Dynamic Network Strategies for SARS-CoV-2 Control on a Cruise Ship.

• Type of Material: Article
• Authors: Samuel Jenness, Emory University; Kathryn S. Willebrand, Yale Institute of Global Health, New Haven, CT 06510, USA.; Benjamin Lopman, Emory University; Amyn A. Malik, Yale Institute of Global Health, New Haven, CT 06510, USA.; Saad Omer, Emory University
• Language: English
• Date: 2020-10-06
• Publisher: National Institutes of Health
• Publication Version: Preprint (Prior to Peer Review)
• Copyright Statement: © The Author(s) 2020.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1101/2020.08.26.20182766
• Title of Journal or Parent Work: medRxiv
• Grant/Funding Information: This work was supported by National Institutes of Health grants R01 AI138783, R01 GM12428003S1, and R01 HD097175.
• Keywords: Medicine, Research & Experimental; Nursing; SARS-CoV-2; Public health; Dynamic connectivity
• Research Categories: Health Sciences, Nursing; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

SARS-CoV-2 outbreaks have occurred on several nautical vessels, driven by the high-density contact networks on these ships. Optimal strategies for prevention and control that account for realistic contact networks are needed. We developed a network-based transmission model for SARS-CoV-2 on the Diamond Princess outbreak to characterize transmission dynamics and to estimate the epidemiological impact of outbreak control and prevention measures. This model represented the dynamic multi-layer network structure of passenger-passenger, passenger-crew, and crew-crew contacts, both before and after the large-scale network lockdown imposed on the ship in response to the disease outbreak. Model scenarios evaluated variations in the timing of the network lockdown, reduction in contact intensity within the sub-networks, and diagnosis-based case isolation on outbreak prevention. We found that only extreme restrictions in contact patterns during network lockdown and idealistic clinical response scenarios could avert a major COVID-19 outbreak. Contact network changes associated with adequate outbreak prevention were the restriction of passengers to their cabins, with limited passenger-crew contacts. Clinical response strategies required for outbreak prevention included early mass screening with an ideal PCR test (100% sensitivity) and immediate case isolation upon diagnosis. Public health restrictions on optional leisure activities like these should be considered until longer-term effective solutions such as a COVID-19 vaccine become widely available.