Determining the level of social distancing necessary to avoid a second COVID-19 epidemic wave: a modelling study for North East London&nbsp;
Authors: Cheetham Nathan , Waites William , Ebyarimpa Irene , Leber Werner , Brennan Katie , Panovska-Griffiths Jasmina 
Published: September 2020

Abstract
Background: As England is starting to ease lockdown restrictions in a phased manner, it is important to determine the level of social distancing, quantified here as the daily number of social contacts per person, i.e. the daily contact rate, needed to maintain control of the COVID-19 epidemic and not exceed acute bed capacity in case of a secondary wave later this year. This work uses mathematical modelling to simulate the levels of COVID-19 in North East London (NEL) and inform the level of social distancing necessary to protect the public and the healthcare demand from a secondary COVID-19 wave during 2020. Methods: We used a Susceptible-Exposed-Infected-Removed (SEIR) model describing the transmission of SARS-CoV-2 in North East London (NEL), calibrated to data on confirmed COVID-19 associated hospitalisations, hospital discharges and in-hospital deaths in NEL. To account for the uncertainty in both the infectiousness period and the proportion of symptomatic infection, we simulated nine scenarios for different combinations of infectiousness period (1, 3 and 5 days) and proportion of symptomatic infection (70%, 50% and 25% of all infections). Across all scenarios, the calibrated model was used to assess the risk of occurrence and forecast the strength and timing of a second COVID-19 wave under varying levels of daily contact rate from July 04, 2020. Specifically, the daily contact rate required to suppress the epidemic and prevent resurgence of COVID-19 cases, and the daily contact rate required to stay within the acute bed capacity of the NEL system without any additional intervention measures after July 2020, were determined across the nine different scenarios. Results: Our results caution against a full relaxing of the lockdown, predicting that a return to pre-COVID-19 levels of social contact from July 04, 2020 may induce a second wave up to eight times the original wave. With different levels of social distancing continuing into next year, the second wave can be avoided or the strength of the second wave can be mitigated. Keeping the daily contact rate lower than 5 or 6, depending on scenarios, for the rest of this year, can prevent increase in the number of COVID-19 cases, could keep the effective reproduction number R below 1 and a second COVID-19 wave may be avoided in NEL. A daily contact rate between 6 and 7, across scenarios, is likely to increase R above 1 and result in a secondary COVID-19 wave with significantly increased COVID-19 cases and associated deaths, but with demand for hospital based care remaining within the bed capacity of the NEL health and care system. In contrast, an increase in daily contact rate above 8 to 9, depending on scenarios, will likely exceed the acute bed capacity in NEL and may potentially require additional lockdowns. This scenario is associated with significantly increased COVID-19 cases and deaths, and acute COVID-19 care demand is likely to require significant scaling down of the usual operation of the health and care system, and should be avoided.Conclusions: Our findings suggest that to avoid a second COVID-19 wave and to stay within the acute bed capacity of the NEL health and care system, phased relaxing of the social distancing in NEL is advised with a view to limiting the average number of social interactions in the population. Increasing the social interaction rapidly could result in a second COVID-19 wave that will likely exceed the acute bed capacity in the system, and depending on the strength of the resurgence may require additional lockdown measures.