen / Shapiro, Adrienne E / Zabinsky, Zelda B / Barnabas, Ruanne V

medRxiv : the preprint server for health sciences

2023

Abstract: Introduction: Antiretroviral therapy (ART) and TB preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase uptake of ART and TPT ... ...

Abstract	Introduction: Antiretroviral therapy (ART) and TB preventive treatment (TPT) both prevent tuberculosis (TB) disease and deaths among people living with HIV. Differentiated care models, including community-based care, can increase uptake of ART and TPT to prevent TB in settings with a high burden of HIV-associated TB, particularly among men. Methods: We developed a gender-stratified dynamic model of TB and HIV transmission and disease progression among 100,000 adults ages 15-59 in KwaZulu-Natal, South Africa. We drew model parameters from a community-based ART initiation and resupply trial in sub-Saharan Africa (Delivery Optimization for Antiretroviral Therapy, DO ART) and other scientific literature. We simulated the impacts of community-based ART and TPT care programs during 2018-2027, assuming that community-based ART and TPT care were scaled up to similar levels as in the DO ART trial (i.e., ART coverage increasing from 49% to 82% among men and from 69% to 83% among women) and sustained for ten years. We projected the number of TB cases, deaths, and disability-adjusted life years (DALYs) averted relative to standard, clinic-based care. We calculated program costs and incremental cost-effectiveness ratios from the provider perspective. Results: If community-based ART care could be implemented with similar effectiveness to the DO ART trial, increased ART coverage could reduce TB incidence by 27.0% (range 21.3% - 34.1%) and TB mortality by 36.0% (range 26.9% - 43.8%) after ten years. Increasing both ART and TPT uptake through community-based ART with TPT care could reduce TB incidence by 29.7% (range 23.9% - 36.0%) and TB mortality by 36.0% (range 26.9% - 43.8%). Community-based ART with TPT care reduced gender disparities in TB mortality rates by reducing TB mortality among men by a projected 39.8% (range 32.2% - 46.3%) and by 30.9% (range 25.3% - 36.5%) among women. Over ten years, the mean cost per DALY averted by community-based ART with TPT care was $846 USD (range $709 - $1,012). Conclusions: By substantially increasing coverage of ART and TPT, community-based care for people living with HIV could reduce TB incidence and mortality in settings with high burdens of HIV-associated TB and reduce TB gender disparities.
Language	English
Publishing date	2023-08-22
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.08.21.23294380
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Article ; Online: COVID-19 Pandemic Response Simulation: Impact of Non-pharmaceutical Interventions on Ending Lockdowns

Lee, Serin / Zabinsky, Zelda B / Kofsky, Stephen M / Liu, Shan

medRxiv

Abstract: As many federal and state governments are starting to ease restrictions on non-pharmaceutical interventions (NPIs) used to flatten the curve, we developed an agent-based simulation to model the incidence of COVID-19 in King County, WA under several ... ...

Abstract	As many federal and state governments are starting to ease restrictions on non-pharmaceutical interventions (NPIs) used to flatten the curve, we developed an agent-based simulation to model the incidence of COVID-19 in King County, WA under several scenarios. While NPIs were effective in flattening the curve, any relaxation of social distancing strategies yielded a second wave. Even if daily confirmed cases dropped to one digit, daily incidence can peak again to 874 cases without import cases. Therefore, policy makers should be very cautious in reopening society.
Keywords	covid19
Language	English
Publishing date	2020-05-04
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.04.28.20080838
Database	COVID19

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Article ; Online: Optimizing Implementation of Hepatitis C Birth-Cohort Screening and Treatment Strategies: Model-Based Projections.

Li, Yuankun / Huang, Hao / Zabinsky, Zelda B / Liu, Shan

MDM policy & practice

2017 Volume 2, Issue 1, Page(s) 2381468316686795

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2017-01-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2861432-X
ISSN	2381-4683 ; 2381-4683
ISSN (online)	2381-4683
ISSN	2381-4683
DOI	10.1177/2381468316686795
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