COVID-19 Pandemic Tradeoffs: Launch of web-toolProfessor Tony Blakely, Population Interventions Unit, CEB, MSPGH
Dr Tim Wilson, Population Interventions Unit, CEB, MSPGH, University of Melbourne
Luke Thorburn, Hunt Lab for Intelligence Research at the University of Melbourne
Nathan Grills, Nossal Institute, MSPGH, University of Melbourne
Transport Health Urban Design (THUD) Laboratory team at the Melbourne School of Design:o Dr Jason Thompson built the original agent-based model (ABM)o Profs Stevenson and McClure, THUD, contributed to early development of the ABM
o Drs Haifeng Zhao and Sachith Seneviratne (THUD) provided high-speed computing support.
Population interventions team, MSPGH:o Dr Driss Ait Ouakrim, Ms Ameera Katar and Mr Patrick Abraham undertook the literature review
to establish which diseases and conditions are associated with lockdowns
o Drs Laxman Bablani and Patrick Andersen contributed coding and expertise to assist theproportional multistate lifetable modellingo Dr Natalie Carvalho contributed health economic advice.

Structure

1. Live look at tool

2. Some power point slides of figures taken from tool
3. Our interpretation of what matters
4. What next?

Reminder – what our Vaccine Rollout looks like3

COVID-19 Trade Offs (default settings)

UptakeRelax
VE (trans)
R0 =75%off75%
3.125

4

For every scenario you select, we give yououtputs for four policy response scenarios• Aggressive elimination:• approximating the intensity of response taken in NZ and Victoria in 2020

• Moderate elimination:• approximating the responses by NSW to outbreaks (later to lockdown, earlier
out, rely more on contact tracing; but still trying to eliminate)• Tight suppression:• approximating the South Korea approach to keeping numbers low, but notgoing for elimination• Loose suppression:• approximating Europe before Christmas 2020 ‘living with the virus’5

We simulate four policy strategies, with and without
relaxation
Trigger in average daily cases per million in the last 7 days (or total cases inlast 7 days for Victorian population) with trigger thresholds → stage 3
Strategy

Relaxation ‘off’

Relaxation ‘on’All phases

Aggressive elimination

0.23 (>10)

Moderate elimination

0.9 (>42)

Tight suppression

10 (>460)

Loose suppression50 (>2310)
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We simulate four policy strategies, with and without
relaxation
Trigger in average daily cases per million in the last 7 days (or total cases inlast 7 days for Victorian population) with trigger thresholds → stage 3
Strategy

Relaxation ‘off’

Relaxation ‘on’

All phases

Phase 1a and 1b(priority, 70+,ATSI 65+)

Phase 2a(50+, ATSI 18+)

Phase 2b(rest adults)

Phase 3(children)

Aggressive elimination

0.23 (>10)

0.23 (>10)

0.45 (>20)

0.91 (>40)

1.82 (>80)

Moderate elimination

0.9 (>42)

0.9 (>42)

1.82 (>84)

3.64 (>168)

7.27 (>336)

Tight suppression

10 (>460)

10 (>460)

20 (>924)

40 (>1,848)

80 (>3,696)

Loose suppression50 (>2310)

50 (>2310)

100 (>4,620)

200 (>9,240)

400 (>18,480)7

Live demonstration of tool

COVID-19 Pandemic Trade-off tool8

Default when you open tool

UptakeRelax
VE (trans)
R0 =75%off75%
3.125

9

Pretty pessimistic scenario
UptakeRelax
VE (trans)
R0 =60%
on75%
3.75

10

Perhaps my best guess scenario
UptakeRelax
VE (trans)
R0 =75%
on90%
3.75

11

Optimistic scenario (probably unrealistic)
UptakeRelax
VE (trans)
R0 =75%
off90%
2.5

12

What about sole effect of vaccine uptake on my best
guess scenario? (Relax: on; VE (trans) 90%; R0 = 3.75)
60%

Uptake

75%
90%

13

Summarizing 216 scenarios: average weekly
number of infections in Phase 2b15

Summarizing 216 scenarios: proportion of timein stage 3 or 4 lockdown in Phase 2b16

Net health impacts- Social restrictions (including lockdowns) are essential to control COVID-19- But there are likely unintended health consequences- Moreover, the ‘right’ balance of strategy and lockdowns (given unintended healthconsequences) will likely vary as vaccine coverage increases- We undertook an international literature review to determine which diseases (and risk factors)
are associated with lockdowns:-Increase: depression, anxiety, self-harm (but not suicide), intimate partner violence
Decrease: road traffic injury, physical activity- Blue ones include in web-tool now, others (and uncertainty analyses) coming soon

17Net-health impacts for my scenario at COVID-19
Pandemics Trade-off web-tool

Uptake = 75%; Relax = on; VE (trans) = 90%; R0 = 3.75

18We encourage you to make your own
interpretations … but here are ours (so far)--

The likelihood of future uncontrolled outbreaks is – unsurprisingly – considerably greater if we adopt aloose suppression approach.
The risk varies markedly with the R0 of the circulating variant. Therefore, the greater infectivity of newvariants is of grave concern until vaccine coverage is high for a vaccine that reduces transmission.
--An ongoing aggressive elimination strategy (as per NZ and Vic in 2020) will not be optimal as vaccine
coverage increases
But we need to minimize viral incursions from overseas until vaccine coverage is high:--Gives one pause to think given Brisbane situation right now with UK variant that probably has R0 somewherearound our 3.75 scenario

Again, thinking of Brisbane now
we will explore border options more explicitly in the next month (and update the web-tool).

If children are not vaccinated, an Australian population strongly resilient to incursions of the virus isunlikely. As shown by others (e.g. Zachreson, Change, Cliff and Prokopenko (2021)) herd immunity will
be hard – if not impossible – to achieve without vaccinating children.
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What next?
We will be evolving this web-tool to:- Include specific options for border opening (it is currently part of ‘model uncertainty’)- Build in uncertainty about the health impacts- Add in net health expenditure and GDP costs for each scenario- Include a cost-effectiveness tool to work out what is an ‘optimal’ scenario to pursue- Updating inputs to the model as out evidence-base globally and in Australasia improves

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COVID-19 Pandemic Tradeoffs: Launch of web-tool
Web-tool: https://populationinterventions.science.unimelb.edu.au/pandemic-trade-offs/- this power point there too- here you will find user guide too
Summary up at The Pursuit about now: https://pursuit.unimelb.edu.au/
And you can go to the Population Interventions Unit website:- https://mspgh.unimelb.edu.au/research-groups/centre-for-epidemiology-andbiostatistics-research/population-interventions