Historical review and reflections on the participation of acupuncture and moxibustion in the treatment of epidemics in the People’s Republic of China (from 1950 until now)

Since the establishment of the People’s Republic of China, both the Communist Party and the government have placed great emphasis on the advancement of traditional Chinese medicine. Acupuncture and moxibustion have been actively involved in combating major epidemics such as malaria, schistosomiasis, and COVID-19. This article conducts a historical review of these three significant cases to elucidate how the acupuncture community has effectively utilized its unique advantages and characteristics through theoretical discussions, clinical practices, experimental research, as well as receiving administrative leadership and political support from the Communist Party of China and government. We provide an objective evaluation of their effectiveness while summarizing historical experiences to serve as a reference for future utilization of acupuncture and moxibustion therapy in epidemic relief efforts. Additionally, propose four suggestions: strengthening Party leadership and enhancing political support;timely summarization of experiences to establish programs and systems;deepening scientific research by integrating experimental findings with clinical practice;focusing on public awareness campaigns and education to solidify grassroots foundations.

Impact of COVID-19 Epidemic on the International Food Supply Chain and Countermeasures of Shandong Province

The COVID-19 epidemic has exerted an impact on the global food supply chain,and also has contributed to the tendency of food hoarding and short supply;strong food demand has led to a rapid rise in international food prices,which has put enormous pressure on China's food import,and domestic food price showed a rise trend accordingly.In order to ensure sufficient and stable supply of China's food market,it is necessary to adhere to the food security strategy of"food self-sufficiency"for a long term.In the spring agricultural production,Shandong Province has taken effective measures to stabilize food production and achieved good results.It has not been greatly affected by the COVID-19 epidemic;however,under the continuous spread of foreign epidemics,we must adhere to the dual hard core operation of epidemic prevention and production,and explore the establishment of technical specifications for agricultural production under normal conditions for epidemic prevention and control to ensure the food security.

Mathematical Modelling of the COVID-19 Epidemic in Northern Ireland in 2020

In this study, we investigate the dynamics of the COVID-19 epidemic in Northern Ireland from 1st March 2020 up to 25th December 2020, using several copies of a Susceptible-Exposed-Infectious-Recovered (SEIR) compartmental model, and compare it to a detailed publicly available dataset. We split the data into 10 time intervals and fit the models on the consecutive intervals to the cumulative number of confirmed positive cases on each interval. Using the fitted parameter estimates, we also provide estimates of the reproduction number. We also discuss the limitations and possible extensions of the employed model.

Analysis of the Role of General Practitioners Services in Rural Areas during the COVID-19 Epidemic

Since the outbreak of the COVID-19,various regions of China have been rapidly deployed under the leadership of the Central Committee of the Party to actively prevent and control the COVID-19.The rural areas of my country have weak links to the prevention and management of public health emergencies.Problems include lack of medical and health resources and farmers’low awareness of epidemic prevention.Situations that correspond to the prevention and management of the COVID-19 are more serious.As the patient’s first contact and“gatekeeper”in the fight against the epidemic,the general practitioner is responsible for the“first visit-subsequent ongoing intervention”.This article is about the prevention and control of the COVID-19 epidemics and epidemic prevention in terms of dissemination of knowledge,informed crowd control,joint prevention and control,and standardized management of people.This is a summary of the efforts of general practitioners.Quarantine at home,interactive referrals to medical consortiums,special care for contracted families.The function during the management period aims to analyze the role played by general practitioners during the epidemic and to provide new ideas for the prevention and management of the epidemic.Provide more targeted general practitioner-style services in rural areas to promote the implementation and improvement of health and poverty alleviation.The health level of the rural population provides a theoretical standard.

Effects of policies and containment measures on control of COVID- 19 epidemic in Chongqing

