The spatio-temporal spread of infectious pathogens: lessons learned from COVID-19

16 September 2021

Julien Arino (Julien.Arino@umanitoba.ca)

Department of Mathematics & Data Science Nexus
University of Manitoba

Canadian Centre for Disease Modelling
Canadian COVID-19 Mathematical Modelling Task Force
NSERC-PHAC Emerging Infectious Disease Modelling Consortium

Thank you

for receiving me in your homes/offices and to ..

  • many people over the years, including most recently
    • Pierre-Yves Boëlle (IPLESP, Sorbonne Université, Paris)
    • Evan Milliken (University of Louisville)
    • Stéphanie Portet (U of M)
  • based also on earlier work with Nicolas Bajeux, S. Portet and James Watmough
  • PHAC external modelling group members for discussions
Funding NSERC and CIHR

Funding and logistical support: Public Health Agency of Canada (PHAC)

Pathogens have been mobile for a while

It first began, it is said, in the parts of Ethiopia above Egypt, and thence descended into Egypt and Libya and into most of the [Persian] King's country. Suddenly falling upon Athens, it first attacked the population in Piraeus [..] and afterwards appeared in the upper city, when the deaths became much more frequent.
Thucydides (c. 460 BCE - c. 395 BCE)

History of the Peloponnesian War

Outline

  • Movement and the spatialisation of an epidemic
  • The initial spread of COVID-19
  • Role of transport restrictions
  • Role of quarantine

Movement and the spatialisation of an epidemic

Following 2 slides

  • SS (blue), II (red), RR (green) model
  • Individuals spatially located
  • Interaction radius to model local movement
  • When contacts occur, each contact is infecting with indicated P\mathbb{P}.. so binomial
  • Infecting contact to an RR is "lost"
    • First slide: fixed infectious period of 5 days
    • Second slide: infectious period in U(3,10)\mathcal{U}(3,10) days

This is good for diseases of (not winged) animals

  • Range is typically not huge
  • Disease moving between species see patchiness of the support bridged by variety of ranges in the different species

Model of Lopez, Coutinho, Buratini & Massad (1999)

tS(x,t)=λ(x,t)S(x,t)μS(x,t)+μN(x)+γ1I(x,t)tI(x,t)=λ(x,t)S(x,t)(μ+γ1+γ2)I(x,t)tR(x,t)=γ2I(x,t)μR(x,t)\begin{aligned} \frac{\partial}{\partial t}S(x,t) &= -\lambda(x,t)S(x,t) - \mu S(x,t) + \mu N(x) + \gamma_1 I(x,t) \\ \frac{\partial}{\partial t}I(x,t) &= \lambda(x,t)S(x,t)-(\mu+\gamma_1+\gamma_2) I(x,t) \\ \frac{\partial}{\partial t}R(x,t) &= \gamma_2I(x,t)-\mu R(x,t) \end{aligned}

with force of infection

λ(x,t)=1N0Ldxβ(x,x)I(x,t)\lambda(x,t) = \frac 1N\int_0^L dx'\beta(x,x')I(x',t)

and total population along the road

N=0LdxN(x)N = \int_0^L dx'N(x')

Why human diseases differ

  • Pathogens of humans follow .. humans
  • Not all humans are mobile, but some humans have for a very long time been more mobile (because of trade)
  • Complex spatial patterns have been observed for a long time

First known epidemics (from Wikipedia)

Event Date Location Disease Death toll (estimate)
Plague of Megiddo 1350 BCE Megiddo, land of Canaan Unknown Unknown
Plague of Athens 429–426 BCE Greece, Libya, Egypt, Ethiopia Possibly typhus, typhoid fever or VHF 75,000–100,000
412 BCE epidemic 412 BCE Greece, Roman Republic Possibly influenza Unknown
Antonine Plague 165–180 CE (possibly up to 190 CE) Roman Empire Possibly smallpox 5–10 million
Jian'an Plague 217 CE Han dynasty Possibly typhoid fever or VHF Unknown
Plague of Cyprian 250–266 CE Europe Possibly smallpox Unknown
Plague of Justinian (1st plague pandemic) 541–549 CE Europe and West Asia Bubonic plague 15–100 million (25–60% of population of Europe)
Roman Plague of 590 (1st plague pandemic) 590 CE Rome, Byzantine Empire Bubonic plague Unknown
Plague of Sheroe (1st plague pandemic) 627–628 CE Bilad al-Sham Bubonic plague 25,000+
Plague of Amwas (1st plague pandemic) 638–639 CE Byzantine Empire, West Asia, Africa Bubonic plague 25,000+
Plague of 664 (1st plague pandemic) 664–689 CE British Isles Bubonic plague Unknown
Plague of 698–701 (1st plague pandemic) 698–701 CE Byzantine Empire, West Asia, Syria, Mesopotamia Bubonic plague Unknown
735–737 Japanese smallpox epidemic 735–737 CE Japan Smallpox 2 million (approx. 1/3 of Japanese population)
Plague of 746–747 (1st plague pandemic) 746–747 CE Byzantine Empire, West Asia, Africa Bubonic plague Unknown

Human epidemics have evolved..

