Survival-Convolution Models for Predicting COVID-19 Cases and Assessing Effects of Mitigation Strategies

Countries around the globe have implemented unprecedented measures to mitigate the coronavirus disease 2019 (COVID-19) pandemic. We aim to predict the COVID-19 disease course and compare the effectiveness of mitigation measures across countries to inform policy decision making using a robust and parsimonious survival-convolution model. We account for transmission during a pre-symptomatic incubation period and use a time-varying effective reproduction number (R-t) to reflect the temporal trend of transmission and change in response to a public health intervention. We estimate the intervention effect on reducing the transmission rate using a natural experiment design and quantify uncertainty by permutation. In China and South Korea, we predicted the entire disease epidemic using only early phase data (2-3 weeks after the outbreak). A fast rate of decline inR(t)was observed, and adopting mitigation strategies early in the epidemic was effective in reducing the transmission rate in these two countries. The nationwide lockdown in Italy did not accelerate the speed at which the transmission rate decreases. In the United States,R(t)significantly decreased during a 2-week period after the declaration of national emergency, but it declined at a much slower rate afterwards. If the trend continues after May 1, COVID-19 may be controlled by late July. However, a loss of temporal effect (e.g., due to relaxing mitigation measures after May 1) could lead to a long delay in controlling the epidemic (mid-November with fewer than 100 daily cases) and a total of more than 2 million cases.