Dataset Information

Implicit feedback policies for COVID-19: why "zero-COVID" policies remain elusive.

ABSTRACT: Successful epidemic modeling requires understanding the implicit feedback control strategies used by populations to modulate the spread of contagion. While such strategies can be replicated with intricate modeling assumptions, here we propose a simple model where infection dynamics are described by a three parameter feedback policy. Rather than model individuals as directly controlling the contact rate which governs the spread of disease, we model them as controlling the contact rate's derivative, resulting in a dynamic rather than kinematic model. The feedback policy used by populations across the United States which best fits observations is proportional-derivative control, where learned parameters strongly correlate with observed interventions (e.g., vaccination rates and mobility restrictions). However, this results in a non-zero "steady-state" of case counts, implying current mitigation strategies cannot eradicate COVID-19. Hence, we suggest making implicit policies a function of cumulative cases, resulting in proportional-integral-derivative control with higher potential to eliminate COVID-19.

SUBMITTER: Jadbabaie A

PROVIDER: S-EPMC9947911 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Implicit feedback policies for COVID-19: why "zero-COVID" policies remain elusive.

Jadbabaie Ali A Sarker Arnab A Shah Devavrat D

Scientific reports 20230223 1

Successful epidemic modeling requires understanding the implicit feedback control strategies used by populations to modulate the spread of contagion. While such strategies can be replicated with intricate modeling assumptions, here we propose a simple model where infection dynamics are described by a three parameter feedback policy. Rather than model individuals as directly controlling the contact rate which governs the spread of disease, we model them as controlling the contact rate's derivativ ...[more]

PMID: 36823214

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Project description:BackgroundCerebral malaria (CM) results in significant paediatric death and neurodisability in sub-Saharan Africa. Several different alterations to typical Transcranial Doppler Ultrasound (TCD) flow velocities and waveforms in CM have been described, but mechanistic contributors to these abnormalities are unknown. If identified, targeted, TCD-guided adjunctive therapy in CM may improve outcomes.MethodsThis was a prospective, observational study of children 6 months to 12 years with CM in Blantyre, Malawi recruited between January 2018 and June 2021. Medical history, physical examination, laboratory analysis, electroencephalogram, and magnetic resonance imaging were undertaken on presentation. Admission TCD results determined phenotypic grouping following a priori definitions. Evaluation of the relationship between haemodynamic, metabolic, or intracranial perturbations that lead to these observed phenotypes in other diseases was undertaken. Neurological outcomes at hospital discharge were evaluated using the Paediatric Cerebral Performance Categorization (PCPC) score.ResultsOne hundred seventy-four patients were enrolled. Seven (4%) had a normal TCD examination, 57 (33%) met criteria for hyperaemia, 50 (29%) for low flow, 14 (8%) for microvascular obstruction, 11 (6%) for vasospasm, and 35 (20%) for isolated posterior circulation high flow. A lower cardiac index (CI) and higher systemic vascular resistive index (SVRI) were present in those with low flow than other groups (p < 0.003), though these values are normal for age (CI 4.4 [3.7,5] l/min/m2, SVRI 1552 [1197,1961] dscm-5m2). Other parameters were largely not significantly different between phenotypes. Overall, 118 children (68%) had a good neurological outcome. Twenty-three (13%) died, and 33 (19%) had neurological deficits. Outcomes were best for participants with hyperaemia and isolated posterior high flow (PCPC 1-2 in 77 and 89% respectively). Participants with low flow had the least likelihood of a good outcome (PCPC 1-2 in 42%) (p < 0.001). Cerebral autoregulation was significantly better in children with good outcome (transient hyperemic response ratio (THRR) 1.12 [1.04,1.2]) compared to a poor outcome (THRR 1.05 [0.98,1.02], p = 0.05).ConclusionsCommon pathophysiological mechanisms leading to TCD phenotypes in non-malarial illness are not causative in children with CM. Alternative mechanistic contributors, including mechanical factors of the cerebrovasculature and biologically active regulators of vascular tone should be explored.

Dataset Information

Implicit feedback policies for COVID-19: why "zero-COVID" policies remain elusive.

Publications

Implicit feedback policies for COVID-19: why "zero-COVID" policies remain elusive.

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