BACKGROUND Coronavirus disease 2019(COVID-19)is an emerging,rapidly evolving disease that spreads through the respiratory system and is highly contagious.In March 2020,the World Health Organization declared the COVID-19 outbreak a pandemic.In China,the pandemic was controlled after 2 mo through effective policies and containment measures.Describing the detailed policies and containment measures used to control the epidemic in Chongqing will provide a reference for the prevention and control of COVID-19 in other areas of the world.AIM To explore the effects of different policies and containment measures on the control of the COVID-19 epidemic in Chongqing.METHODS Epidemiological data on COVID-19 in Chongqing were prospectively collected from January 21 to March 15,2020.The policies and prevention measures implemented by the government during the epidemic period were also collected.Trend analysis was performed to explore the impact of the main policy measures on the effectiveness of the control of COVID-19 in Chongqing.As of March 15,the cumulative incidence of COVID-19 in Chongqing was 1.84/100000(576 cases)and the infection fatality rate was 1.04%(6/576).The spread of COVID-19 was controlled by effective policies that involved establishing a group for directing the COVID-19 epidemic control effort;strengthening guidance and supervision;ensuring the supply of daily necessities and medical supplies and equipment to residents;setting up designated hospitals;implementing legal measures;and enhancing health education.Medical techniques were implemented to improve the recovery rate and control the epidemic.Policies such as“the lockdown of Wuhan”,“initiating a first-level response to major public health emergencies”,and“implementing the closed management of residential communities”significantly curbed the spread of COVID-19.Optimizing the diagnosis process,shortening the diagnosis time,and constructing teams of clinical experts facilitated the provision of“one team of medical experts for each patient”treatment for severe patients,which significantly improved the recovery rate and reduced the infection fatality rate.CONCLUSION The prevention policies and containment measures implemented by the government and medical institutions are highly effective in controlling the spread of the epidemic and increasing the recovery rate of COVID-19 patients.

Lessons for Epidemic Emergency Policy: A Scoping Review of Ebola and COVID-19 Pandemics in Africa

Ebola Virus Disease (EVD) outbreaks in Central and West Africa 2013-2020 were the deadliest, most intense and most widely spread. On top of this, the novel Corona Virus Disease 2019 (COVID-19) has given us all a new experience. It is imperative to draw lessons to prepare for future disease outbreaks. This was a scoping review, a method that allows the assessment of emerging evidence. The objectives of the review were to 1) describe the manifestation of the epidemics;2) elaborate on the social and economic effects;3) characterize the responses;and 4) draw lessons. The findings show that Ebola risk is permanent and even increasing. The next COVID-19 epidemic is around the corner. For Africa, the situation has been made worse by poverty and fragility of institutions. Africa’s incapacity to manufacture its own vaccines, medicines, diagnostics and protective wear has been detrimental in the management of epidemics. The need for personal and home hygiene has been emphatically brought to attention. The trust in the government and other agencies is the cornerstone in the management of emergencies. The use of armed soldiers should be discouraged, for they scare people from seeking help. It is much better to use trusted local leaders instead of strangers during pandemic emergencies. Understanding the local politics without getting involved in them is essential. It is critical to understand community and individual perception of the risk of the disease in question. Often neglected is the psycho-social aspect, which should be planned early. The science of response measures ought to be explained simply and transparently, as part of risk communication. Emergency funds should be raised, and made easy and quick to disburse. Mechanisms of sharing health technologies and knowledge need to be devised under the UN. People centeredness ought to guide the conduct of trans-border movements and all transactions during pandemics.

Understanding the Treatment of COVID-19 and other Epidemics in Traditional Chinese Medicine

Epidemics spread quickly and are highly contagious.And there has been a profound understanding of etiology,pathogenesis,prevention,and treatment of these diseases in traditional Chinese medicine(TCM).Coronavirus disease 2019(COVID‑19)falls into the category of“epidemic dampness”,and the core pathogenesis is that latency of externally‑contracted dampness turbidity and epidemic toxin in pleurodiaphragmatic interspace provokes Shaoyang ministerial fire and causes concomitant attack of external and internal pathogens,resulting in wood fire tormenting metal and the upward rushing of dampness fire(toxin),ultimately leading to a syndrome of epidemic toxin blocking the lung.Throughout the treatment of COVID‑19,Professor Shiyun Yan uses the“harmonizing”method and sticks to the basic principles of“protecting middle qi,pectoral qi and yin fluid”to consolidate the root,dispersing externally and clearing internally and using in combination drugs cold and warm in property.The specific treatment approaches include ventilating lung and expelling pathogens,clearing heat and removing the toxin,tonifying qi and nourishing yin,activating blood and resolving stasis,resolving dampness,and dredging collaterals,to prevent the patient’s condition from getting worse and save the dying.

