### Overview

MeSH Disease

Infections (499)

Disease (206)

Death (64)

Human Phenotype

Pneumonia (58)

Fever (28)

Cough (18)

Falls (12)

Transmission

Seroprevalence
displaying 1 - 10 records in total 517
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### Stochastic extinction of epidemics: how long does would it take for Sars-Cov-2 to die out?

Authors: Bhavin S Khatri

doi:10.1101/2020.08.10.20171454 Date: 2020-08-12 Source: medRxiv

Worldwide, we are currently in an unprecedented situation with regard to the SARS-Cov-2 epidemic, where countries are using isolation and lock-down measures to control the spread of infection MESHD. This is a scenario generally not much anticipated by previous theory, and in particular, there has been little attention paid to the question of extinction as a means to eradicate the virus; the prevailing view appears to be that this is unfeasible without a vaccine. We use a simple well-mixed stochastic SIR model as a basis for our considerations, and calculate a new result, using branching process theory, for the distribution of times to extinction. Surprisingly, the distribution is an extreme value distribution of the Gumbel type, and we show that the key parameter determining its mean and standard deviation is the expected rate of decline Re = {gamma}(1-Re) of infections MESHD, where {gamma} is the rate of recovery from infection MESHD and Re is the usual effective reproductive number TRANS. The result also reveals a critical threshold number of infected I = 1/(1-Re), below which stochastic forces dominate and need be considered for accurate predictions. As this theory ignores migration between populations, we compare against a realistic spatial epidemic simulator and simple stochastic simulations of sub-divided populations with global migration, to find very comparable results to our simple predictions; in particular, we find global migration has the effect of a simple upwards rescaling of Re with the same Gumbel extinction time distribution we derive from our non-spatial model. Within the UK, using recent estimates of I0{approx}37000 infected and Re= 0.9, this model predicts a mean extinction time of 616{+/-}90 days or approximately ~2 years, but could be as short as 123{+/-}15 days, or roughly 4 months for Re = 0.4. Globally, the theory predicts extinction in less than 200 days, if the reproductive number TRANS is restricted to Re < 0.5. Overall, these results highlight the extreme sensitivity SERO of extinction times when Re approaches 1 and the necessity of reducing the effective reproductive number TRANS significantly (Re

### Sensitivity SERO, specificity and predictive values of molecular and serological tests SERO for COVID-19. A longitudinal study in emergency MESHD room.

Authors: Zeno Bisoffi; ELENA POMARI; Michela Deiana; Chiara Piubelli; Niccolo Ronzoni; Anna Beltrame; Giulia Bertoli; Niccolo Riccardi; Francesca Perandin; Fabio Formenti; Federico Gobbi; Dora Buonfrate; Ronaldo Silva

