If containment is not possible, how do we minimize mortality for COVID-19 and other emerging infectious disease outbreaks?

Andreas Handel; Joel Miller; Yang Ge; Isaac Chun-Hai Fung

Scenario 1 in figure 1 shows a situation without interventions. Scenario 2 shows a situation where strong interventions are applied to protect all age groups. This reduces mortality the most while interventions are active, however, a subsequent outbreak occurs, and the total number infected and dead is similar to the no intervention scenario (7). Scenarios 3-5 show interventions that preferentially target children, adults, and the elderly, respectively. Each scenario leads to fewer infected and dead, despite weaker interventions compared to scenario 2. This is due to the prevention of a second large outbreak once interventions are removed. Importantly, while interventions 3-5 have a similar impact on the reduction of cases, the intervention targeting the elderly saves by far the most lives. Figure 1 : Susceptible, Infected, and percent deaths averted for different intervention scenarios. Scenario S1 shows a situation without any interventions, the maximum number of people get infected, the overshoot (gray arrow) is large, susceptibles drop far below the herd immunity level (solid horizontal line). In S2, strong interventions are applied to all groups, elderly are fully protected and children and adults have a reduction in infection rates of 90%. This is enough to drive down the outbreak while the interventions are active, thus initially reducing mortality the most. However, once the interventions are stopped, a consecutive outbreak occurs, leading to an overshoot and drop in susceptibles similar to the first scenario, and the overall number of averted deaths at the end of the outbreak is low. In S3-S5, the . CC-BY-NC 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.