  • because human mobility has changed a lot:
    • Range has vastly increased
    • Time to range has diminished
    • Duration of travel has decreased (on average)
    • Fraction of population able to undertake travel has increased

The human world is fragmented

  • Political divisions: nation groups (e.g., EU), nations, provinces/states, regions, counties, cities..
  • With increasing administration, movement between jurisdictions might become more complicated
  • Data is also integrated at the jurisdicional level
  • Long range mobility is a bottom\totop\totop\tobottom process ("moving between cones")
  • Mobility in bottom layer is on a more continuous support than higher levels
  • Situation is highly variable even at the country level

Cones of resolution

= various levels or scales of the functional or spatial aspects of a diffusion process. Scale (cone of resolution) takes on two dimensions: functional (decisions made by different groups of individuals) and spatial (manifestations of these decisions as observed in a spatial context)

Modelling heterogeneity using metapopulations

J. Arino. Spatio-temporal spread of infectious pathogens of humans. Infectious Disease Modelling, 2017

Movement for compartment cc in patch 1

Nc1=pL{1}mc1pNcpNc1pL{1}mcp1N_{c1}' = \textcolor{red}{\sum_{\mathclap{p\in\mathcal{L}\setminus\{1\}}}m_{c1p}N_{cp}} \textcolor{blue}{-N_{c1}\sum_{\mathclap{p\in\mathcal{L}\setminus\{1\}}}m_{cp1}}

or

Nc1=pLmc1pNcp assuming mc11=pL{1}mcp1N_{c1}' = \sum_{p\in\mathcal{L}} m_{c1p}N_{cp} \textrm{ assuming } m_{c11}=-\sum_{\mathclap{p\in\mathcal{L}\setminus\{1\}}} m_{cp1}

In each patch, put a system describing the evolution of the number of individuals in each compartment present

\gdef\I{\mathcal{I}} \gdef\U{\mathcal{U}} Assume uninfected (ss) and infected (ii) compartments U\U and I\I. For all jUj\in\U, kIk\in\I and L\ell\in\mathcal{L}

sj=fj(S,I)  +  qLmjqsjqik=gk(S,I)  +  qLmkqikq\begin{align*} s_{j\ell}' &= f_{j\ell}(S_\ell,I_\ell) \textcolor{red}{\;+\;\sum_{\mathclap{q\in\mathcal{L}}} m_{j\ell q}s_{jq}} \\ i_{k \ell}' &= g_{k\ell}(S_\ell,I_\ell) \textcolor{red}{\;+\;\sum_{\mathclap{q\in\mathcal{L}}} m_{k\ell q}i_{kq}} \end{align*}

ff and gg describe interactions between compartments in a given location. Might involve more than S,IS_\ell,I_\ell, but always local (\ell)

Sums describe movement of (individuals from) compartments between locations

Describing movement - The movement matrix

Movement from location qLq\in\mathcal{L} to location pLp\in\mathcal{L} occurs at rate mXpqm_{Xpq} for individuals in compartment XX

\gdef\M{\mathcal{M}} Movement matrix for compartment XX:

MX=(qL,qpmXq1mX12mX1LmX21qL,qpmXq2mX2LmXL1mXL2qL,qpmXqL)\M^X = \begin{pmatrix} -\sum\limits_{\mathclap{q\in\mathcal{L},q\neq p}} m_{Xq1} & m_{X12} & \cdots & m_{X1|\mathcal{L}|} \\ m_{X21} & -\sum\limits_{\mathclap{q\in\mathcal{L},q\neq p}} m_{Xq2} & & m_{X2|\mathcal{L}|} \\ & & & \\ m_{X|\mathcal{L}|1} & m_{X|\mathcal{L}|2} & & -\sum\limits_{\mathclap{q\in\mathcal{L},q\neq p}} m_{Xq|\mathcal{L}|} \end{pmatrix}

J. Arino, N. Bajeux & S. Kirkland. Number of source patches required for population persistence in a source-sink metapopulation with explicit movement. Bulletin of Mathematical Biology, 2019

The initial spread of COVID-19

First detections outside China

Date Location Note
13 Jan. Thailand Arrived 8 Jan.
16 Jan. Japan Arrived 6 Jan.
20 Jan. Republic of Korea Airport detected on 19 Jan.
20 Jan. USA Arrived Jan. 15
23 Jan. Nepal Arrived 13 Jan.
23 Jan. Singapore Arrived 20 Jan.
24 Jan. France Arrived 22 Jan.
24 Jan. Vietnam Arrived 13 Jan.
25 Jan. Australia Arrived 19 Jan.
25 Jan. Malaysia Arrived 24 Jan.