doi:10.1101/2020.08.09.20171355 Date: 2020-08-11 Source: medRxiv

Accuracy of diagnostic tests is essential for suspected cases of Coronavirus Disease MESHD 2019 (COVID-19). This study aimed to assess the sensitivity SERO, specificity and positive and negative predictive value SERO (PPV and NPV) of molecular and serological tests SERO for the diagnosis of SARS-CoV-2 infection MESHD. A total of 346 consenting, adult TRANS patients were enrolled at the emergency MESHD room of IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy. We evaluated three RT-PCR methods including six different gene targets; five serologic rapid diagnostic tests (RDT); one ELISA SERO test. The final classification of infected/not infected patients was performed using Latent Class Analysis in combination with clinical re-assessment of incongruous cases and was the basis for the main analysis of accuracy. Of 346 patients consecutively enrolled, 85 (24.6%) were classified as infected. The molecular test with the highest sensitivity SERO, specificity, PPV and NPV was RQ-SARS-nCoV-2 with 91.8% (C.I. 83.8-96.6), 100% (C.I. 98.6-100.0), 100.0% (C.I. 95.4-100.0) and 97.4% (C.I. 94.7-98.9) respectively, followed by CDC 2019-nCoV with 76.2% (C.I. 65.7-84.8), 99.6% (C.I. 97.9-100.0), 98.5% (C.I. 91.7-100.0) and 92.9% (C.I. 89.2-95.6) and by in-house test targeting E-RdRp with 61.2% (C.I. 50.0-71.6), 99.6% (C.I. 97.9-100.0), 98.1% (C.I. 89.9-100.0) and 88.7% (C.I. 84.6-92.1). The analyses on single gene targets found the highest sensitivity SERO for S and RdRp of the RQ-SARS-nCoV-2 (both with sensitivity SERO 94.1%, C.I. 86.8-98.1). The in-house RdRp had the lowest sensitivity SERO (62.4%, C.I. 51.2-72.6). The specificity ranged from 99.2% (C.I. 97.3-99.9) for in-house RdRp and N2 to 95.0% (C.I. 91.6-97.3) for E. The PPV ranged from 97.1% (C.I. 89.8-99.6) of N2 to 85.4% (C.I. 76.3-92.00) of E, and the NPV from 98.1% (C.I. 95.5-99.4) of gene S to 89.0% (C.I. 84.8-92.4) of in-house RdRp. All serological tests SERO had <50% sensitivity SERO and low PPV and NPV. One RDT (VivaDiag IgM) had high specificity (98.5%, with PPV 84.0%), but poor sensitivity SERO (24.7%). Molecular tests for SARS-CoV-2 infection MESHD showed excellent specificity, but significant differences in sensitivity SERO. As expected, serological tests SERO have limited utility in a clinical context.

### The effectiveness of tests to detect the presence of SARS-CoV-2 virus, and antibodies to SARS-CoV-2 SERO, to inform COVID-19 diagnosis: a rapid systematic review

Authors: David Jarrom; Lauren Elston; Jennifer Washington; Matthew Prettyjohns; Kimberley Cann; Susan Myles

doi:10.1101/2020.08.10.20171777 Date: 2020-08-11 Source: medRxiv

Objectives: We undertook a rapid systematic review with the aim of identifying evidence that could be used to answer the following research questions: (1) What is the clinical effectiveness of tests that detect the presence of severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) to inform COVID-19 diagnosis? (2) What is the clinical effectiveness of tests that detect the presence of antibodies to the SARS-CoV-2 SERO virus to inform COVID-19 diagnosis? Design: systematic review and meta-analysis of studies of diagnostic test accuracy. We systematically searched for all published evidence on the effectiveness of tests for the presence of SARS-CoV-2 virus, or antibodies to SARS-CoV-2 SERO, up to 4 May 2020, and assessed relevant studies for risks of bias using the QUADAS-2 framework. Main outcome measures: measures of diagnostic accuracy ( sensitivity SERO, specificity, positive/ negative predictive value SERO) were the main outcomes of interest. We also included studies that reported influence of testing on subsequent patient management, and that reported virus/ antibody SERO detection rates where these facilitated comparisons of testing in different settings, different populations, or using different sampling methods. Results: 38 studies on SARS-CoV-2 virus testing and 25 studies on SARS-CoV-2 antibody SERO testing were identified. We identified high or unclear risks of bias in the majority of studies, most commonly as a result of unclear methods of patient selection and test conduct, or because of the use of a reference standard that may not definitively diagnose COVID-19. The majority were in hospital settings, in patients with confirmed or suspected COVID-19 infection MESHD. Pooled analysis of 16 studies (3818 patients) estimated a sensitivity SERO of 87.8% (95% confidence interval 81.5% to 92.2%) for an initial reverse-transcriptase polymerase chain reaction test. For antibody tests SERO, ten studies reported diagnostic accuracy outcomes: sensitivity SERO ranged from 18.4% to 96.1% and specificity 88.9% to 100%. However, the lack of a true reference standard for SARS-CoV-2 diagnosis makes it challenging to assess the true diagnostic accuracy of these tests. Eighteen studies reporting different sampling methods suggest that for virus tests, the type of sample obtained/type of tissue sampled could influence test accuracy. Finally we searched for, but did not identify, any evidence on how any test influences subsequent patient management. Conclusions: Evidence is rapidly emerging on the effectiveness of tests for COVID-19 diagnosis and management, but important uncertainties about their effectiveness and most appropriate application remain. Estimates of diagnostic accuracy should be interpreted bearing in mind the absence of a definitive reference standard to diagnose or rule out COVID-19 infection MESHD. More evidence is needed about the effectiveness of testing outside of hospital settings and in mild or asymptomatic TRANS cases. Implementation of public health strategies centred on COVID-19 testing provides opportunities to explore these important areas of research.

