Abstract
Following the April 16, 2020 release of the Opening Up America Again guidelines for relaxing coronavirus disease 2019 (COVID-19) social distancing policies, local leaders are concerned about future pandemic waves and lack robust strategies for tracking and suppressing transmission. Here, we present a strategy for triggering short-term shelter-in-place orders when hospital admissions surpass a threshold. We use stochastic optimization to derive triggers that ensure hospital surges will not exceed local capacity and lockdowns are as short as possible. For example, Austin, Texas-the fastest-growing large city in the United States-has adopted a COVID-19 response strategy based on this method. Assuming that the relaxation of social distancing increases the risk of infection sixfold, the optimal strategy will trigger a total of 135 d (90% prediction interval: 126 d to 141 d) of sheltering, allow schools to open in the fall, and result in an expected 2,929 deaths (90% prediction interval: 2,837 to 3,026) by September 2021, which is 29% of the annual mortality rate. In the months ahead, policy makers are likely to face difficult choices, and the extent of public restraint and cocooning of vulnerable populations may save or cost thousands of lives.
Highlights
Following the April 16, 2020 release of the Opening Up America Again guidelines for relaxing coronavirus disease 2019 (COVID19) social distancing policies, local leaders are concerned about future pandemic waves and lack robust strategies for tracking and suppressing transmission
All of our results are based on simulating variable levels of social distancing using a data-driven model for COVID-19 transmission and healthcare needs in the Austin, TX, metropolitan statistical area (MSA) [16]
Based on COVID-19 hospitalization data from the Austin–Round Rock MSA through April 16, we estimate that local COVID-19 transmission rates dropped by approximately 95% following the March 24 Stay Home – Work Safe Order (SHWSO), as detailed in SI Appendix
Summary
Following the April 16, 2020 release of the Opening Up America Again guidelines for relaxing coronavirus disease 2019 (COVID19) social distancing policies, local leaders are concerned about future pandemic waves and lack robust strategies for tracking and suppressing transmission. To avert unmanageable surges in COVID-19 hospitalizations, state and local policy makers across the United States have implemented shelter-in-place orders to enforce social distancing. In the absence of prophylactic and therapeutic countermeasures, nonpharmaceutical interventions are the only option for mitigating pandemic morbidity and mortality Measures such as closures of schools and nonessential businesses, prohibitions on public gatherings, requiring social distancing, and restricting travel, along with ordering face covering, frequent hand washing, surface cleaning, and staying at home when sick, can reduce both the frequency and risks of contacts between susceptible and infected people. We apply the framework to derive optimal triggers for initiating and relaxing shelter-in-place orders to minimize the number of days of costly social distancing while ensuring that COVID-19 hospitalizations do not exceed local capacity.
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