Understanding the Treatment of COVID-19 and other Epidemics in Traditional Chinese Medicine

Epidemics spread quickly and are highly contagious.And there has been a profound understanding of etiology,pathogenesis,prevention,and treatment of these diseases in traditional Chinese medicine(TCM).Coronavirus disease 2019(COVID-19)falls into the category of“epidemic dampness”,and the core pathogenesis is that latency of externally-contracted dampness turbidity and epidemic toxin in pleurodiaphragmatic interspace provokes Shaoyang ministerial fire and causes concomitant attack of external and internal pathogens,resulting in wood fire tormenting metal and the upward rushing of dampness fire(toxin),ultimately leading to a syndrome of epidemic toxin blocking the lung.Throughout the treatment of COVID-19,Professor Shiyun Yan uses the“harmonizing”method and sticks to the basic principles of“protecting middle qi,pectoral qi and yin fluid”to consolidate the root,dispersing externally and clearing internally and using in combination drugs cold and warm in property.The specific treatment approaches include ventilating lung and expelling pathogens,clearing heat and removing the toxin,tonifying qi and nourishing yin,activating blood and resolving stasis,resolving dampness,and dredging collaterals,to prevent the patient’s condition from getting worse and save the dying.

Partial Unlock for COVID-19-Like Epidemics Can Save 1 - 3 Million Lives Worldwide

Background: A large percentage of deaths in an epidemic or pandemic can be due to overshoot of population (herd) immunity, either from the initial peak or from planned or unplanned exit from lockdown or social distancing conditions. Objectives: We study partial unlock or reopening interaction with seasonal effects in a managed epidemic to quantify overshoot effects on small and large unlock steps and discover robust strategies for reducing overshoot. Methods: We simulate partial unlock of social distancing for epidemics over a range of replication factor, immunity duration and seasonality factor for strategies targeting immunity thresholds using overshoot optimization. Results: Seasonality change must be taken into account as one of the steps in an easing sequence, and a two-step unlock, including seasonal effects, minimizes overshoot and deaths. It may cause undershoot, which causes rebounds and assists survival of the pathogen. Conclusions: Partial easing levels, even low levels for economic relief while waiting on a vaccine, have population immunity thresholds based on the reduced replication rates and may experience overshoot as well. We further find a two-step strategy remains highly sensitive to variations in case ratio, replication factor, seasonality and timing. We demonstrate a three or more step strategy is more robust, and conclude that the best possible approach minimizes deaths under a range of likely actual conditions which include public response.

Study on Influence of the COVID-19 Epidemic on Tourism Consumption Structure in Shandong Province

At the end of 2019,the sudden outbreak of the COVID-19 epidemic brought great challenges to the world,and China's tourism industry suffered an unprecedented heavy blow.Exploring the impact of the epidemic on tourism consumption structure has become a research focus in the post-epidemic era.In this study,based on Shandong Tourism Statistics Handbook from 2018 to 2020,taking Shandong Province as an example,the changes of total tourism revenue and tourism consumption structure in Shandong Province before and after the COVID-19 epidemic were compared to predict the development of tourism in Shandong Province in the post-epidemic era and find out existing problems,and optimization paths were put forward for the development of tourism in Shandong Province in the post-epidemic era.

The Application of the “3 + 1” Mode in the COVID-19 Epidemic Prevention and Control at the Infection Ward of a Designated Comprehensive Hospital for COVID-19 Treatment

Objective: We assess the application effect of the “3 + 1” mode in the COVID-19 epidemic prevention and control at the infection ward of a designated comprehensive hospital for COVID-19 treatment. Method: Based on the features of the inpatients of the infection ward and their relatives, a “3 + 1” mode for the COVID-19 prevention and control is developed to conform to the demands for epidemic prevention and control and the overall prevention and control scheme of the whole hospital. Here, “3” stands for the epidemic prevention and control system, personnel management, and prevention and control measures;“1” stands for COVID-19 testing. Result: From March 1, 2020 to March 31, 2021, a total of 3056 patients were hospitalized in the three infection wards. Among them, 265 patients had a fever, and 113 patients had respiratory symptoms. None of them were infected with COVID-19. The participation rate of the test about the knowledge related to COVID-19 and the knowledge mastery rate were both 100% among the medical staff. None of the inpatients and their companions or the medical staff was diagnosed with COVID-19. Conclusion: Thus the “3 + 1” mode proves successful for avoiding nosocomial infection and the spread of the epidemic.

