Fear, Access, and the Real-Time Estimation of Etiological Parameters for Outbreaks of Novel Pathogens

Nina H Fefferman; Eric Lofgren; Nianpeng Li; Pieter Blue; David Weber; Abdul-Aziz Yakubu

Regardless of the particular mechanism through which we attempt to characterize the 339 changes in diagnostic sensitivity and specificity, our results demonstrate (in both theory 340 and practice) how these dynamics may be incorporated into epidemiological modeling 341 efforts and how the results may translate into a more accurate understanding of infectious 342 disease dynamics. 343 344 Some studies have been able to assess the impact of public health announcement-or 345 media-driven behavioral change with regard to disease risk and diagnosis (e.g. (Sharma et 346 al. 2003) ). It is clear that we will need to develop better models that explicitly capture the 347 major factors that can effect change in public behavior regarding health care and 348 diagnosis. While it may be impossible to accurately assess the impact of behavioral 349 changes in health care seeking behavior for past epidemics, one possible course of action 350 going forwards would be to ask physicians, hospitals and laboratories to record and report 351 the number of tests performed in addition to merely the number of cases positively 352 diagnosed, regardless of acknowledge threat of outbreaks. 353 354 These models and insights may also be of critical use our collective ongoing efforts to 355 understand and predict the progression of COVID-19. Not only do we provide the 356 obvious alternations to the standard epidemic predictions for error rates in testing, we 357 also provide a mechanism by which to correct our understanding of 0 R based on changes 358 in access to tests of various sensitivities and specificities over time. This is especially 359 important given both the formulation of governmental responses to the pandemic (i.e. 360 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.