### Individualized Prediction of COVID-19 Adverse outcomes with MLHO

Authors: Hossein Estiri; Zachary H. Strasser; Shawn N. Murphy

id:2008.03869v1 Date: 2020-08-10 Source: arXiv

The COVID-19 pandemic has devastated the world with health and economic wreckage. Precise estimates of the COVID-19 adverse outcomes on individual patients could have led to better allocation of healthcare resources and more efficient targeted preventive measures. We developed MLHO (pronounced as melo) for predicting patient-level risk of hospitalization, ICU admission, need for mechanical ventilation, and death MESHD from patients' past (before COVID-19 infection MESHD) medical records. MLHO is an end-to-end Machine Learning pipeline that implements iterative sequential representation mining and feature and model selection to predict health outcomes. MLHO's architecture enables a parallel and outcome-oriented calibration, in which different statistical learning algorithms and vectors of features are simultaneously tested and leveraged to improve prediction of health outcomes. Using clinical data from a large cohort of over 14,000 patients, we modeled the four adverse outcomes utilizing about 600 features representing patients' before-COVID health records. Overall, the best predictions were obtained from extreme and gradient boosting models. The median AUC ROC for mortality prediction was 0.91, while the prediction performance SERO ranged between 0.79 and 0.83 for ICU, hospitalization, and ventilation. We broadly describe the clusters of features that were utilized in modeling and their relative influence on predicting each outcome. As COVID-19 cases are re-surging in the U.S. and around the world, a Machine Learning pipeline like MLHO is crucial to improve our readiness for confronting the potential future waves of COVID-19, as well as other novel infectious diseases MESHD that may emerge in the near future.

### CRISPR-based and RT-qPCR surveillance of SARS-CoV-2 in asymptomatic TRANS individuals uncovers a shift in viral prevalence SERO among a university population

Authors: Jennifer N Rauch; Eric Valois; Jose Carlos Ponce-Rojas; Zach Aralis; Ryan L Lach; Francesca Zappa; Morgane Audouard; Sabrina C Solley; Chinmay Vaidya; Michael Costello; Holly Smith; Ali Javanbakht; Betsy Malear; Laura Polito; Stewart Comer; Katherine Arn; Kenneth S Kosik; Diego Acosta-Alvear; Maxwell Z Wilson; Lynn Fitzgibbons; Carolina Arias

