Bidirectional impact of imperfect mask use on reproduction number of COVID-19:A next generation matrix approach

The use of masks as a means of reducing transmission of COVID-19 outside healthcare settings has proved controversial.Masks are thought to have two modes of effect:they prevent infection with COVID-19 in wearers;and prevent transmission by individuals with subclinical infection.We used a simple next-generation matrix approach to estimate the conditions under which masks would reduce the reproduction number of COVID-19 under a threshold of 1.Our model takes into account the possibility of assortative mixing,where mask users interact preferentially with other mask users.We make 3 key observations:1.Masks,even with suboptimal efficacy in both prevention of acquisition and transmission of infection,could substantially decrease the reproduction number for COVID-19 if widely used.2.Widespread masking may be sufficient to suppress epidemics where R has been brought close to 1 via other measures(e.g.,distancing).3.“Assortment”within populations(the tendency for interactions between masked individuals to be more likely than interactions between masked and unmasked individuals)would rapidly erode the impact of masks.As such,mask uptake needs to be fairly universal to have an effect.This simple model suggests that widespread uptake of masking could be determinative in suppressing COVID-19 epidemics in regions with R(t)at or near 1.

Countries at risk of importation of chikungunya virus cases from Southern Thailand: A modeling study

Southern Thailand has been experiencing a large chikungunya virus(CHIKV)outbreak since October 2018.Given the magnitude and duration of the outbreak and its location in a popular tourist destination,we sought to determine international case exportation risk and identify countries at greatest risk of receiving travel-associated imported CHIKV cases.We used a probabilistic model to estimate the expected number of exported cases from Southern Thailand between October 2018 and April 2019.The model incorporated data on CHIKV natural history,infection rates in Southern Thailand,average length of stay for tourists,and international outbound air passenger numbers from the outbreak area.For countries highly connected to Southern Thailand by air travel,we ran 1000 simulations to estimate the expected number of imported cases.We also identified destination countries with conditions suitable for autochthonous CHIKV transmission.Over the outbreak period,we estimated that an average of 125(95%credible interval(CrI):102e149)cases would be exported from Southern Thailand to international destinations via air travel.China was projected to receive the most cases(43,95%CrI:30e56),followed by Singapore(7,95%CrI:2e12)and Malaysia(5,95%CrI:1e10).Twenty-three countries were projected to receive at least one imported case,and 64%of these countries had one or more regions that could potentially support autochthonous CHIKV transmission.The overall risk of international exportation of CHIKV cases associated with the outbreak is Southern Thailand is high.Our model projections are consistent with recent reports of CHIKV in travelers returning from the region.Countries should be alert to the possibility of CHIKV infection in returning travelers,particularly in regions where autochthonous transmission is possible.