Epidemic Diseases and Chinese Medicine:Example of Severe Acute Respiratory Syndrome and COVID-19

Epidemic diseases,known and studied in China since antiquity,are one of the main chapters of the School of Exogenous Febrile Diseases(温病学派)•Along with the legends about epidemic demons,China has developed over the centuries a medical approach based on the teachings of Huang Di Nei Jing(《黄帝内经》Internal Classic),Nan Jing(《难经》Classic of Difficulties'),and Shang Han Lun(《伤寒论》Treatise of Harmful Cold).However,it was in the 17th century,after the great break of the Song,Jin,and Yuan eras that an innovative spirit Wu Youxing(吴有性)first foresaw the existence of microorganisms as we know them now.His Wen Yi Lun(《瘟疫论》Treatise on Pestilences)foreshadows an original approach to epidemic diseases,particularly emerging infectious diseases of the 21st century:severe acute respiratory syndrome 2003-2004 and the COVID-19 pandemic are perfect examples.In this first article,which will be followed by two others,we will examine the classical and modern Chinese definitions of these dreadful plagues.

Psychological Study of a Patient with COVID-19 at the Early Stage of the Epidemic

Coronavirus disease-2019 (COVID-19) caused by novel coronavirus 2019 (2019-nCoV) has led to 199,466,211 confirmed cases, including 4,244,541 deaths by 6:44 pm CEST. This epidemic is now on the period of global outbreak, the control of COVID-19 has severely challenged the world. At the beginning of the outbreak, patients infected or suspected were observed and close contacts were isolated. The country delayed the resumption of work and school and all walks of life are seriously affected. All kinds of true and false information and rumours on the internet exist, aggravating people’s anxiety and restlessness. These factors altogether often induce people to feel various negative emotions and psychological problems. In this paper, a patient with COVID-19 was examined through psychological dynamic observation at the beginning of the epidemic. It was found that in the early stage of the epidemic, due to the lack of clear treatment guidelines, the main treatment methods and psychological problems were the main reasons affecting the recovery of patients. Many uncertain factors, including individual and social factors and quarantine, worry about the prognosis, etc, resulting in anxiety, fear, unacceptance, insomnia, irritability and other pessimistic moods. After 16 days of symptomatic treatment, psychological counselling and adjustments in a timely manner, the patient eventually recovered and was discharged. The discussion of this case could serve as a reference for the treatment and rehabilitation of patients with COVID-19 in other countries and regions.

Risk Factors for Severity and Mortality of Patients Hospitalized for COVID-19 during the 3rd Wave of the Epidemic-Sao Tome and Principe

Rationale: In the literature, some risk factors for severity and mortality from COVID-19 have been indicated. However, these factors can change, depending on the characteristics of the population and health services. In this sense, longitudinal studies can be useful for understanding local realities and subsidizing health actions based on these realities. Objective: To analyze the risk factors for severity and death in hospitalized patients with COVID-19. Methods: A retrospective cohort of patients with COVID-19 hospitalized from August 1 to October 16, 2021 (3rd wave of the pandemic), notified by the Department of Epidemiological Surveillance of Sao Tome and Principe. We employed measures of strength of associations for the analysis of exposure risk factors. Results: We analyzed 110 hospitalized patients (31.8% severe-critical and 68.2% non-severe). The risk factors for severe forms of COVID-19 were: being aged ≥60 years (RR = 3.3), being male (RR = 2), having comorbidities (RR = 2) and the risk increases to 10-fold for multicomorbidities, with emphasis on obesity, neoplasia, skin-muscle-surgical infection, dementia and to some degree CVD. 62.9% of patients with severe forms of the disease were not vaccinated. Risk factors for death among hospitalized and severe/critical cases, respectively, were having comorbidities (RR = 8 and 2.4) multicomorbidities (RR = 10 and 2.8 for those with 2 comorbidities and RR = 33.3 and 4 for those with 3 or 4 comorbidities), especially diabetes, dementia, neoplasia, cutaneous-muscular infection, and obesity. Although CVD was not associated with risk factors for death, these were the most frequently found among the severely hospitalized and deaths. In addition, important risk factors associated with death were not using corticoids (RR = 3.3, 230-fold risk) and not using anticoagulants-heparin (RR = 1.3, 30% risk) more compared to the severe cases that did use them. Most of the patients who died (63.2%) were not vaccinated. Moreover, having only 1 dose of the vaccine was a risk factor 1.9 times more for death among all hospitalized patients, but in the severe cases, there was no association between the variable vaccination and death. Among those hospitalized with 2 doses, it was a 0.5-fold protective factor among those hospitalized. The Delta variant of Sarscov-2 was the one found among severe cases and deaths investigated by genetic sequencing, with more exuberant clinical features compared to the other 2 previous vaccinations. Conclusion: Being elderly, male and presenting comorbidities, mainly multicomorbidities were the main characteristics associated with severity of COVID-19. On the other hand, comorbidities, and even worse, multicomorbidities, hospitalization for respiratory failure, lowered level of consciousness, no use of corticoid and no use of anticoagulation in critically ill patients, and not having at least 2 doses of vaccine for covid-19, were characteristics associated with death by COVID-19. These results will help inform healthcare providers so that the best interventions can be implemented to improve outcomes for patients with COVID-19. Public health interventions must be carefully tailored and implemented in these susceptible groups to reduce the risk of mortality in patients with COVID-19 and then the risk of major complications. Intensive and regular follow-up is needed to detect early occurrences of clinical conditions.

