1.
Introduction
The COVID-19 pandemic raging around the world has severely impacted daily life, work, education and travel [1]–[5]. Numerous measures are taken in various regions [6]–[9] (case isolation, travel restrictions, social distancing, closure of public places, etc.) to prevent the spread of the outbreak. Multiple studies [10]–[14] show that travel restrictions, which fall into two categories, domestic travel restrictions [10]–[12] and international travel restrictions [13], [14], can be among the most effective and commonly used measures against early outbreak. In the Netherlands [10], simulation results showed domestic travel restrictions could reduce the average number of clinical COVID-19 cases. If no action is taken, there is a significant risk of a large-scale outbreak. By imposing international travel restrictions in Australia [13], COVID-19 imports were reduced by 79%, and the outbreak was delayed by approximately one month. However, research on travel restrictions, whether domestic or international, remains in the period of qualitative description. This paper attempts to quantify the effect of travel restrictions on the spread of COVID-19 in Wuhan. We introduce the travel proportion in an epidemic model to measure the level of travel restrictions. The importance of this concept is that it builds a bridge between travel restrictions and clinical cases. The numbers of clinical cases corresponding to different travel proportions can be obtained by simulations.
In today's global economy, travel restrictions are undoubtedly a fatal blow to economic development [15]–[19]. If travel restrictions lead to a major economic downturn, the impact may outweigh the pandemic itself [20], [21]. It's crucial to find the appropriate travel proportion that will control the epidemic without causing a serious economic slowdown. When formulating epidemic prevention measures, local governments generally weigh three important indicators: infected persons, medical resources and economic development. The travel proportion provides a valuable reference for the government to formulate policies.
In an epidemic model with incubation period, the incidence rate can be expressed as f(S, Ia, Is), where S, Ia and Is respectively represent the susceptible population, the asymptomatic population and the symptomatic population. This study chooses the bilinear incidence rate that is denoted as f(S, Ia, Is) = αaSIa + αsSIs, where αa and αs represent infection rates of asymptomatic and symptomatic patients. In the predator-prey model, if p is the proportion of prey with refuge, the probability of the meeting becomes 1 – p of the original [22]–[25]. Whether predation or infection, they are all encounters that occur in flat space. If the uninfected and infected populations are simultaneously reduced to p of the original, then the probability of the encounter becomes p2 of the original. The incidence rate with the travel proportion of p can be expressed as f(S, Ia, Is) = αap2SIa + αsp2SIs.
2.
Methods
2.1. Modeling
So far, scholars have constructed various models based on the propagation characteristics of COVID-19 [26]–[30]. This paper divides the population into four parts, susceptible (S(t)), asymptomatic infected (Ia(t)), symptomatic infected (Is(t)) and recovered (R(t)) populations.
Susceptible population (S(t)): It is assumed that the input of the population is a constant (Λ), and the natural mortality of the population is µ. Both symptomatic patients and asymptomatic patients have the ability to infect, and the transmission ability of symptomatic patients is stronger than that of asymptomatic patients (αa < αs). If the allowable travel proportion is p, the incidence rate is αaSpIap + αsSpIsp. There is no vertical transmission of the disease. The change rate of the susceptible population is
Asymptomatic infected population (Ia(t)): It is assumed that all infected persons will experience an incubation period, and the infected persons in the incubation period will be transformed into symptomatic patients in a fixed proportion of β. The change rate of the asymptomatic population is
Symptomatic infected population (Is(t)): The recovery and mortality rates of symptomatic infected patients are δ1 and µ1 + µ. Then, the change rate of the symptomatic population is
Recovered population (R(t)): The recovered population comes from the symptomatic population with a proportion of δ1. Then, we get
Integrating the above four dimensions, we obtain
The next generation matrix method is used to solve for the basic reproductive number [31]. Rewrite system (2.1) to X=[Ia,Is,S,R]T. The disease-free equilibrium is x0=(0,0,Λµ,0). Then, we get
i = 1, 2, 3, 4. We calculate the Jacobian matrix of r(xi) and h(xi) on disease-free equilibrium
i, j = 1, 2, 3, 4. Hence, the basic reproductive number is
p2Λµαa and p2Λµαs can be regarded as the numbers of asymptomatic and symptomatic patients. 1β+µ and 1δ1+µ1+µ represent the mean times to removal for asymptomatic and symptomatic patients. ββ+µ is the ratio of asymptomatic patients to symptomatic patients.
