Prevention of household transmission crucial to stop the catastrophic spread of COVID-19 in cities

Gutierrez Brizuela, N.; Gutierrez Pulido, H.; Roosa, K.; Garcia Chan, N.; Hernandez-Bello, J.; Munoz-Valle, J. F.; Macedo-Ojeda, G.; Lopez-Chavez, J. A.; Gonzalez Estevez, G.; Villanueva Lomeli, R.; Chowell, G.

After weeks under lockdown, metropolitan areas fighting the spread of COVID-19 aim to balance public health goals with social and economic standards for well-being. Mathematical models of disease transmission seeking to evaluate mitigation strategies must assess the possible impacts of social distancing, economic lockdowns and other measures. However, obscure relations between model parameters and real-world phenomena complicate such analyses. Here, we use a high-resolution metapopulation model of Guadalajara (GDL, Western Mexico) to represent daily mobility patterns driven by economic activities and their relation to epidemic growth. Given the prominence of essential activities in the city's economy, we find that strategies aiming to mitigate the risk of out-of-home interactions are insufficient to stop the catastrophic spread of COVID-19. Using baseline reproduction numbers R0 = [2.5, 3.0] in the absence of interventions, our simulations suggest that household transmission alone can make Rt ~ 1, and is estimated to drive 70 {+/-} 15% of current epidemic growth. This sets an upper bound for the impact of mobility-based interventions, which are unlikely to lower Rt below 1.3 and must be complemented with aggressive campaigns for early case detection and isolation. As laboratory testing and health services become insufficient to meet demand in GDL and most other cities, we propose that cities facilitate guidelines and equipment to help people curb spreading within their own homes. Postponing these actions will increase their economic cost and decrease their potential returns.