Epidemic Diseases and Chinese Medicine: Example of SARS and COVID-19: Part Two

Along with the legends about epidemic demons,China has developed over the centuries a medical approach to epidemic diseases based on the teachings of Hucng Di Nei Jing(《黄帝内经》Huangdi s Intermnal Classic),Nan Jing(《难经》Classic of Difficult Issues),and Shang Han Lun(《伤寒论》Treatise on Cold Damage).Other doctors and scientists participated in this evolution of knowledge,like Wang Shuhe(王叔和),Ge Hong(葛洪),Chao Yuanfang(巢元方),Sun Simiao(孙思邈),and Liu Wansu(刘完素).However,it was in the 17^th century,after the great break of the Song,Jin,and Yuan eras that an innovative spirit,Wu Youke(吴又可1582-1652)first foresaw the existence of microorganisms as we know them now.His Wen Yi Lun(《瘟疫论》Treatise on Pestilence)foreshadows an original approach to epidemic diseases,particularly emerging infectious diseases of the 21^st century.After them,traditional Chinese medicine developed a comprehensive method of diagnosing and treating of these diseases(Epidemic Diseases Theory瘟疫学说)within the School ofHeat Diseases(温病学派).In a third article,we will examine some applications in the treatment of the SARS 2003-2004 epidemic(非典型肺炎)and the current COVID-19(新型冠状病毒肺炎)pandemic.

China's model to combat the COVID-19 epidemic:a public health emergency governance approach

The outbreak of Coronavirus Disease 2019(COVID-19)is of global health concern.It is a serious public health emergency for the entire world,threatening human life and public health security.To address the epidemic,it is necessary not only to take good prevention and treatment measures,but also to have effective and targeted public health emergency governance.That said,reports focusing on governance are scant.In this commentary,we summarize China’s model to combat the COVID-19 epidemic from a public health emergency governance approach.Stemmed from goals and values,a number of mechanisms are put forward,which include:a whole-ofgovernment response and accountability,setting up a multi-sectoral cooperation platform,swiftly scaling up epidemic emergency capacity,whole-of-society actions with engagement of social organizations,and engaging citizens in the epidemic prevention and control.As the epidemic continues to evolve,other countries might learn from China to build their own,context-specific models for better outcomes.

First two months of the 2019 Coronavirus Disease(COVID-19)epidemic in China:realtime surveillance and evaluation with a second derivative model

Background:Similar to outbreaks of many other infectious diseases,success in controlling the novel 2019 coronavirus infection requires a timely and accurate monitoring of the epidemic,particularly during its early period with rather limited data while the need for information increases explosively.Methods:In this study,we used a second derivative model to characterize the coronavirus epidemic in China with cumulatively diagnosed cases during the first 2 months.The analysis was further enhanced by an exponential model with a close-population assumption.This model was built with the data and used to assess the detection rate during the study period,considering the differences between the true infections,detectable and detected cases.Results:Results from the second derivative modeling suggest the coronavirus epidemic as nonlinear and chaotic in nature.Although it emerged gradually,the epidemic was highly responsive to massive interventions initiated on January 21,2020,as indicated by results from both second derivative and exponential modeling analyses.The epidemic started to decelerate immediately after the massive actions.The results derived from our analysis signaled the decline of the epidemic 14 days before it eventually occurred on February 4,2020.Study findings further signaled an accelerated decline in the epidemic starting in 14 days on February 18,2020.Conclusions:The coronavirus epidemic appeared to be nonlinear and chaotic,and was responsive to effective interventions.The methods used in this study can be applied in surveillance to inform and encourage the general public,public health professionals,clinicians and decision-makers to take coordinative and collaborative efforts to control the epidemic.

