Predictions from standard epidemiological models of consequences of segregating and isolating vulnerable people into care facilities

Abstract

AbstractObjectivesSince the declaration of the COVID-19 pandemic, many governments have imposed policies to reduce contacts between people who are presumed to be particularly vulnerable to dying from respiratory illnesses and the rest of the population. These policies typically address vulnerable individuals concentrated in centralized care facilities and entail limiting social contacts with visitors, staff members, and other care home residents. We use a standard epidemiological model to investigate the impact of such circumstances on the predicted infectious disease attack rates, for interacting robust and vulnerable populations.DesignWe implement a general susceptible-infectious-recovered (SIR) compartmental model with two populations: robust and vulnerable. The key model parameters are the per-individual frequencies of within-group (robust-robust and vulnerable-vulnerable) and between-group (robust-vulnerable and vulnerable-robust) infectious-susceptible contacts and the recovery times of individuals in the two groups, which can be significantly longer for vulnerable people.ResultsAcross a large range of possible model parameters including degrees of segregation versus intermingling of vulnerable and robust individuals, we find that concentrating the most vulnerable into centralized care facilities virtually always increases the infectious disease attack rate in the vulnerable group, without significant benefit to the resistant group.ConclusionsIsolated care homes of vulnerable residents are predicted to be the worst possible mixing circumstances for reducing harm in epidemic or pandemic conditions.Strengths and limitations of this studyWe implement a simplest-possible sufficiently-realistic SIR model for an infectious respiratory disease with two interacting populations: robust and vulnerable.We investigate the predicted attack rates for a large range of parameters representing different degrees of segregation or isolation of the minority vulnerable population.We make broad-ranging conclusions about the consequences of segregation and isolation of vulnerable people, which apply to any epidemic model based on the SIR foundational assumptions.Large-parameter-range exploration is needed because the actual parameter values, especially the frequencies of infectious contacts, are not well delimited by empirical measurements and are often essentially unknown.