Case importations

J. Arino & S. Portet. A simple model for COVID-19. Infectious Disease Modelling, 2020

J. Arino, N. Bajeux, S. Portet & J. Watmough. Quarantine and the risk of COVID-19 importation. Epidemiology & Infection, 2020

Importations

  • In Ecology, importations are called introductions and have been studied for a while, because they are one of the drivers of evolution and, more recently, because of invasive species

  • An importation occurs when an individual who acquired the infection in a jurisdiction makes their way to another jurisdiction while still infected with the disease

  • Geographies greatly influence reasoning

    • At the country level, importations quickly become less relevant
    • Consider an isolated location of 500 people.. disease may become extinct then be reimported

Our base model for considering COVID-19 uses detection-based compartments

Modify the usual SS (susceptible), LL (latent), II (infectious with symptoms), AA (infectious without symptoms) and RR (recovered)

  • DD (instead of II) are detected (positive tests)
  • UU (instead of AA) are undetected (even with symptoms)

pp fraction of cases detected a posteriori (stricto sensu)

J. Arino & S. Portet. A simple model for COVID-19. Infectious Disease Modelling, 2020

Understanding variant dynamics and how to control it

  • Suppose a resident variant is propagating in a population, say, the original wild type or, now, B.1.1.7
  • A novel variant comes along, say B.1.617.2 (SARS-CoV-2 Delta) that is more transmissible

Q:

  • How long until novel replaces resident variant in terms of propagation?
  • What role do importations play in this?
  • How does one diminish role of importations and how useful are measures used to do so?
J. Arino, P.-Y. Boëlle, E.M. Milliken & S. Portet. Risk of COVID-19 variant importation - How useful are travel control measures? Infectious Disease Modelling, 2021

S.P Otto, T. Day, J. Arino, C. Colijn et al. The origins and potential future of SARS-CoV-2 variants of concern in the evolving COVID-19 pandemic. Current Biology, 2021

Travel interruptions

Mur de la Peste in Cabrières-d’Avignon

Interruption of travel during first wave

Country Travel suspension First_case
Seychelles 2020-03-03 2020-03-14
El Salvador 2020-03-17 2020-03-18
Cape Verde 2020-03-17 2020-03-20
Sudan 2020-03-17 2020-04-05
Marshall Islands 2020-04-22 2020-10-29
Vanuatu 2020-03-20 2020-11-11
North Korea 2020-01-21 Unreported
Turkmenistan 2020-03-20 Unreported
Tuvalu 2020-03-26

Quarantine

(Quarantaine)

Quarantine \neq Isolation

  • Quarantine is indiscriminate and applies to all incoming flux
  • Isolation is imposed to known or suspected cases and known contacts
  • First used in (the lazzarettos of) Dubrovnik in 1377
  • Name comes from Venitian quarantena
Lazzaretto vecchio
Lazzaretto nuovo

Effect of quarantine on importation rates

1/λ1/\lambda the mean time between case importations, 1/λq1/\lambda_q the mean quarantine-regulated time between case importations, cc the efficacy of quarantine (in %). Then

λq=(100c)×λ\lambda_q = (100-c)\times \lambda

Suppose 1/λ=1/\lambda= 5 days and efficacy of quarantine is 90% at 7 days and 98% at 14 days, respectively

Then 1/λq=1/\lambda_q= 50 and 250 days, respectively

Conclusion

  • Case importations will occur no matter what
  • Success of an importation depends on transmissibility of novel vs resident variant
  • Travel interruptions are not efficacious at all on average
    • Need to be put in place very early on
  • Quarantine is an efficacious tool to control case importations
    • It does not stop spread, but helps slow it down
    • Less stigmatising than travel interruptions
  • Problem very quickly switches from input to local control

Emergency response during public health crises

  • Get in there to help .. and for the adrenalin
  • Get out of there burned out (19-20 hours a day 7 days a week the first two months, down to 80-100 hours/week now)
  • Interesting and frustrating at the same time
  • You are one of many being consulted. Don't expect anything you say to be used
  • Expect wild goose chases, many aborted publications (it's not relevant anymore!)
  • You sometimes get insider information and data but are often sworn to secrecy

Merci / Miigwech / Thank you / Xièxie

Left hand side

Right hand side