ABSTRACTWe assess the efficacy of spatially targeted lockdown or mass-testing and case-isolation in individual communities, as a compliment to contact-tracing and social-distancing, for containing SARS-CoV-2 outbreaks. Using the UK as a case study, we construct a stochastic branching process model for the virus transmission, embedded on a network interaction model encoding mobility patterns in the UK. The network model is based on commuter data from the 2011 census, a catchment area model for schools, and a phenomenological model for mobility and interactions outside of work, school, and the home. We show that for outbreak scenarios where contact-tracing and moderate social distancing alone provide suppression but do not contain the spread, targeted lockdowns or mass-testing interventions at the level of individual communities (with just a few thousand inhabitants) can be effective at containing outbreaks. For spatially targeted mass-testing, a moderate increase in testing capacity would be required (typically < 40000 additional tests per day), while for local lockdowns we find that only a small fraction (typically < 0.1%) of the population needs to be locked down at any one time (assuming that one third of transmission occurs in the home, at work or school, and out in the wider community respectively). The efficacy of spatially targeted interventions is contingent on an appreciable fraction of transmission events occurring within (relative to across) communities. Confirming the efficacy of community-level interventions therefore calls for detailed investigation of spatial transmission patterns for SARS-CoV-2, accounting for sub-community-scale transmission dynamics, and changes in mobility patterns due to the presence of other containment measures (such as social distancing and travel restrictions).Disclaimer: We stress that this is a working paper where results are preliminary and subject to change. In particular, we note that the efficacy of spatially targeted interventions are sensitive to the relative proportions of intra-versus inter-community transmission (for a given definition of community boundaries), which in turn is sensitive to the assumptions about the transmission dynamics across different contexts. Whilst the assumptions made here about transmission across contexts are motivated, we are currently updating our model to make the estimated inter- and intra-community transmission rates as robust as possible, as well as running a comprehensive suite of sensitivity tests and different outbreak scenarios.
Coronavirus Disease in Pakistan: Response and Challenges from Prevention to Care