During the COVID-19 pandemic, some countries, such as Australia, China, Iceland, New Zealand, Thailand and Vietnam, successfully implemented an elimination strategy. Until June 2021, Atlantic Canada and Canada’s territories had also experienced prolonged periods with few SARS-CoV-2 community cases. Such regions had a need for epidemiological models that could assess the risk of SARS-CoV-2 outbreaks, but most existing frameworks are applicable to regions where SARS-CoV-2 is spreading in the community, and so it was necessary to adapt existing frameworks to meet this need. We distinguish between infections that are travel-related and those that occur in the community, and find that in Newfoundland and Labrador (NL), Nova Scotia, and Prince Edward Island the mean percentage of daily cases that were travel-related was 80% or greater (July 1, 2020 – May 31, 2021). We show that by December 24, 2021, the daily probability of an Omicron variant community outbreak establishing in NL was near one, and nearly twice as high as the previous high, which occurred in September 2021 when the Delta variant was dominant. We evaluate how vaccination and new variants might affect hypothetical future outbreaks in Mt. Pearl, NL. Our modelling framework can be used to evaluate alternative plans to relax public health restrictions when high levels of vaccination are achieved in regions that have implemented an elimination strategy.

[CBC Opinion, 18 March 2022]

…For elimination of COVID-19 to be feasible, severe public health measures must be able to reduce cases within a reasonable number of days so restrictions can be eased before the next outbreak… But when a disease is highly transmissible, outbreaks occur often, and the virus spreads easily even when restrictions are in place…

[Royal Society Open Science, 16 June 2021]

In many jurisdictions, public health authorities have implemented travel restrictions to reduce coronavirus disease 2019 (COVID-19) spread. Policies that restrict travel within countries have been implemented, but the impact of these restrictions is not well known. On 4 May 2020, Newfoundland and Labrador (NL) implemented travel restrictions such that non-residents required exemptions to enter the province. We fit a stochastic epidemic model to data describing the number of active COVID-19 cases in NL from 14 March to 26 June. We predicted possible outbreaks over nine weeks, with and without the travel restrictions, and for contact rates 40–70% of pre-pandemic levels. Our results suggest that the travel restrictions reduced the mean number of clinical COVID-19 cases in NL by 92%. Furthermore, without the travel restrictions there is a substantial risk of very large outbreaks. Using epidemic modelling, we show how the NL COVID-19 outbreak could have unfolded had the travel restrictions not been implemented. Both physical distancing and travel restrictions affect the local dynamics of the epidemic. Our modelling shows that the travel restrictions are a plausible reason for the few reported COVID-19 cases in NL after 4 May.

Empirical observations and mathematical models show that climate warming can lead to the northern (or, more generally, poleward) spread of host species ranges and their corresponding diseases. Here, we consider an unexpected possibility whereby climate warming facilitates disease spread in the opposite direction to the directional shift in the host species range. To explore this possibility, we consider two host species, both susceptible to a disease, but spatially isolated due to distinct thermal niches, and where prior to climate warming the disease is endemic in the northern species only. Previous theoretical results show that species distributions can lag behind species thermal niches when climate warming occurs. As such, we hypothesize that climate warming may increase the overlap between northern and southern host species ranges, due to the northern species lagging behind its thermal tolerance limit. To test our hypothesis, we simulate climate warming as a reaction-diffusion equation model with a Susceptible-Infected (SI) epidemiological structure, for two competing species with distinct temperature-dependent niches. We show that climate warming, by shifting both species niches northwards, can facilitate the southward spread of disease, due to increased range overlap between the two populations. As our model is general, our findings may apply to viral, bacterial, and prion diseases that do not have thermal tolerance limits and are inextricably linked to their hosts distributions, such as the spread of rabies from arctic to red foxes.

[Canada Communicable Disease Report, April 2023]

Background: Case underreporting during the coronavirus disease 2019 (COVID-19) pandemic has been a major challenge to the planning and evaluation of public health responses. School children were often considered a less vulnerable population and underreporting rates may have been particularly high. In January 2022, the Canadian province of Newfoundland and Labrador (NL) was experiencing an Omicron variant outbreak (BA.1/BA.2 subvariants) and public health officials recommended that all returning students complete two rapid antigen tests (RATs) to be performed three days apart.

Methods: To estimate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we asked parents and guardians to report the results of the RATs completed by K–12 students (approximately 59,000 students) using an online survey.

Results: When comparing the survey responses with the number of cases and tests reported by the NL testing system, we found that one out of every 4.3 (95% CI, 3.1–5.3) positive households were captured by provincial case count, with 5.1% positivity estimated from the RAT results and 1.2% positivity reported by the provincial testing system. Of positive test results, 62.9% (95% CI, 44.3–83.0) were reported for elementary school students, and the remaining 37.1% (95% CI, 22.7–52.9) were reported for junior high and high school students. Asymptomatic infections were 59.8% of the positive cases. Given the low survey participation rate (3.5%), our results may suffer from sample selection biases and should be interpreted with caution.

