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Kahn, Rebecca

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Kahn

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Rebecca

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Kahn, Rebecca

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2018 - 20204

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Author's Publications: search.filters.isAuthorOfPublication.d0ba2ba6-e75c-44be-be19-ca63c7b1a16e

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    Modeling the Comparative Impact of Individual Quarantine vs. Active Monitoring of Contacts for the Mitigation of COVID-19
    (2020-03-08) Peak, Corey; Kahn, Rebecca; Grad, Yonatan; Childs, Lauren; Li, Ruoran; Lipsitch, Marc; Buckee, Caroline
    Individual quarantine and active monitoring of contacts are core disease control strategies, particularly for emerging infectious diseases such as Coronavirus Disease 2019 (COVID-19). To estimate the comparative efficacy of these interventions to control COVID-19, we fit a stochastic branching model, comparing two sets of reported parameters for the dynamics of the disease. Our results suggest that individual quarantine may contain an outbreak of COVID-19 with a short serial interval (4.8 days) only in settings with high intervention performance where at least three-quarters of infected contacts are individually quarantined. However, in settings where this performance is unrealistically high and the outbreak of COVID-19 continues to grow, so too will the burden of the number of contacts traced for active monitoring or quarantine. In such circumstances where resources are prioritized for scalable interventions such as social distancing, we show active monitoring or individual quarantine of high-risk contacts can contribute synergistically to social distancing. To the extent that interventions based on contact tracing can be implemented, therefore, they can help mitigate the spread of COVID-19. Our model highlights the urgent need for more data on the serial interval and the extent of presymptomatic transmission in order to make data-driven policy decisions regarding the cost-benefit comparisons of individual quarantine vs. active monitoring of contacts.
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    U.S. county-level characteristics to inform equitable COVID-19 response
    (Cold Spring Harbor Laboratory, 2020-04-11) Chin, Taylor; Kahn, Rebecca; Li, Ruoran; Chen, Jarvis; Krieger, Nancy; Buckee, Caroline; Balsari, Satchit; Kiang, Mathew
    Background: The spread of Coronavirus Disease 2019 (COVID-19) across the United States confirms that not all Americans are equally at risk of infection, severe disease, or mortality. A range of intersecting biological, demographic, and socioeconomic factors are likely to determine an individual’s susceptibility to COVID-19. These factors vary significantly across counties in the United States, and often reflect the structural inequities in our society. Recognizing this vast inter-county variation in risks will be critical to mounting an adequate response strategy. Methods and Findings: Using publicly available county-specific data we identified key biological, demographic, and socioeconomic factors influencing susceptibility to COVID-19, guided by international experiences and consideration of epidemiological parameters of importance. We created bivariate county-level maps to summarize examples of key relationships across these categories, grouping age and poverty; comorbidities and lack of health insurance; proximity, density and bed capacity; and race and ethnicity, and premature death. We have also made available an interactive online tool that allows public health officials to query risk factors most relevant to their local context. Our data demonstrate significant inter-county variation in key epidemiological risk factors, with a clustering of counties in certain states, which will result in an increased demand on their public health system. While the East and West coast cities are particularly vulnerable owing to their densities (and travel routes), a large number of counties in the Southeastern states have a high proportion of at-risk populations, with high levels of poverty, comorbidities, and premature death at baseline, and low levels of health insurance coverage. The list of variables we have examined is by no means comprehensive, and several of them are interrelated and magnify underlying vulnerabilities. The online tool allows readers to explore additional combinations of risk factors, set categorical thresholds for each covariate, and filter counties above different population thresholds. Conclusion: COVID-19 responses and decision making in the United States remain decentralized. Both the federal and state governments will benefit from recognizing high intra-state, inter-county variation in population risks and response capacity. Many of the factors that are likely to exacerbate the burden of COVID-19 and the demand on healthcare systems are the compounded result of long-standing structural inequalities in US society. Strategies to protect those in the most vulnerable counties will require urgent measures to better support communities’ attempts at social distancing and to accelerate cooperation across jurisdictions to supply personnel and equipment to counties that will experience high demand.
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    Impact of stochastically generated heterogeneity in hazard rates on individually randomized vaccine efficacy trials
    (SAGE Publications, 2018) Kahn, Rebecca; Hitchings, Matt; Bellan, Steven; Lipsitch, Marc
    Background/aims Network structure and individuals' level of exposure to a pathogen can impact results from efficacy evaluation studies of interventions against infectious diseases. Heterogeneity in infection risk can cause randomized groups to increasingly differ as a trial progresses and as more high-risk individuals become infected (described in prior work as the "frailty" phenomenon). Here, we show the impact this phenomenon can have on an individually randomized trial of a leaky vaccine in which all participants are exchangeable a priori. Methods We model a vaccine trial by generating a network of individuals grouped into communities, which are connected to a larger main population. We then simulate an epidemic, deterministically and with time-varying transmission rates in the main population and stochastically in the communities. The disease natural history follows a susceptible-exposed-infectious-recovered model. Simulation results are used to estimate vaccine efficacy [Formula: see text] with a Cox proportional hazards model. Results We find downward bias in [Formula: see text] associated with low connectivity between communities in the study population and high force of infection, even when all participants in the trial are exchangeable at the time of randomization. This phenomenon arises because the stochastic dynamics in such a setting randomly lead to community-level variation in the force of infection. Stratifying a Cox model by community alleviates this bias with no loss of power. Conclusion Understanding and accounting for the impact of heterogeneous hazard rates can allow for more accurate estimates of [Formula: see text] in epidemic settings.
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    How to detect and reduce potential sources of biases in epidemiologic studies of SARS-CoV-2
    (2020-11-10) Accorsi, Emma; Qiu, Xueting; Rumpler, Eva; Kennedy-Shaffer, Lee; Kahn, Rebecca; Joshi, Keya; Goldstein, Edward; Stensrud, Mats J.; Niehus, Rene; Cevik, Muge; Lipsitch, Marc
    In response to the coronavirus disease (COVID-19) pandemic, public health scientists have produced a large and rapidly expanding body of literature that aims to answer critical questions, such as the proportion of the population in a geographic area that has been infected; the transmissibility of the virus and factors associated with high infectiousness or susceptibility to infection; which groups are the most at risk of infection, morbidity and mortality; and the degree to which antibodies confer protection to re-infection. Observational studies are subject to a number of different biases, including confounding, selection bias, and measurement error, that may threaten their validity or influence the interpretation of their results. To assist in the critical evaluation of a vast body of literature and contribute to future study design, we outline and propose solutions to biases that can occur across different categories of observational studies of COVID-19. We consider potential biases that could occur in five categories of studies: (1) cross-sectional seroprevalence, (2) longitudinal seroprotection, (3) risk factor studies to inform interventions, (4) studies to estimate the secondary attack rate, and (5) studies that use secondary attack rates to make inferences about infectiousness and susceptibility.