Pandemic Severity Assessment Framework: Difference between revisions

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| [[COVID-19 pandemic]] || 5 || 4~7
| [[COVID-19 pandemic]] || 5 || 4~7
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=== COVID's variants ===
[[Variants of SARS-CoV-2#Overview|Covid variants' transmissibility and clinical severity]] have been occasionally estimated, generally relative to the original Wuhan-strain.
{| class="wikitable"
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! Covid variant !! Transmissibility (% increase from Wuhan) !! Clinical Severity (% increase from Wuhan)
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| {{nowrap|{{Flag|United Kingdom}}}}, British variant || 5 ({{Estimate|74|unit=%|prefix=sym|mini=auto}} higher<wbr /><ref name="volz">{{cite techreport|vauthors=Volz E, Mishra S, Chand M, Barrett JC, Johnson R, Geidelberg L, Hinsley WR, Laydon DJ, Dabrera G, O'Toole Á, Amato R|display-authors=6|date=2021-01-04|title=Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: Insights from linking epidemiological and genetic data|url=http://medrxiv.org/lookup/doi/10.1101/2020.12.30.20249034|via=[[medRxiv]]|type=[[Preprint]]|doi=10.1101/2020.12.30.20249034|hdl=10044/1/85239|hdl-access=free|access-date=2021-03-22}}</ref>) || {{Estimate|64|32|104|unit=%|prefix=sym|mini=auto}} more lethal<wbr /><ref>{{cite journal|vauthors=Challen R, Brooks-Pollock E, Read JM, Dyson L, Tsaneva-Atanasova K, Danon L|date=March 2021|title=Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study|journal=BMJ|volume=372|pages=n579|doi=10.1136/bmj.n579|pmc=7941603|pmid=33687922|id=n579}}</ref>
|-
|{{Flag|United States}}, Callifornian variant
|5 ({{Estimate|20|unit=%|prefix=sym|mini=auto}} ({{val|18.6|-|24.2|u=%}}) higher<wbr /><ref name="cdc-variants" /><ref>{{cite journal|display-authors=6|vauthors=Deng X, Garcia-Knight MA, Khalid MM, Servellita V, Wang C, Morris MK, Sotomayor-González A, Glasner DR, Reyes KR, Gliwa AS, Reddy NP, Sanchez San Martin C, Federman S, Cheng J, Balcerek J, Taylor J, Streithorst JA, Miller S, Kumar GR, Sreekumar B, Chen PY, Schulze-Gahmen U, Taha TY, Hayashi J, Simoneau CR, McMahon S, Lidsky PV, Xiao Y, Hemarajata P, Green NM, Espinosa A, Kath C, Haw M, Bell J, Hacker JK, Hanson C, Wadford DA, Anaya C, Ferguson D, Lareau LF, Frankino PA, Shivram H, Wyman SK, Ott M, Andino R, Chiu CY|date=March 2021|title=Transmission, infectivity, and antibody neutralization of an emerging SARS-CoV-2 variant in California carrying a L452R spike protein mutation|journal=medRxiv|type=[[Preprint]]|doi=10.1101/2021.03.07.21252647|pmc=7987058|pmid=33758899}}</ref>)
|Under investigation
|-
|{{Flag|South Africa}} variant
|5 ({{Estimate|50|20|113|unit=%|type=cri|prefix=sym|mini=auto}} higher<wbr /><ref name="ECDC1" />)
|Under investigation
|-
|{{Flag|India}} variant
|Under investigation
|Under investigation
|-
|{{Flag|Brazil}}, P1 variant
|5 ({{Estimate|152|127|178|unit=%|prefix=sym|mini=auto}} higher<wbr /><ref>{{cite journal|display-authors=6|vauthors=Coutinho RM, Marquitti FM, Ferreira LS, Borges ME, da Silva RL, Canton O, Portella TP, Lyra SP, Franco C, Plucinski MM, Lessa FC|date=2021-03-23|title=Model-based estimation of transmissibility and reinfection of SARS-CoV-2 P.1 variant|url=https://www.medrxiv.org/content/10.1101/2021.03.03.21252706v2|type=[[Preprint]]|page=9|doi=10.1101/2021.03.03.21252706|access-date=2021-04-09|quote=Table 1: Summary of the fitted parameters and respective confidence intervals considering the entire period, November 1 2020-January 31, 2021 maintaining the same pathogenicity of the previous variant. Parameter: Relative transmission rate for the new variant. Estimate: 2.52. 2.50%: 2.27. 97.50%: 2.78.|work=[[medRxiv]]}}</ref>{{efn-ua|Another preliminary study<ref name="cadde-p1"/> has estimated that P.1 may be 170–240% more transmissible, with a [[credible interval]] with a low probability of 50%.}}<wbr />{{Better source needed|date=March 2021|reason=Preprint and not peer reviewed (WP:MEDRS)}})
|{{Estimate|45|10|80|50|unit=%|type=cri|prefix=sym|mini=auto}} more lethal<wbr /><ref name="cadde-p1" />
|}
|}


