Modelling the end of a Zero-COVID strategy using nirmatrelvir/ritonavir, vaccination and NPIs in Wallis and FutunaResearch in context
Summary: Background: Ending Zero-COVID is challenging, particularly when vaccine coverage is low. Considering Wallis and Futuna, a French Zero-COVID territory affected by reluctance to vaccination, low immunity and high levels of comorbidities, we investigate how targeted use of nirmatrelvir/ritona...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | The Lancet Regional Health. Western Pacific |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606522002498 |
| _version_ | 1828098672720609280 |
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| author | Antoine Brault Cécile Tran-Kiem Clément Couteaux Valérie Olié Juliette Paireau Yazdan Yazdanpanah Jade Ghosn Guillaume Martin-Blondel Paolo Bosetti Simon Cauchemez |
| author_facet | Antoine Brault Cécile Tran-Kiem Clément Couteaux Valérie Olié Juliette Paireau Yazdan Yazdanpanah Jade Ghosn Guillaume Martin-Blondel Paolo Bosetti Simon Cauchemez |
| author_sort | Antoine Brault |
| collection | DOAJ |
| description | Summary: Background: Ending Zero-COVID is challenging, particularly when vaccine coverage is low. Considering Wallis and Futuna, a French Zero-COVID territory affected by reluctance to vaccination, low immunity and high levels of comorbidities, we investigate how targeted use of nirmatrelvir/ritonavir (brand name Paxlovid) can complement vaccination and non-pharmaceutical interventions (NPIs), and mitigate the epidemic rebound expected when Zero-COVID ends. Methods: We developed a discrete age-stratified compartmental model describing SARS-CoV-2 spread and healthcare impact once Wallis and Futuna reopens. It accounts for comorbidity risk groups (CRG), vaccine coverage (2 doses, 3 doses), the effectiveness of vaccines (recent or old injection), treatments and NPIs. In our baseline scenario, cases aged 65+ in intermediate/high CRG and 40+ in high CRG are eligible for treatment. Findings: The epidemic is expected to start 13–20 days after reopening with a doubling time of 1.6-3.7 days. For medium transmission intensity (R0 = 5), 134 (115–156) hospital admissions are expected within 3 months, with no pharmaceutical measures. In our baseline scenario, admissions are reduced by 11%–21% if 50% of the target group receive treatment, with maximum impact when combined with NPIs and vaccination. The number of hospitalisations averted (HA) per patient treated (PT) is maximum when 65+ in high CRG are targeted (0.124 HA/PT), quickly followed by 65+ in intermediate/high CRG (0.097 HA/PT), and any 65+ (0.093 HA/PT). Expanding the target group increases both PT and HA, but marginal gains diminish. Interpretation: Modelling suggests that test and treat may contribute to the mitigation of epidemic rebounds at the end of Zero-COVID, particularly in populations with low immunity and high levels of comorbidities. Funding: RECOVER, VEO, AXA, Groupama, SpF, IBEID, INCEPTION, EMERGEN. |
| first_indexed | 2024-04-11T08:04:39Z |
| format | Article |
| id | doaj.art-4643178628a449439b56cd52822bfc6a |
| institution | Directory Open Access Journal |
| issn | 2666-6065 |
| language | English |
| last_indexed | 2024-04-11T08:04:39Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj.art-4643178628a449439b56cd52822bfc6a2022-12-22T04:35:35ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652023-01-0130100634Modelling the end of a Zero-COVID strategy using nirmatrelvir/ritonavir, vaccination and NPIs in Wallis and FutunaResearch in contextAntoine Brault0Cécile Tran-Kiem1Clément Couteaux2Valérie Olié3Juliette Paireau4Yazdan Yazdanpanah5Jade Ghosn6Guillaume Martin-Blondel7Paolo Bosetti8Simon Cauchemez9Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, Paris, FranceMathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, Paris, France; Collège doctoral, Sorbonne Université, Paris, FranceAgence de Santé de Wallis et Futuna, FranceSanté publique France, FranceMathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, Paris, France; Santé publique France, FranceInfections Antimicrobials Modelling Evolution (IAME), INSERM UMR 1137, Université Paris Cité, Paris, FranceInfections Antimicrobials Modelling Evolution (IAME), INSERM UMR 1137, Université Paris Cité, Paris, FranceService des Maladies Infectieuses et Tropicales, CHU de Toulouse, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR 1291 - CNRS UMR 5051 - Université Toulouse III, FranceMathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, Paris, FranceMathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, Paris, France; Corresponding author. Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, 28 rue du Dr Roux, 75015 Paris, France.Summary: Background: Ending Zero-COVID is challenging, particularly when vaccine coverage is low. Considering Wallis and Futuna, a French Zero-COVID territory affected by reluctance to vaccination, low immunity and high levels of comorbidities, we investigate how targeted use of nirmatrelvir/ritonavir (brand name Paxlovid) can complement vaccination and non-pharmaceutical interventions (NPIs), and mitigate the epidemic rebound expected when Zero-COVID ends. Methods: We developed a discrete age-stratified compartmental model describing SARS-CoV-2 spread and healthcare impact once Wallis and Futuna reopens. It accounts for comorbidity risk groups (CRG), vaccine coverage (2 doses, 3 doses), the effectiveness of vaccines (recent or old injection), treatments and NPIs. In our baseline scenario, cases aged 65+ in intermediate/high CRG and 40+ in high CRG are eligible for treatment. Findings: The epidemic is expected to start 13–20 days after reopening with a doubling time of 1.6-3.7 days. For medium transmission intensity (R0 = 5), 134 (115–156) hospital admissions are expected within 3 months, with no pharmaceutical measures. In our baseline scenario, admissions are reduced by 11%–21% if 50% of the target group receive treatment, with maximum impact when combined with NPIs and vaccination. The number of hospitalisations averted (HA) per patient treated (PT) is maximum when 65+ in high CRG are targeted (0.124 HA/PT), quickly followed by 65+ in intermediate/high CRG (0.097 HA/PT), and any 65+ (0.093 HA/PT). Expanding the target group increases both PT and HA, but marginal gains diminish. Interpretation: Modelling suggests that test and treat may contribute to the mitigation of epidemic rebounds at the end of Zero-COVID, particularly in populations with low immunity and high levels of comorbidities. Funding: RECOVER, VEO, AXA, Groupama, SpF, IBEID, INCEPTION, EMERGEN.http://www.sciencedirect.com/science/article/pii/S2666606522002498COVID-19SARS-CoV-2TreatmentAntiviralNirmatrelvir/ritonavirPaxlovid |
| spellingShingle | Antoine Brault Cécile Tran-Kiem Clément Couteaux Valérie Olié Juliette Paireau Yazdan Yazdanpanah Jade Ghosn Guillaume Martin-Blondel Paolo Bosetti Simon Cauchemez Modelling the end of a Zero-COVID strategy using nirmatrelvir/ritonavir, vaccination and NPIs in Wallis and FutunaResearch in context The Lancet Regional Health. Western Pacific COVID-19 SARS-CoV-2 Treatment Antiviral Nirmatrelvir/ritonavir Paxlovid |
| title | Modelling the end of a Zero-COVID strategy using nirmatrelvir/ritonavir, vaccination and NPIs in Wallis and FutunaResearch in context |
| title_full | Modelling the end of a Zero-COVID strategy using nirmatrelvir/ritonavir, vaccination and NPIs in Wallis and FutunaResearch in context |
| title_fullStr | Modelling the end of a Zero-COVID strategy using nirmatrelvir/ritonavir, vaccination and NPIs in Wallis and FutunaResearch in context |
| title_full_unstemmed | Modelling the end of a Zero-COVID strategy using nirmatrelvir/ritonavir, vaccination and NPIs in Wallis and FutunaResearch in context |
| title_short | Modelling the end of a Zero-COVID strategy using nirmatrelvir/ritonavir, vaccination and NPIs in Wallis and FutunaResearch in context |
| title_sort | modelling the end of a zero covid strategy using nirmatrelvir ritonavir vaccination and npis in wallis and futunaresearch in context |
| topic | COVID-19 SARS-CoV-2 Treatment Antiviral Nirmatrelvir/ritonavir Paxlovid |
| url | http://www.sciencedirect.com/science/article/pii/S2666606522002498 |
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