不同介入措施對COVID-19中重症疫情控制的成效探討

Effectiveness of different measures in reducing the daily number of moderate to severe cases of COVID-19

10.6288/TJPH.202302_42(1).111098

鄭珺元(Michael Chun-Yuan Cheng)；王亮懿(Liang-Yi Wang)

新冠肺炎 ； 住院率 ； 介入措施 ； 分枝模型 ； COVID-19 ； hospitalization rate ； intervention measures ； Branching model

台灣公共衛生雜誌

42卷1期（2023 / 02 / 24）

32 - 41

繁體中文;英文

目標：新冠肺炎的介入措施可分為針對個人層面的個案型介入（如接觸者回溯或檢疫）與針對大眾的群體型介入（如口罩與疫苗），隨疫情流感化趨勢與疫苗施打，防疫目標從清零轉為降低中重症個案對醫療的衝擊，故本研究欲探討不同介入措施對於中重症住院人數的影響。方法：本研究使用Hellewell等人於2020年開發出的分枝模型（branching model）進行模擬，搭配Omicron變種病毒的流行病學資料與不同假設情境，並計算不同介入措施組合下的每日住院人數作為評價依據。結果：本研究發現群體型介入比個案型介入有效，但在較高強度的群體型介入下加入個案型介入，會有較佳的效果，而若疫苗能有效降低染疫後住院率，應優先提高疫苗覆蓋率而非追求疫苗避免感染有效性，以減緩對醫療量能的衝擊。結論：在鬆綁個案型介入的過程中，需考量是否已有一定群體型介入的支持，同時若希望能控制中重症與住院人數，須提高疫苗覆蓋率而不是以追求疫苗避免感染有效性為優先事項。

Objectives: Interventions for controlling COVID-19 can be classified into case-based (e.g., contact tracing and quarantining) and population-based (e.g., using masks and receiving vaccines) measures. The objective of pandemic control has now shifted from reducing the daily number of cases to reducing that of hospitalizations through vaccination. COVID-19 has started exhibiting flu-like characteristics. Therefore, in this study, we compared different measures in terms of their effectiveness in reducing the daily number of moderate to severe cases of COVID-19. Methods: The branching model developed by Hellewell (2020) was used for simulation. The epidemiological data of the Omicron variant and various hypothetical scenarios were analyzed. The outcome variable of our study was the daily number of hospitalizations under different measures and their combinations. Results: Population-based measures were more effective than case-based measures; however, their combination led to the best outcomes. If vaccination reduced the number of COVID-19-related hospitalizations, the focus was on increasing vaccine coverage to increase medical capacity rather than enhancing vaccine efficacy. Conclusions: While loosening case-based measures, the government must consider whether population-based measures can support this change. Furthermore, to reduce the daily number of moderate to severe cases of COVID-19, vaccine coverage, rather than vaccine efficacy, must be improved.