Revision as of 20:50, 27 April 2021

The Pandemic Severity Assessment Framework (PSAF) is an evaluation framework which uses quadrants to evaluate both the transmissibility and clinical severity of a pandemic and to combine these into an overall impact estimate.[1] Clinical severity is calculated via multiple measures including case fatality rate, case-hospitalization ratios, and deaths-hospitalizations ratios, while viral transmissibility is measured via available data among secondary household attack rates, school attack rates, workplace attack rates, community attack rates, rates of emergency department and outpatient visits for influenza-like illness.[2][3]

The PSAF superseded the 2007 linear Pandemic Severity Index (PSI), which assumed 30% spread and measured case fatality rate (CFR) to assess the severity and evolution of the pandemic.[3][4] The United States Centers for Disease Control and Prevention (CDC) adopted the PSAF as its official pandemic severity assessment tool in 2014,[4] and it was the official pandemic severity assessment tool listed in the CDC's National Pandemic Strategy at the time of the COVID-19 pandemic.[5]

Measures used in the framework

Historically, measures of pandemic severity were based on the case fatality rate.[6] However, the case fatality rate might not be an adequate measure of pandemic severity during a pandemic response because:[2]

  • Deaths may lag several weeks behind cases, making the case fatality rate an underestimate
  • The total number of cases may not be known, making the case fatality rate an overestimate[7]
  • A single case fatality rate for the entire population may obscure the effect on vulnerable sub-populations, such as children, the elderly, those with chronic conditions, and members of certain racial and ethnic minorities
  • Fatalities alone may not account for the full effects of the pandemic, such as absenteeism or demand on healthcare services

To account for the limitations of measuring the case fatality rate alone, the PSAF rates severity of a disease outbreak on two dimensions: clinical severity of illness in infected persons; and the transmissibility of the infection in the population.[2] Each dimension can be measured using more than one measure, which are scaled to facilitate comparison. Having multiple measures for each dimension offers flexibility to choose a measure that is readily available, accurate, and representative of the impact of the pandemic. It also allows comparison across measures for a more complete understanding of the severity. The framework gives commentary on the strengths and limitations of various measures of clinical severity and transmissibility as well as guidelines for scaling them. It also provides examples of assessing past pandemics using the framework.[2]

Measures of transmissibility

The original documentation for the PSAF includes the following as potential measures of transmissibility:[2]

Measures of clinical severity

The original documentation for the PSAF includes the following as potential measures of clinical severity:[2]

Severity of past pandemics using the Pandemic Severity Assessment Framework

Estimates of hypothetical influenza deaths in the 2010 United States population (308,745,538 persons) across varying values of case-fatality ratio and the cumulative incidence of infection in the population. Selected estimated numbers of deaths are indicated with a black line, across each relevant combination of case-fatality ratio and cumulative incidence. In addition, the background color transitions from blue to yellow to red as the estimated absolute number of deaths increases. Case-fatality ratio is an example of a clinical severity measure and cumulative incidence of infection is an example of a transmissibility measure in the Pandemic Severity Assessment Framework.[2]

