Code Monkey home page Code Monkey logo

rt-comparison-uk-public's Introduction

Evaluating the use of the reproduction number as an epidemiological tool, using spatio-temporal trends of the Covid-19 outbreak in England

DOI

Abstract

The time-varying reproduction number (Rt: the average number secondary infections caused by each infected person) may be used to assess changes in transmission potential during an epidemic. Since new infections usually are not observed directly, it can only be estimated from delayed and potentially biased data. We estimated Rt using a model that mapped unobserved infections to observed test-positive cases, hospital admissions, and deaths with confirmed Covid-19, in seven regions of England over March through August 2020. We explored the sensitivity of Rt estimates of Covid-19 in England to different data sources, and investigated the potential of using differences in the estimates to track epidemic dynamics in population sub-groups.

Our estimates of transmission potential varied for each data source. The divergence between estimates from each source was not consistent within or across regions over time, although estimates based on hospital admissions and deaths were more spatio-temporally synchronous than compared to estimates from all test-positives. We compared differences in Rt with the demographic and social context of transmission, and found the differences between Rt may be linked to biased representations of sub-populations in each data source: from uneven testing rates, or increasing severity of disease with age, seen via outbreaks in care home populations and changing age distributions of cases.

We highlight that policy makers should consider the source populations of Rt estimates. Further work should clarify the best way to combine and interpret Rt estimates from different data sources based on the desired use.

Resources

Quick highlights on twitter

1/7 In the UK, the reproduction (R) number is a #COVID19 policy headline. But what is R based on, and what does it really tell us about who is getting infected? New paper with @seabbs, @sbfunk, and others at @cmmid_lshtm: https://t.co/cAWEL1oKYn [NOT PEER REVIEWED] pic.twitter.com/DfWWRCeBvk

— Katharine Sherratt (@kathsherratt) October 26, 2020

Daily updating UK estimates

We publish daily estimates of Rt from each data source across the UK, and Rt from case counts globally, at epiforecasts.io.

Run the code used in the paper

These steps are a minimal guide to reproducing the code.

Please raise an issue if you are interested in running any of the code and find problems, or to discuss any part of the ideas, paper, or code base.

rt-comparison-uk-public's People

Contributors

kathsherratt avatar sbfnk avatar

Stargazers

 avatar  avatar

Watchers

 avatar  avatar  avatar  avatar  avatar  avatar  avatar

Forkers

jfontestad

rt-comparison-uk-public's Issues

Post review edits

Following review, some edits to make in this google doc: 201203 - Rt comparison - revision

General

  • reword title
    • Now:

    Exploring surveillance data biases when estimating the reproduction number: with insights into varying subpopulation transmission in the first Covid-19 outbreak in England

  • correct Rt typesetting
    • to be corrected in Word when revisions complete
  • capitalise “Table” and “Figure” references
  • changing “Rts” throughout, e.g. changing to “Rt values” or “Rt estimates”
    • edited to Rt estimates, estimates of Rt, Rt estimated from...
  • page 7, line 46, ref should be to Fig SI2A, rather than SI1A

Methods

  • test out UK specific delays if time permits

    • this was not completed in time
  • clarify - delays for hospital admissions and test positives are treated as having the same delay from onset (and therefore the same lag from infection to observation)

    • _ included, page 4 para 1_
  • Page 5 – extra explanation as to how the uncertain distributions were then sampled. For example, how are the uncertainty in both mean and standard deviation captured. When estimating these delays, mean and standard deviation are coupled, so is the uncertainty generated from e.g. a posterior sample of mean and standard deviation pairs, or are means and standard deviations sampled assuming the uncertainty is independent?

    • Edited to include (google doc p4):

    When sampling uncertain distributions of time intervals, the mean and standard deviation were sampled independently. However the impact of this assumption is limited as while samples were used in the fitting process, the convolution was not explicitly defined.

  • P5, L37: Is this prior informed by the data not equivalent to “using the data twice”?

    • Edited to include: (google doc p3)

    This method therefore uses the same data both as a prior and in fitting. This assumes that observed growth is equivalent to unobserved growth, and particularly impacts the first few observations. We explored the alternative of using an independent time point prior, but this suffered problems with model identification.

  • P5, L38: How are imputations done?

