2020 •
Predictable county-level estimates of R0 for COVID-19 needed for public health planning in the USA
Authors:
Anthony R. Ives, Claudio Bozzuto
Abstract:AbstractThe basic reproduction number, R0, determines the rate of spread of a communicable disease and therefore gives fundamental information needed to plan public health interventions. Estimated R0 values are only useful, however, if they accurately predict the future potential rate of spread. Using mortality records, we estimated the rate of spread of COVID-19 among 160 counties and county-aggregates in the USA. Most of the high among-county variance in the rate of sp (...) AbstractThe basic reproduction number, R0, determines the rate of spread of a communicable disease and therefore gives fundamental information needed to plan public health interventions. Estimated R0 values are only useful, however, if they accurately predict the future potential rate of spread. Using mortality records, we estimated the rate of spread of COVID-19 among 160 counties and county-aggregates in the USA. Most of the high among-county variance in the rate of spread was explained by four factors: the timing of the county-level outbreak (partial R2 = 0.093), population size (partial R2 = 0.34), population density (partial R2 = 0.13), and spatial location (partial R2 = 0.42). Of these, the effect of timing is explained by early steps that people and governments took to reduce transmission, and population size is explained by the sample size of deaths that affects the statistical ability to estimate R0. For predictions of future spread, population density is important, likely because it scales the average contact rate among people. To generate support for a possible explanation for the importance of spatial location, we show that SARS-CoV-2 strains containing the G614 mutation to the spike gene are associated with higher rates of spread (P = 0.016). The high predictability of R0 based on population density and spatial location allowed us to extend estimates to all 3109 counties in the lower 48 States. The high variation of R0 among counties argues for public health policies that are enacted at the county level for controlling COVID-19.(Read More)
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