The original developers of the PSAF provided a model for the number of hypothetical deaths in the United States 2010 population of an influenza pandemic using the PSAF. While the axes of the PSAF are scaled measures of transmissibility and clinical severity, this model uses the case-fatality ratio instead of the scaled measure of clinical severity and the cumulative incidence of infection instead of the scaled measure of transmissibility.[2]

Influenza severity

Scaled examples of past influenza pandemics and past influenza seasons. Color scheme included to represent corresponding estimates of hypothetical influenza deaths in the 2010 US population, with the same color scale as the previous figure.[2]

During its development, the PSAF was applied to past influenza pandemics and epidemics, resulting in the following assessments:[2]

Influenza pandemic or flu season Transmissibility Clinical Severity
Spanish flu pandemic 5 7
1957–1958 influenza pandemic 4 4
1968 influenza pandemic 4 3
1977-1978 influenza epidemic 2 2
2006-2007 flu season 1 1
2007-2008 flu season 2 3
2009 swine flu pandemic 3 2

COVID-19 pandemic severity

A team of Brazilian researchers preliminarily assessed the severity of the COVID-19 pandemic using the PSAF in April 2020 based on Chinese data through 11 February 2020.[8] In their preliminary assessment, they rate COVID-19's scaled transmissibility at 5 and its scaled clinical severity at 4 to 7, placing the COVID-19 pandemic in the "very high severity" quadrant. This preliminary assessment ranks the COVID-19 pandemic as the most severe pandemic since the 1918 influenza pandemic.

Human and pandemic coronaviruses Transmissibility Clinical Severity
COVID-19 pandemic 5 4~7

COVID's variants

Covid variants' transmissibility and clinical severity have been occasionally estimated, generally relative to the original Wuhan-strain.

Covid variant Transmissibility (% increase from Wuhan) Clinical Severity (% increase from Wuhan)
 United Kingdom, British variant 5 (74% higher[9]) 64% (32–104%) more lethal[10]
 United States, Callifornian variant 5 (20% (18.6%–24.2%) higher[11][12]) Under investigation
 South Africa variant 5 (50% (20–113%) higher[13]) Under investigation
 India variant Under investigation Under investigation
 Brazil, P1 variant 5 (152% (127–178%) higher[14][A][better source needed]) 45% (50% CrI, 10–80%) more lethal[15]

