key: cord-0713834-ta1xl6es authors: Tian, T.; Tan, J.; Jiang, Y.; Wang, X.; Zhang, H. title: Evaluate the timing of resumption of business for the states of New York, New Jersey and California via a pre-symptomatic and asymptomatic transmission model of COVID-19 date: 2020-05-20 journal: nan DOI: 10.1101/2020.05.16.20103747 sha: 9c691bf5cf58fef70b556f0f5d7eea31801b75a2 doc_id: 713834 cord_uid: ta1xl6es The United States has the highest numbers of confirmed cases and death of COVID-19, where confirmed cases took up nearly half in the hot spot states of New York, New Jersey and California. The workforce in these states was required to work from home except for essential services to minimize the risk of the spread of COVID-19. Premature reopening of economy will lead to broader spread of COVID-19, while the opposite situation would cause greater loss of economy. We proposed an epidemic compartmental model in considering the pre-symptomatic transmission and asymptomatic transmission of COVID-19, to estimate the numbers of unidentified infected cases and simulate the possible outcomes of resumption of economy at different forthcoming Mondays. The states of New York and New Jersey were not recommended to reopen the economy before May 18 since it may increase 22.44% and 60.18% for the numbers of cumulative confirmed cases if the second wave of the infection would happen, respectively. While that may be feasible for California to reopen business on May 11 if appropriate control measures for prevention of the second wave of the infection are implemented, because of the less benefit for delaying reopening the economy and the relatively smaller magnitude of Outbreak of COVID-19. confirmed cases of COVID-19 worldwide 4 . The first "battle" against COVID-19 in China has provided experience and likely outcomes of interventions to the ongoing hard-hit areas. As a novel and acute infectious disease, the transmissibility of COVID-19 was unclear at the early stage of epidemic, the Chinese government implemented relatively strict nonpharmaceutical interventions in the hot spot areas, where the public transportations were suspended within and outside of the city in Hubei province since January 23, 2020 5 . All nationwide residents were recommended to stay at home except for essential needs. The holiday season of the Chinese Spring Festival had been prolonged to late February when essential services were recommenced operating gradually outside Hubei province 6 . By now, a comprehensive resumption of business is approaching in China 7 . Meanwhile, the confirmed case of COVID-19 was first reported during late January 2020 in the United States 8 . There were over 1000 cumulative confirmed cases on March 13, 2020 9 , when the White House declared a national emergency concerning COVID-19 outbreak 10 and issued a "call to action" coronavirus guidelines on March 16, 2020 11 . The United States has become the most severe country of COVID-19 with 295,122, 113,856, and 46,209 cumulative confirmed cases in the states of New York, New Jersey, and California until April 28, 2020 2 , respectively. Making things worse, New York and California are the two states that contribute the most to the real gross domestic product (GDP) over years in the United States 12 . . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint 25,300 beds and 5,300 hospitals, 87,800 beds and 463,000 hospitals in the state of New York, New Jersey and California, respectively. On April 13, 2020, there were 7 states joined together to form a multi-state council to combat COVID-19 and to help reopen the economy including the top 3 states whose cumulative confirmed cases were the largest 22 . As the epidemic of COVID-19 was getting worse in the United States, the state governors issued a series of interventions to slow the spread of virus, including requiring all individuals to stay at home and reducing the workforce in the industries. The whole social system was slowed down, and thus, the time to restore the economy in the United States, especially for three states of New York, New Jersey, and California has been the most significant and consequential decision for the president of the United States and the governors of the states. To recover the economy for people to return to work, the key concern is the risk and severity of the second wave of the infection. To assess the risk and severity of the second wave of the infection after the resumption of business, it is important to consider the unobserved numbers of unidentified infected cases in the community. Our approach is based on publicly available data to simulate the possible outcomes of an outbreak of COVID-19 at different business reopening dates and to provide recommendations as to when it is reasonable safe for people back to work. The estimated cumulative numbers of infected individuals (including . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 20, 2020. For considering the potential risk of infectious disease, we present the estimated numbers of unidentified infected cases per 100000 for states of New York, New Jersey, and California, which are given in Fig. 3 . Based on Fig. 3 , the estimated timing of the . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. For the control of epidemic, it was reasonable to alleviate the lagging effect, which could be achieved by shortening the ‫ܦ‬ in SIHC model. Notice that ‫ܦ‬ was also affected by the testing rate and testing speed, except the length of incubation period. And the estimated ‫ܦ‬ of all three states were smaller than 5.1, it implied the policy enhancing the testing rate may be implemented in all three states, which was effective to reduce the unidentified number of infected during incubation period and . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint asymptomatic carriers. Meanwhile, according to pending data 10 reported for three states, there was a considerable number of testing results remaining pending in California, which implied the remarkably lower testing speed in California. However, the pending data of the states of New York and New Jersey were negligible, which were consistent with estimated ‫ܦ‬ for these states. The higher numbers of unidentified infected cases were obtained, the higher risks for the resumption of business would have been. According to Fig. 4 is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. The decision for the resumption of business is not only a public health issue, but also economic issue. What we are focusing on is the epidemiological feasibility of returning to work at an early date, there are still many other factors needed to be paid attention 24 . Meanwhile, for the period after resumption of work, if the number of unidentified infected cases is still non-zero, the risks for the second wave of the infection would never vanish, which underscore the necessity of maintaining epidemic prevention measures, such as, wearing a mask and keeping a social distance. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint Fig. 2 . The magnitude of outbreak of COVID-19 in the three states of New York ( Fig. 2-a) , New Jersey (Fig. 2-b) , and California (Fig. 2-c) from March 13 to July c . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint 11, 2020. The daily confirmed new cases form March 13 to May 4, 2020, were observed data, combing with the projected cases until July 11, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint The corresponding 95% credible intervals were represented in each state. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint We collected the epidemic data from March 13, 2020 when the national emergency concerning COVID-19 was proclaimed to May 10, 2020 in three states of New York, New Jersey and California. The data are available on COVID-19.direct 2 . . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. (c) Self-healing without being confirmed ‫)ܪ(‬ is assumed to be no longer infectious and resistant to COVID-19. (d) Confirmed cases (‫ܥ‬ሻ contain two kinds of individuals: patients in hospital and asymptomatic carriers who are assumed to stay at home, and unable to transmit the disease. We introduced Susceptible (ܵ) -Unidentified infected ‫)ܫ(‬ -Self-healing without being CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint Notes on R0. Califonia: Department of Anthropological Sciences & Methods. Bayesian Inference and Decision Theory An introduction to MCMC for machine learning Understanding the metropolis-hastings algorithm Construction of semi-Markov genetic-space-time SEIR models and inference The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing confirmed cases) model: for California state ("stay home except for essential needs" in Fig. 1 is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint Data availability: Daily reported confirmed cases of COVID-19 from March 13, 2020 to May 4, 2020 for three states of New York, New Jersey and California from the website "https://covid-19.direct/state". All data are publicly available.. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 20, 2020. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted May 20, 2020. We declare no competing interests.. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted May 20, 2020. . https://doi.org/10.1101/2020.05.16.20103747 doi: medRxiv preprint