Influence of population mobility on the novel coronavirus disease(COVID-19)epidemic:based on panel data from Hubei,China

Background:The novel coronavirus disease(COVID-19)was first reported in Wuhan,China.The mass population mobility in China during the Spring Festival has been considered a driver to the transmission of COVID-19,but it still needs more empirical discussion.Methods:Based on the panel data from Hubei,China between January 6th and February 6th,2020,a random effects model was used to estimate the impact of population mobility on the transmission of COVID-19.Stata version 12.0 was used,and p<0.05 was considered statistically significant.Results:The COVID-19 was more likely to be confirmed within 11-12 days after people moved from Wuhan to 16 other prefecture-level cities in Hubei Province,which suggests a period of 11-12 days from contact to being confirmed.The daily confirmed cases and daily increment in incidence in 16 prefecture-level cities show obvious declines 9-12 days post adaptation of city lockdown at the local level.Conclusion:Population mobility is found to be a driver to the rapid transmission of COVID-19,and the lockdown intervention in local prefecture-level cities of Hubei Province has been an effective strategy to block the COVID-19 epidemic.

Investigation and Research on the Psychological Status of Children and Adolescents During the Epidemic Period of COVID-19

Objective:The paper was to analyze the investigation and study of the psychological status of children and adolescents during the epidemic period of COVID-19.Methods:From March 5th to 11th,2020,1766 students from 8 to 18 years old in Yan'an area were taken as the research objects,and the psychological characteristics of this group of people during the epidemic period of COVID-19 were analyzed by the online questionnaires.Results:In the questionnaire,all children and adolescents were in good psychological conditions,and they had not shown serious negative psychological emotions,and they attached great importance to COVID-19.Conclusion:The psychological changes of children and adolescents during the epidemic period of COVID-19 are diverse.Most children and adolescents have a good mental state,and a few have negative psychological emotions.It can strengthen the psychological management of children and adolescents during the epidemic,and promote the healthy growth of children and adolescents clinically.

Reconstructing and forecasting the COVID-19 epidemic in the United States using a 5-parameter logistic growth model

Background:Many studies have modeled and predicted the spread of COVID-19(coronavirus disease 2019)in the U.S.using data that begins with the first reported cases.However,the shortage of testing services to detect infected persons makes this approach subject to error due to its underdetection of early cases in the U.S.Our new approach overcomes this limitation and provides data supporting the public policy decisions intended to combat the spread of COVID-19 epidemic.Methods:We used Centers for Disease Control and Prevention data documenting the daily new and cumulative cases of confirmed COVID-19 in the U.S.from January 22 to April 6,2020,and reconstructed the epidemic using a 5-parameter logistic growth model.We fitted our model to data from a 2-week window(i.e.,from March 21 to April 4,approximately one incubation period)during which large-scale testing was being conducted.With parameters obtained from this modeling,we reconstructed and predicted the growth of the epidemic and evaluated the extent and potential effects of underdetection.Results:The data fit the model satisfactorily.The estimated daily growth rate was 16.8%overall with 95%CI:[15.95,17.76%],suggesting a doubling period of 4 days.Based on the modeling result,the tipping point at which new cases will begin to decline will be on April 7th,2020,with a peak of 32,860 new cases on that day.By the end of the epidemic,at least 792,548(95%CI:[789,162,795,934])will be infected in the U.S.Based on our model,a total of 12,029 cases were not detected between January 22(when the first case was detected in the U.S.)and April 4.Conclusions:Our findings demonstrate the utility of a 5-parameter logistic growth model with reliable data that comes from a specified period during which governmental interventions were appropriately implemented.Beyond informing public health decision-making,our model adds a tool for more faithfully capturing the spread of the COVID-19 epidemic.