As a growing number of people seek to educate themselves on coronavirus COVID-19, while confined to their homes, a better understanding can be gained by taking a look at how to model an epidemic.
Researchers have created highly complex models of the spread of infections. For example, BlueDot’s disease-tracking model, described in this podcast, monitors the Internet with AI language translators and evaluates the network effects of transmission based on air travel itineraries. However, a surprising amount of insight can be gained from a very simple approach called the SIR model.
SIR model
The SIR model divides the population into three classes. The susceptible class (S) includes everyone who can catch the infection. In the case of a novel virus like corona, it seems that the entire global population was initially susceptible. The infected class (I) includes all those currently infected and able to transmit the virus to susceptible people. The removed class (R) includes everyone who has recovered from the virus or, unfortunately, died. In the model, these people no longer transmit the disease nor are they susceptible. The idea is that people move from the susceptible class to the infected class to the removed class.
Although there is much focus in the media on the exponential rise of the total number of cases of coronavirus, this figure includes recoveries and deaths. In one sense this is a huge underestimate, because the figures only includes people who have taken a test and returned a positive result. As explained by Tomas Pueyo, many people do not display symptoms until around 5 days after infection and for over 90% these symptoms are mild, so there could be ten times more people infected than the official figures suggest. In another sense, the figures are a huge exaggeration, because people who have recovered are unlikely to be infectious, because their immune systems have fought off the virus.
The SIR model measures the number of infectious people. On the worldometers site these are called “active cases”. The critical insight of the SIR model, shown in the diagram above, is that the class of infected people grows if the daily number of new cases exceeds the number of closed cases.
Closed cases – removal rate
In a real epidemic, experts don’t really know how many people are infected, but they can keep track of those who have died or recovered. So it is best to start by considering the rate of transfer from infected to removed. After some digging around, it appears that the average duration of an infection is about 2 weeks. So in a steady state situation, about on person in 14 or 7% of those infected would recover every day. This percentage would be a bit less than this if the epidemic is spreading fast, because there would be more people who have recently acquired the virus, so let’s call it 6%. For the death rate, we need the number of deaths divided by the (unknown) total number of people infected. This is likely to be lower than the “case fatality rate” reported on worldometers because that divides the number of deaths only be the number of positive tests. The death rate is estimated to be 2-3%. If we add 3% to the 6% of those recovering, the removal rate (call it “a”) is estimated to be 9%.
In the absence of a cure or treatment for the virus, it is unlikely that the duration of infectiousness can be reduced. As long as hospitals are not overwhelmed, those who might otherwise have died may be saved. However, there is not much that governments or populations can do to speed up the daily rate of “closed cases”. The only levers available are those to reduce the number of “new cases” below 9%. This appeared to occur as a result of the draconian actions taken in China in the second half of February, but the sharp increase in new cases that became apparent over the weekend of 6/7 March spooked the financial markets.
New cases – infection rate
In the SIR model, the number of new infections depends on three factors: the number of infectious people, the number of susceptible people and the something called the infection rate (r), which measures the probability that an infected person passes on the virus to a susceptible person either through direct contact or indirectly, for example, by contaminating a surface, such as a door handle.
Governments can attempt to reduce the number of new infections by controlling each of the three driving factors. Clearly, hand washing and avoiding physical contact can reduce the infection rate. Similarly infected people are encouraged to isolate themselves in order to reduce the proportion of susceptible people exposed to direct or indirect contact. Guidance to UK general practitioners is to advise patients suffering from mild symptoms to stay at home and call 111, while those with serious symptoms should call 999.
When will it end?
As more people become infected, the number of susceptible people naturally falls. Until there is a vaccine, there is nothing governments can do to speed up this decline. Eventually, when enough people will have caught the current strain of the virus, so-called “herd immunity” will prevail. It is not necessary for everyone to have come into contact with the virus, rather it is sufficient for the number of susceptible people to be smaller than a critical value. Beyond this point infected people, on average, recover before they encounter a susceptible person. This is how the epidemic will finally start to die down.
When people refer to the transmission rate or reproduction rate of a virus, they mean the number of secondary infections produced by a primary infection across a susceptible population. This is equal to the number of susceptible people times the infection rate divided by the removal rate. This determines the threshold number of susceptible people below which the number of infections falls. The critical value is equal to removal rate relative to the infection rate (a/r) . When the number of susceptible people falls to this critical value, the number of infected people will reach a peak and subsequently decline. More susceptible people will still continue to be infected, but at a decreasing rate, until the infection dies out completely, by which time a significant part of the population will have been infected.
This looks very scary indeed
Running the figures through the SIR model produces some extremely scary predictions. At the time of writing, new cases of infection were rising at a rate of about 15%. At this rate, the virus could spread to 2/3 of the population before it dies out. If three percent of those infected die, the virus would kill 2 percent of the population. Based on results so far these would be largely elderly people or those suffering from complications, so it is extremely important that they are protected from infection. If the virus continues to run out of control, the number of deaths could run into the millions before the epidemic ends.
It is absolutely essential to reduce the infection rate and keep it low, particularly among the elderly and vulnerable groups
We should watch China carefully for new cases. If none arise, it suggests that a large proportion of the population gained immunity through infection, even though lower numbers of infections were reported. However, if the imposition of constraints temporary reduced the infection rate, leaving a large susceptible pool still vulnerable, the epidemic could re-emerge once the constraints are relaxed.
What to do?
The imposition of governments restrictions on travel and large gatherings are forcing the people to rethink their options. Where possible, office workers, university students, schoolchildren and sportsmen may find themselves congregating online in virtual environments rather than in the messy and dangerous real world.
Among cyclists, this ought to be good news for Zwift and other online platforms. Zwift seems to be particularly well-positioned, due to its strong social aspect, which allows riders to meet and race against each other in virtual races. It also has the potential to allow world tour teams to compete in virtual races.
In fact the ability to meet friends and do things together virtually would have applications across all walks of life. Sports fans need something between the stadium and the television. Businesses need a medium that fills the gap between a physical office and a conference call. Schools and universities require better ways to ensure that students can learn, while classrooms and lecture theatres are closed. These innovations may turn out to be attractive long after the coronavirus scare has subsided.
While the prospect of going to the pub or a crowded nightclub loses its appeal, cycling offers the average person a very attractive alternative way to meet friends while avoiding close proximity with large groups of people. As the weather improves, the chance to enjoying some exercise in the fresh air looks ever more enticing.
End notes
SIR model based on: Mathematical Biology J.D. Murray, chapter 19
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