2.2. Parameters and initial values
According to the data released by the Wuhan Bureau of Statistics, the resident population of Wuhan is 11,081,000, and the natural mortality rate is 1.6 × 10–5 per day [32]. When the incubation period of COVID-19 is 7 days [34], β is 1/7. Tab. 1 shows the values of all parameters for model (2.1). The initial value is (11081000, 105, 27.6, 2) [33].
3.
Results
Six important indicators are considered, namely, basic reproductive number (R0), final susceptible population (S∞), final recovered population (R∞), peak of asymptomatic infected population, peak of symptomatic infected population and death toll. Tab. 2 shows the values of the six indicators corresponding to their travel proportions. Fig. 1, 2, 3 show the changes of S, Ia, Is and R with time when the travel proportion ranges from 35% to 100%.
In the absence of travel restrictions, the peak number of symptomatic cases is about 2 million. This number is a quarter of the simulation results in [35]. It can be found that the model developed in [35] contains Q(t), which represents quarantine. There is no doubt that quarantine has a very good effect on reducing the number of infections. In this paper, the peak of infection occurs roughly 30 days later. For [35], that was 40 days, because quarantine has the effect of delaying the time of peak infection [36]–[39]. As can be seen from the brown curve in Fig. 1, the epidemic lasts for about 60 days. The simulation result in [35] was that the outbreak lasted for about 100 days. Quarantine lengthens the cycle of infection. Tab. 2 shows that although there is a large number of people infected with COVID-19, the final number of deaths is not very high.
Fig. 2 shows the changes of S, Ia, Is and R with time when travel proportion drops from 80% to 40%. As the travel proportion decreases, the number of susceptible people rises, which means the number of infections decreases. The infections peak and death toll both decline. Another very interesting finding is that the lower the travel proportion, the later the peak time of infection and the longer the duration of infection. In fact most of the preventive measures such as social distance, quarantine, isolation, etc. have the effect of reducing the peak of infections and delaying the peak time [40]–[43].
When the travel proportion is reduced from 40% to 35%, the basic reproductive number is reduced to less than 1, and COVID-19 spreads no more widely, which is shown in Fig. 3. Therefore, the key to whether travel restrictions can completely prevent the spread of the epidemic is that the travel proportion exceeds the threshold. It can be seen that the spread is very sensitive to the travel proportion near the threshold.
4.
Discussion
How to formulate corresponding policies according to the travel proportion is an issue worth discussing. For example, when the travel proportion is one third, it should be applied to every unit. One third of a town can go out to shop, work and study at the same time. One third of a town's community is allowed to go out at the same time. One third of the people in a building of the community from the town can go out at the same time. Only one person is allowed to go out in a family of three people at the same time.
Severe epidemic prevention measures, such as suspending public transport, closing entertainment places and banning public gatherings, can produce good results in a short time[44], [45]. However, the long-term travel restrictions will definitely bring serious harm to life, study and work [46]–[48]. The pandemic even triggered people's travel fear[49]. The use of travel restrictions, quarantines, and other measures to control epidemics has been controversial because these strategies raise political, ethical, and socioeconomic issues [50], [51]. Finding a balance between the public interest and individual rights is a very challenging matter. Normally, the cost-effectiveness and the travel restrictions are combined to comprehensively evaluate the effect of epidemic prevention measures [52]. Appropriate travel proportion can not only meet the needs of people's lives, work and tourism, but it also will not cause large-scale infection.
5.
Conclusions
Travel proportion is introduced into the epidemic model to quantify the trend of COVID-19 transmission in Wuhan. The basic reproductive number can be obtained by the next generation matrix method. When the travel proportion is less than 35%, COVID-19 will not spread on a large scale. Simulation experiments find that the lower the travel proportion, the smaller the peak infections and the later the peak time. The appropriate travel proportion can maintain the normal operation of society without causing outbreaks.