Effectiveness of potential antiviral treatments in COVID-19 transmission control: a modelling study

Abstract

Background: Novel coronavirus disease 2019 (COVID-19) causes an immense disease burden. Although public health countermeasures effectively controlled the epidemic in China, non-pharmaceutical interventions can neither be maintained indefinitely nor conveniently implemented globally. Vaccination is mainly used to prevent COVID-19, and most current antiviral treatment evaluations focus on clinical efficacy. Therefore, we conducted population-based simulations to assess antiviral treatment effectiveness among different age groups based on its clinical efficacy.

Methods: We collected COVID-19 data of Wuhan City from published literature and established a database (from 2 December 2019 to 16 March 2020). We developed an age-specific model to evaluate the effectiveness of antiviral treatment in patients with COVID-19. Efficacy was divided into three types: (1) viral activity reduction, reflected as transmission rate decrease [reduction was set as v (0-0.8) to simulate hypothetical antiviral treatments]; (2) reduction in the duration time from symptom onset to patient recovery/removal, reflected as a 1/γ decrease (reduction was set as 1-3 days to simulate hypothetical or real-life antiviral treatments, and the time of asymptomatic was reduced by the same proportion); (3) fatality rate reduction in severely ill patients (f_c) [reduction (z) was set as 0.3 to simulate real-life antiviral treatments]. The population was divided into four age groups (groups 1, 2, 3 and 4), which included those aged ≤ 14; 15-44; 45-64; and ≥ 65 years, respectively. Evaluation indices were based on outbreak duration, cumulative number of cases, total attack rate (TAR), peak date, number of peak cases, and case fatality rate (f).

Results: Comparing the simulation results of combination and single medication therapy s, all four age groups showed better results with combination medication. When 1/γ = 2 and v = 0.4, age group 2 had the highest TAR reduction rate (98.48%, 56.01-0.85%). When 1/γ = 2, z = 0.3, and v = 0.1, age group 1 had the highest reduction rate of f (83.08%, 0.71-0.12%).

Conclusions: Antiviral treatments are more effective in COVID-19 transmission control than in mortality reduction. Overall, antiviral treatments were more effective in younger age groups, while older age groups showed higher COVID-19 prevalence and mortality. Therefore, physicians should pay more attention to prevention of viral spread and patients deaths when providing antiviral treatments to patients of older age groups.

Keywords: Age group; Antiviral treatment; COVID-19; Transmission model.

Fig. 1

The framework of Susceptible–Exposed–Symptomatic–Asymptomatic-Recovered/Removed (SEIAR) model

Fig. 2

Summary of reported parameters of p, ω, γ. a Reference about proportion of asymptomatic. b Reference about infectious period of asymptomatic. c Reference about incubation/latent period

Fig. 3

Evaluation of the effectiveness of potential antiviral treatments (with highest TAR reduction in each age group). a ≤ 14 years; b15–44 years; c 45–64 years; d ≥ 65 years

Fig. 4

Evaluation of the effectiveness of potential antiviral treatments (with highest f reduction in each age group). a ≤ 14 years; b 15–44 years; c 45–64 years; d ≥ 65 years

Fig. 5

The results of sensitivity analysis. a κ = 0.65, ≤ 14 years; b: κ = 0.65, 15–44 years; c κ = 0.65, 45–64 years; d κ = 0.65, ≥ 65 years; e p = 0.36, ≤ 14 years; f p = 0.36, 15–44 years; g p = 0.36, 45–64 years; h p = 0.36, ≥ 65 years