Conclusion: The underreporting ratio is consistent with ratios calculated from serology data and provides insights into infection prevalence and asymptomatic infections in school children; a currently understudied population.

[AIMS Mathematics, 13 December 2021]

As COVID-19 vaccines become available, different model-based approaches have been developed to evaluate strategic priorities for vaccine allocation to reduce severe illness. One strategy is to directly prioritize groups that are likely to experience medical complications due to COVID-19, such as older adults. A second strategy is to limit community spread by reducing importations, for example by vaccinating members of the mobile labour force, such as rotational workers. This second strategy may be appropriate for regions with low disease prevalence, where importations are a substantial fraction of all cases and reducing the importation rate reduces the risk of community outbreaks, which can provide significant indirect protection for vulnerable individuals. Current studies have focused on comparing vaccination strategies in the absence of importations, and have not considered allocating vaccines to reduce the importation rate. Here, we provide an analytical criteria to compare the reduction in the risk of hospitalization and intensive care unit (ICU) admission over four months when either older adults or rotational workers are prioritized for vaccination. Vaccinating rotational workers (assumed to be 6,000 individuals and about 1% of the Newfoundland and Labrador (NL) population) could reduce the average risk of hospitalization and ICU admission by 42%, if no community spread is observed at the time of vaccination, because epidemic spread is reduced and vulnerable individuals are indirectly protected. In contrast, vaccinating all individuals aged 75 and older (about 43,300 individuals, or 8% of the NL population) would lead to a 24% reduction in the average risk of hospitalization, and to a 45% reduction in the average risk of ICU admission, because a large number of individuals at high risk from COVID-19 are now vaccinated. Therefore, reducing the risk of hospitalization and ICU admission of the susceptible population by reducing case importations would require a significantly lower number of vaccines. Benefits of vaccinating rotational workers decrease with increasing infection prevalence in the community. Prioritizing members of the mobile labour force should be considered as an efficient strategy to indirectly protect vulnerable groups from COVID-19 exposure in regions with low disease prevalence.

[PLoS ONE, 10 June 2022]

Contact tracing is a key component of successful management of COVID-19. Contacts of infected individuals are asked to quarantine, which can significantly slow down (or prevent) community spread. Contact tracing is particularly effective when infections are detected quickly, when contacts are traced with high probability, when the initial number of cases is low, and when social distancing and border restrictions are in place. However, the magnitude of the individual contribution of these factors in reducing epidemic spread and the impact of population immunity (due to either previous infection or vaccination), in determining contact tracing outputs is not fully understood. We present a delayed differential equation model to investigate how the immunity status and the relaxation of social distancing requirements affect contact tracing practices. We investigate how the minimal contact tracing efficiency required to keep an outbreak under control depends on the contact rate and on the proportion of immune individuals. Additionally, we consider how delays in outbreak detection and increased case importation rates affect the number of contacts to be traced daily. We show that in communities that have reached a certain immunity status, a lower contact tracing efficiency is required to avoid a major outbreak, and delayed outbreak detection and relaxation of border restrictions do not lead to a significantly higher risk of overwhelming contact tracing. We find that investing in testing programs, rather than increasing the contact tracing capacity, has a larger impact in determining whether an outbreak will be controllable. This is because early detection activates contact tracing, which will slow, and eventually reverse exponential growth, while the contact tracing capacity is a threshold that will easily become overwhelmed if exponential growth is not curbed. Finally, we evaluate quarantine effectiveness in relation to the immunity status of the population and for different viral variants. We show that quarantine effectiveness decreases with increasing proportion of immune individuals, and increases in the presence of more transmissible variants. These results suggest that a cost-effective approach is to establish different quarantine rules for immune and nonimmune individuals, where rules should depend on viral transmissibility after vaccination or infection. Altogether, our study provides quantitative information for contact tracing downsizing in vaccinated populations or in populations that have already experienced large community outbreaks, to guide COVID-19 exit strategies.

[medRxiv, 12 June 2023]

During the COVID-19 pandemic there was substantial variation between countries in the severity of the travel restrictions implemented suggesting a need for better importation models. Data to evaluate the accuracy of importation models is available for the Canadian province of Newfoundland and Labrador (NL; September 2020 to June 2021) as arriving travelers were frequently tested for SARS-CoV-2 and travel-related cases were reported. Travel volume to NL was estimated from flight data, and travel declaration forms completed at entry to Canada, and at entry to NL during the pandemic. We found that during the pandemic travel to NL decreased by 82%, the percentage of travelers arriving from Québec decreased (from 14 to 4%), and from Alberta increased (from 7 to 17%). We derived and validated an epidemiological model predicting the number of travelers testing positive for SARS-CoV-2 after arrival in NL, but found that statistical models with less description of SARS-CoV-2 epidemiology, and with parameters fitted from the validation data more accurately predicted the daily number of travel-related cases reported in NL originating from Canada (R2 = 0.55, ΔAICc = 137). Our results highlight the importance of testing travelers and reporting travel-related cases as these data are needed for importation models to support public health decisions.