1. Al Zabadi, H,Yaseen, N,Alhroub, T,Haj-Yahya, M(2021).Assessment of quarantine understanding and adherence to lockdown measures during the COVID-19 pandemic in Palestine: community experience and evidence for action.Front Public Health,9,570242.
2. Appel C, Dattani S, Hasell J, et al. Coronavirus (COVID-19) cases. Available at: https://ourworldindata.org/covid-cases. Accessed July 24, 2022.
3. Ayouni, I,Maatoug, J,Dhouib, W(2021).Effective public health measures to mitigate the spread of COVID-19: a systematic review.BMC Public Health,21,1015.
4. Backer, JA,Eggink, D,Andeweg, SP(2022).Shorter serial intervals in SARS-CoV-2 cases with Omicron BA. 1 variant compared with Delta variant, the Netherlands, 13to 26 December 2021.Euro Surveill,27,2200042.
5. Benke, C,Autenrieth, LK,Asselmann, E,Pané-Farré, CA(2020).Lockdown, quarantine measures, and social distancing: associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany.Psychiatry Res,293,113462.
6. Burki, TK(2022).Omicron variant and booster COVID-19 vaccines.Lancet Respir Med,10,e17.
7. Cao, J,Ramirez, CM,Alvarez, RM(2022).The politics of vaccine hesitancy in the United States.Soc Sci Q,103,42-54.
8. Centers for Disease Control and Prevention (CDC). Vaccination programs. Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/programs.html. Accessed June 1, 2022.
9. Cheng, HY,Huang, AS(2021).Proactive and blended approach for COVID-19 control in Taiwan.Biochem Biophys Res Commun,538,238-243.
10. Chu, DK,Akl, EA,Duda, S(2020).Physical distancing, face masks, and eye protection to prevent person to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis.Lancet,395,1973-1987.
11. Fine, PE(1993).Herd immunity: history, theory, practice.Epidemiol Rev,15,265-302.
12. Frenier, C,Nikpay, SS,Golberstein, E(2020).COVID-19 has increased medicaid enrollment, but short-term enrollment changes are unrelated to job losses.Health Aff,39,1822-1831.
13. Gupta, S,Montenovo, L,Nguyen, TD(2022).Effects of social distancing policy on labor market outcomes.Contemp Econ Pol,41,166-193.
14. Hellewell, J,Abbott, S,Gimma, A(2020).Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts.Lancet Glob Health,8,e488-e496.
15. Hills, S,Eraso, Y(2021).Factors associated with non-adherence to social distancing rules during the COVID-19 pandemic: a logistic regression analysis.BMC Public Health,21,325.
16. Iboi, EA,Ngonghala, CN,Gumel, AB(2020).Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus.Math Biosci,325,108364.
17. Jassat, W,AbdoolKarim, SS,Mudara, C(2022).Clinical severity of COVID-19 in patients admitted to hospital during the omicron wave in South Africa: a retrospective observational study.Lancet Glob Health,10,e961-e969.
18. Johns Hopkins Coronavirus Resource Center. COVID-19 Dashboard. Available at: https://coronavirus.jhu.edu/map.html. Accessed November 16, 2022.
19. Kerr, CC,Mistry, D,Stuart, RM(2021).Controlling COVID-19 via test-trace-quarantine.Nat Commun,12,2993.
20. Kim, BN,Kim, E,Lee, S,Oh, C(2020).Mathematical model of COVID-19 transmission dynamics in South Korea: the impacts of travel restrictions, social distancing, and early detection.Processes,8,1304.
21. Kim, MS,Seong, D,Li, H(2022).Comparative effectiveness of N95, surgical or medical, and non-medical facemasks in protection against respiratory virus infection: a systematic review and network meta-analysis.Rev Med Virol,32,e2336.
22. Kupferschmidt, K(2022).After Omicron, some scientists foresee’a period of quiet’.Science,375,366-367.
23. Lee, S,Zabinsky, ZB,Wasserheit, JN,Kofsky, SM,Liu, S(2021).COVID-19 pandemic response simulation in a large city: impact of nonpharmaceutical interventions on reopening society.Med Decis Making,41,419-429.
24. Manica, M,De Bellis, A,Guzzetta, G(2022).Intrinsic generation time of the SARS-CoV-2 Omicron variant: an observational study of household transmission.Lancet Reg Health Eur,19,100446.
25. Mohammed, I,Nauman, A,Paul, P(2022).The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: a systematic review.Hum Vaccin Immunother,18,2027160.
26. Ng, TC,Cheng, HY,Chang, HH(2021).Comparison of estimated effectiveness of case-based and population-based interventions on COVID-19 containment in Taiwan.JAMA Intern Med,181,913-921.
27. Ontario Agency for Health Protection and Promotion. COVID-19 variant of concern Omicron (B.1.1.529): risk assessment, January 26, 2022. Available at: https://www.publichealthontario.ca/-/media/documents/ncov/voc/2022/01/covid-19-omicron-b11529-risk-assessment-jan-26.pdf?sc_lang=en. Accessed July 24, 2022.
28. Palgi, Y,Shrira, A,Ring, L(2020).The loneliness pandemic: loneliness and other concomitants of depression, anxiety and their comorbidity during the COVID-19 outbreak.J Affect Disord,275,109-111.
29. Paltiel, AD,Schwartz, JL,Zheng, A,Walensky, RP(2021).Clinical outcomes of a COVID-19 vaccine: implementation over efficacy.Health Aff,40,42-52.
30. Roghani, A(2021).The influence of COVID-19 vaccination on daily cases, hospitalization, and death rate in Tennessee, United States: case study.JMIRx Med,2,e29324.
31. Rolfes, MA,Grijalva, CG,Zhu, Y(2021).Implications of shortened quarantine among household contacts of index patients with confirmed SARS-CoV-2 infection-Tennessee and Wisconsin, April-September 2020.MMWR Morb Mortal Wkly Rep,69,1633-1637.
32. Safi, MA,Gumel, AB(2011).Mathematical analysis of a disease transmission model with quarantine, isolation and an imperfect vaccine.Comput Math Appl,61,3044-3070.
33. Talic, S,Shah, S,Wild, H(2021).Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis.BMJ,375,e068302.
34. Taylor, CA,Whitaker, M,Anglin, O(2022).COVID-19 –associated hospitalizations among adults during SARS-CoV-2 delta and omicron variant predominance, by race/ethnicity and vaccination status-COVID-NET, 14 states, July 2021–January 2022.MMWR Morb Mortal Wkly Rep,71,466-473.
35. Tsou, HH,Cheng, YC,Yuan, HY(2020).The effect of preventing subclinical transmission on the containment of COVID-19: mathematical modeling and experience in Taiwan.Contemp Clin Trials,96,106101.
36. 國家高速網路與計算中心：COVID-19全球疫情地圖。https://covid-19.nchc.org.tw/dt_005-covidTable_taiwan.php。引用2022/07/24。 National Center for High-Performance Computing. COVID-19 Dashboard. Available at: https://covid-19.nchc.org.tw/dt_005-covidTable_taiwan.php. Accessed July 24, 2022.
37. 羅氏集團：新冠病毒抗原自行檢測套裝（鼻腔）。https://dianews.roche.com/SARS-CoV-2-Antigen-Nasal-Self-Test-kit.html。引用2022/07/24。 Roche Ltd. SARS-CoV-2 antigen self test nasal. Available at: https://dianews.roche.com/SARS-CoV2-Antigen-Nasal-Self-Test-kit.html. Accessed July 24, 2022. [In Chinese]