See also

References

  1. ^ Roos, Robert (24 April 2017). "New CDC guidelines on flu pandemic measures reflect 2009 lessons". Center for Infectious Disease Research and Policy. Archived from the original on 30 April 2020. Retrieved 9 May 2020.
  2. ^ a b c d e f g h i j Reed, Carrie; Biggerstaff, Matthew; Finelli, Lyn; Koonin, Lisa M.; Beauvais, Denise; Uzicanin, Amra; Plummer, Andrew; Bresee, Joe; Redd, Stephen C.; Jernigan, Daniel B. (January 2013). "Novel framework for assessing epidemiologic effects of influenza epidemics and pandemics". Emerging Infectious Diseases. 19 (1): 85–91. doi:10.3201/eid1901.120124. ISSN 1080-6059. PMC 3557974. PMID 23260039.
  3. ^ a b Qualls, Noreen; Levitt, Alexandra; Kanade, Neha; Wright-Jegede, Narue; Dopson, Stephanie; Biggerstaff, Matthew; Reed, Carrie; Uzicanin, Amra (21 April 2017). "Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017" (PDF). Morbidity and Mortality Weekly Report. 66 (RR-1). Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention: 1–34. doi:10.15585/mmwr.rr6601a1. ISSN 1057-5987. PMC 5837128. PMID 28426646. Archived (PDF) from the original on 9 May 2020. Retrieved 10 May 2020.
  4. ^ a b Holloway, Rachel; Rasmussen, Sonja A.; Zaza, Stephanie; Cox, Nancy J.; Jernigan, Daniel B. (26 September 2014). "Updated Preparedness and Response Framework for Influenza Pandemics" (PDF). Morbidity and Mortality Weekly Report. 63 (RR-6). Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention: 1–18. ISSN 1057-5987. PMID 25254666. Archived (PDF) from the original on 20 September 2020. Retrieved 10 May 2020. This report provides an update to the 2008 framework to reflect experiences with 2009 H1N1 and recent responses to localized outbreaks of novel influenza A viruses. The revised framework also incorporates the recently developed Influenza Risk Assessment Tool (IRAT) (12) and Pandemic Severity Assessment Framework (PSAF) (13)...PSAF replaces the Pandemic Severity Index as a severity assessment tool (13).
  5. ^ "Pandemic Severity Assessment Framework (PSAF)". National Pandemic Strategy. Centers for Disease Control and Prevention. 3 November 2016. Archived from the original on 4 May 2020. Retrieved 9 May 2020.
  6. ^ Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States (PDF). Centers for Disease Control and Prevention. February 2007. p. 9. Archived (PDF) from the original on 2020-03-19. Retrieved 2020-05-10.
  7. ^ Rajgor, Dimple D.; Lee, Meng Har; Archuleta, Sophia; Bagdasarian, Natasha; Quek, Swee Chye (27 March 2020). "The many estimates of the COVID-19 case fatality rate". The Lancet Infectious Diseases. Elsevier Ltd. doi:10.1016/S1473-3099(20)30244-9. PMID 32224313.
  8. ^ Ribas Freitas, André Ricardo; Napimoga, Marcelo; Donalisio, Maria Rita (April 2020). "Assessing the severity of COVID-19". Epidemiologia e Serviços de Saúde: 5. doi:10.5123/S1679-49742020000200008. PMID 32267300. Archived from the original on 12 December 2020. Retrieved 9 May 2020.
  9. ^ Volz E, Mishra S, Chand M, Barrett JC, Johnson R, Geidelberg L, et al. (2021-01-04). Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: Insights from linking epidemiological and genetic data (Preprint). doi:10.1101/2020.12.30.20249034. hdl:10044/1/85239. Retrieved 2021-03-22 – via medRxiv.
  10. ^ Challen R, Brooks-Pollock E, Read JM, Dyson L, Tsaneva-Atanasova K, Danon L (March 2021). "Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study". BMJ. 372: n579. doi:10.1136/bmj.n579. PMC 7941603. PMID 33687922. n579.
  11. ^ Cite error: The named reference cdc-variants was invoked but never defined (see the help page).
  12. ^ Deng X, Garcia-Knight MA, Khalid MM, Servellita V, Wang C, Morris MK, et al. (March 2021). "Transmission, infectivity, and antibody neutralization of an emerging SARS-CoV-2 variant in California carrying a L452R spike protein mutation". medRxiv (Preprint). doi:10.1101/2021.03.07.21252647. PMC 7987058. PMID 33758899.
  13. ^ Cite error: The named reference ECDC1 was invoked but never defined (see the help page).
  14. ^ Coutinho RM, Marquitti FM, Ferreira LS, Borges ME, da Silva RL, Canton O, et al. (2021-03-23). "Model-based estimation of transmissibility and reinfection of SARS-CoV-2 P.1 variant". medRxiv (Preprint): 9. doi:10.1101/2021.03.03.21252706. Retrieved 2021-04-09. Table 1: Summary of the fitted parameters and respective confidence intervals considering the entire period, November 1 2020-January 31, 2021 maintaining the same pathogenicity of the previous variant. Parameter: Relative transmission rate for the new variant. Estimate: 2.52. 2.50%: 2.27. 97.50%: 2.78.
  15. ^ a b Cite error: The named reference cadde-p1 was invoked but never defined (see the help page).


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