Abstract
We developed a stochastic optimization technology based on a COVID-19 transmission dynamics model to determine optimal pathways from lockdown toward reopening with different scales and speeds of mass vaccine rollout in order to maximize social economical activities while not overwhelming the health system capacity in general, hospitalization beds, and intensive care units in particular. We used the Province of Ontario, Canada as a case study to demonstrate the methodology and the optimal decision trees; but our method and algorithm are generic and can be adapted to other settings. Our model framework and optimization strategies take into account the likely range of social contacts during different phases of a gradual reopening process and consider the uncertainties of these contact rates due to variations of individual behaviors and compliance. The results show that, without a mass vaccination rollout, there would be multiple optimal pathways should this strategy be adopted right after the Province's lockdown and stay-at-home order; however, once reopening has started earlier than the timing determined in the optimal pathway, an optimal pathway with similar constraints no longer exists, and sub-optimal pathways with increased demand for intensive care units can be found, but the choice is limited and the pathway is narrow. We also simulated the situation when the reopening starts after the mass vaccination has been rolled out, and we concluded that optimal pathways toward near pre-pandemic activity level is feasible given an accelerated vaccination rollout plan, with the final activity level being determined by the vaccine coverage and the transmissibility of the dominating strain.
Highlights
AND BACKGROUNDCOVID-19 has had tremendous impacts on public health and the economy globally
We examine the projected confirmed cases of COVID-19 and hospitalized cases including those in ICU according to each of the optimal reopening strategies; we examine the situation when those opportunities were missed and identify a new optimization opportunity facilitated by the accelerated vaccination rollout to allow for a pathway leading to near pre-pandemic activity level
For the optimization initiated on February 14, 2021 and March 14, 2021, we considered a de-escalation strategy to be acceptable if the projected number of ICU beds occupied by COVID-19 patients was within the health care system capacity during the period of cost-evaluation
Summary
AND BACKGROUNDCOVID-19 has had tremendous impacts on public health and the economy globally. While efficacious vaccines exist and are being administered, most nations are in the situation where the wide rollout of vaccination among the general population has not been achieved; most individuals remain susceptible to infection and controlling virus transmission (and the downstream hospitalizations and deaths) while more transmissible variants are actively circulating still poses a real challenge. In this light, the task of identifying smart reopening strategies provides an opportunity for mathematical modeling to assist and inform the reopening decision-making process through means of evidence synthesis
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