    • clarified that imputations are done in the model, with the initial number of infections as described weighted by generation time and Rt
  • what is an uncertain generation time p.m.f

    • p.m.f. is uncertain, or that the p.m.f. is known, but models a stochastic outcome?
    • Edited to include

    The generation time was assumed to be known and fixed over time, with an uncertain mean and standard deviation that was sampled on each model run in order to preserve uncertainty. (google doc p3)

    • Add note to reviewer: this known, fixed generation time assumption is a pragmatic choice to preserve uncertainty - e.g. where sampling at each time step would narrow CIs with little justification for a time-varying generation time - but being explored
  • mathematical details of the modelling that was used, rather than simply references to other papers – e.g. the full Bayesian model specification (with priors)

    • added more model spec including math notation, and included priors (proof: p5 para 3; google doc p2-3)

Discussion

  • UK-specific vs global delays - would this improve/worsen the discrepancy between admissions and deaths

    • see para 5 of page 7. Added some text around decisions to use global vs UK specific delays (ie the trade-off between UK specific delay vs public data). As the implication on the discrepancy, added the following:

    The difference in source of delay distributions should not have substantially altered our conclusions about discrepancies between central estimates of Rt from either test-positives or admissions, compared to Rt from deaths. However, using the public linelist for the delay to test or admission may have introduced additional uncertainty around the respective Rt estimates, compared to greater accuracy (reduced uncertainty) in estimates of Rt from deaths based on a UK-specific delay distribution.

  • Implications of delays being the same for cases / hospitalisations - for example, with the higher testing rate rolled out over summer and wider community testing, the delay from symptom onset to testing might have decreased, whereas the delay from onset to hospital admission will not have experienced the same change.

    • added: google doc p7. Key point:

    This would have a differential impact on the accuracy of Rt estimates over time in either direction, which could explain some of the oscillating variability in Rt estimates from test-positive case data compared to hospital admissions. We had no data over time on delays from symptom onset to reporting in each data source with which to test this hypothesis. However, we have mitigated some of the likely impact by using independent sampling over an uncertain delay distribution for each set of estimates.

  • Page 6 line 55 – “However, as much as spatial variation, the data sources used to estimate Rt influenced the earliest date of epidemic decline.” – edit for clarity

    • Edited to:

    However, the data sources used to estimate Rt was as important as any regional variation in estimating the earliest date of epidemic decline

  • Page 9 line 21 - local nosocomial outbreaks could have also contributed to this discrepancy

    • edited, now includes:

    Alternatively, this may reflect an early sampling bias which disproportionately represented healthcare workers in testing, compared to admissions or deaths data. In the early spring period, testing was largely limited to hospital settings. Rt estimates from test-positives would then represent a separate route of transmission in healthcare settings, compared to that among the general population. If healthcare workers were then less susceptible to severe disease, an early peak in Rt from test-positive cases may be due to a wave of nosocomial infections [#Evans-2020] which would not have been represented in Rt from hospital admissions or deaths. Similarly, if transmission moved through the general population later than transmission in healthcare settings, then the timing of peaks in Rt from each data source would not have matched.

  • discuss whether pooling estimates might help provide a more robust estimate of Rt, or whether it’s better to present multiple estimates to policy makers

    • Edited discussion (draft proof: p10 para 2) to clarify we recommend against pooling estimates, on the basis of both unclear weightings, and information loss (google doc p9, para 1)

Add preprint doi when available

Can be a helpful way of letting people find the preprint and vice versa. Usually I add the paper title to the readme with perhaps the abstract but that is really a stylistic choice.

Drop .Rprof folder

Can get it out of git using (may also need a -r flag)

git rm --cache .Rprof.user

Repository details

In the same vein as #6 i’d usually add some info like the link to the paper the title, and perhaps tags (here Covid-19, EpiNow2, reproduction number, etc etc). Again stylistic and optional.

Recommend Projects

  • React photo React

    A declarative, efficient, and flexible JavaScript library for building user interfaces.

  • Vue.js photo Vue.js

    🖖 Vue.js is a progressive, incrementally-adoptable JavaScript framework for building UI on the web.

  • Typescript photo Typescript

    TypeScript is a superset of JavaScript that compiles to clean JavaScript output.

  • TensorFlow photo TensorFlow

    An Open Source Machine Learning Framework for Everyone

  • Django photo Django

    The Web framework for perfectionists with deadlines.

  • D3 photo D3

    Bring data to life with SVG, Canvas and HTML. 📊📈🎉

Recommend Topics

  • javascript

    JavaScript (JS) is a lightweight interpreted programming language with first-class functions.

  • web

    Some thing interesting about web. New door for the world.

  • server

    A server is a program made to process requests and deliver data to clients.

  • Machine learning

    Machine learning is a way of modeling and interpreting data that allows a piece of software to respond intelligently.

  • Game

    Some thing interesting about game, make everyone happy.

Recommend Org

  • Facebook photo Facebook

    We are working to build community through open source technology. NB: members must have two-factor auth.

  • Microsoft photo Microsoft

    Open source projects and samples from Microsoft.

  • Google photo Google

    Google ❤️ Open Source for everyone.

  • D3 photo D3

    Data-Driven Documents codes.