Sachak-Patwa, Rahil, Byrne, Helen M., Dyson, Louise and Thompson, Robin N. (2021) The risk of SARS-CoV-2 outbreaks in low prevalence settings following the removal of travel restrictions. Communications Medicine, 1 . 39. doi:10.1038/s43856-021-00038-8 ISSN 2730-664X.

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Abstract

Background
Countries around the world have introduced travel restrictions to reduce SARS-CoV-2 transmission. As vaccines are gradually rolled out, attention has turned to when travel restrictions and other non-pharmaceutical interventions (NPIs) can be relaxed.

Methods
Using SARS-CoV-2 as a case study, we develop a mathematical branching process model to assess the risk that, following the removal of NPIs, cases arriving in low prevalence settings initiate a local outbreak. Our model accounts for changes in background population immunity due to vaccination. We consider two locations with low prevalence in which the vaccine rollout has progressed quickly – specifically, the Isle of Man (a British crown dependency in the Irish Sea) and the country of Israel.

Results
We show that the outbreak risk is unlikely to be eliminated completely when travel restrictions and other NPIs are removed. This general result is the most important finding of this study, rather than exact quantitative outbreak risk estimates in different locations. It holds even once vaccine programmes are completed. Key factors underlying this result are the potential for transmission even following vaccination, incomplete vaccine uptake, and the recent emergence of SARS-CoV-2 variants with increased transmissibility.

Conclusions
Combined, the factors described above suggest that, when travel restrictions are relaxed, it may still be necessary to implement surveillance of incoming passengers to identify infected individuals quickly. This measure, as well as tracing and testing (and/or isolating) contacts of detected infected passengers, remains useful to suppress potential outbreaks while global case numbers are high.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Science, Engineering and Medicine > Science > Mathematics
Library of Congress Subject Headings (LCSH):	COVID-19 (Disease) -- Transmission, COVID-19 (Disease) -- Prevention, Travel restrictions, COVID-19 Pandemic, 2020-
Journal or Publication Title:	Communications Medicine
Publisher:	Springer Nature
ISSN:	2730-664X
Official Date:	15 October 2021
Dates:	Date Event 15 October 2021 Published 3 September 2021 Accepted
Volume:	1
Article Number:	39
DOI:	10.1038/s43856-021-00038-8
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	6 September 2021
Date of first compliant Open Access:	8 December 2021
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID EP/L015803/1 [EPSRC] Engineering and Physical Sciences Research Council http://dx.doi.org/10.13039/501100000266 MR/V009761/1 [MRC] Medical Research Council http://dx.doi.org/10.13039/501100000265 MR/V038613/1 UK Research and Innovation http://dx.doi.org/10.13039/100014013 EP/V053507/1 UK Research and Innovation http://dx.doi.org/10.13039/100014013
Related URLs:	Publisher
Open Access Version:	Other

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