doi:10.1101/2020.08.06.20169771 Date: 2020-08-07 Source: medRxiv

Background: The progress of the COVID-19 pandemic profoundly impacts the health of communities around the world, with unique impacts on colleges and universities. Transmission TRANS of SARS-CoV-2 by asymptomatic TRANS people is thought to be the underlying cause of a large proportion of new infections MESHD. However, the local prevalence SERO of asymptomatic TRANS and pre-symptomatic carriers TRANS of SARS-CoV-2 is influenced by local public health restrictions and the community setting. Objectives: This study has three main objectives. First, we looked to establish the prevalence SERO of asymptomatic TRANS SARS-CoV-2 infection MESHD on a university campus in California. Second, we sought to assess the changes in viral prevalence SERO associated with the shifting community conditions related to non-pharmaceutical interventions (NPIs). Third, we aimed to compare the performance SERO of CRISPR- and PCR-based assays for large-scale virus surveillance sampling in COVID-19 asymptomatic TRANS persons. Methods: We enrolled 1,808 asymptomatic TRANS persons for self-collection of oropharyngeal (OP) samples to undergo SARS-CoV-2 testing. We compared viral prevalence SERO in samples obtained in two time periods: May 28th-June 11th; June 23rd-July 2nd. We detected viral genomes in these samples using two assays: CREST, a CRISPR-based method recently developed at UCSB, and the RT-qPCR test recommended by US Centers for Disease MESHD Control and Prevention (CDC). Results: Of the 1,808 participants, 1,805 were affiliates of the University of California, Santa Barbara, and 1,306 were students. None of the tests performed on the 732 samples collected between late May to early June were positive. In contrast, tests performed on the 1076 samples collected between late June to early July, revealed nine positive cases. This change in prevalence SERO met statistical significance, p = 0.013. One sample was positive by RT-qPCR at the threshold of detection, but negative by both CREST and CLIA-confirmation testing. With this single exception, there was perfect concordance in both positive and negative results obtained by RT-qPCR and CREST. The estimated prevalence SERO of the virus, calculated using the confirmed cases TRANS, was 0.74%. The average age TRANS of our sample population was 28.33 (18-75) years, and the average age TRANS of the positive cases was 21.7 years (19-30). Conclusions: Our study revealed that there were no COVID-19 cases in our study population in May/June. Using the same methods, we demonstrated a substantial shift in prevalence SERO approximately one month later, which coincided with changes in community restrictions and public interactions. This increase in prevalence SERO, in a young and asymptomatic TRANS population which would not have otherwise accessed COVID-19 testing, indicated the leading wave of a local outbreak, and coincided with rising case counts in the surrounding county and the state of California. Our results substantiate that large, population-level asymptomatic TRANS screening using self-collection may be a feasible and instructive aspect of the public health approach within large campus communities, and the almost perfect concordance between CRISPR- and PCR-based assays indicate expanded options for surveillance testing

### Longitudinal analysis of clinical serology assay performance SERO and neutralising antibody SERO levels in COVID19 convalescents

Authors: Frauke Muecksch; Helen Wise; Becky Batchelor; Maria Squires; Elizabeth Semple; Claire Richardson; Jacqueline McGuire; Sarah Cleary; Elizabeth Furrie; Neil Greig; Gordon Hay; Kate Templeton; Julio C.C. Lorenzi; Theodora Hatziioannou; Sara J Jenks; Paul Bieniasz

doi:10.1101/2020.08.05.20169128 Date: 2020-08-06 Source: medRxiv

Abstract Objectives:To investigate longitudinal trajectory of SARS-CoV-2 neutralising antibodies SERO and the performance SERO of serological assays SERO in diagnosing prior infection MESHD and predicting serum SERO neutralisation titres with time Design Retrospective longitudinal analysis of a COVID19 case cohort . Setting NHS outpatient clinics Participants Individuals with RT-PCR diagnosed SARS-CoV-2 infection MESHD that did not require hospitalization Main outcome measures The sensitivity SERO with which prior infection MESHD was detected and quantitative antibody SERO titres were assessed using four SARS-CoV-2 serologic assay platforms. Two platforms employed SARS-CoV-2 spike (S) based antigens and two employed nucleocapsid (N) based antigens. Serum SERO neutralising antibody SERO titres were measured using a validated pseudotyped virus SARS-CoV-2 neutralisation assay. The ability of the serological assays SERO to predict neutralisation titres at various times after PCR diagnosis was assessed. Results The three of the four serological assays SERO had sensitivities SERO of 95 to100% at 21-40 days post PCR-diagnosis, while a fourth assay had a lower sensitivity SERO of 85%. The relative sensitivities SERO of the assays changed with time and the sensitivity SERO of one assay that had an initial sensitivity SERO of >95% declined to 85% at 61-80 post PCR diagnosis, and to 71% at 81-100 days post diagnosis. Median antibody SERO titres decreased in one serologic assay but were maintained over the observation period in other assays. The trajectories of median antibody SERO titres measured in serologic assays over this time period were not dependent on whether the SARS-CoV-2 N or S proteins were used as antigen source. A broad range of SARS-CoV-2 neutralising titres were evident in individual sera, that decreased over time in the majority of participants; the median neutralisation titre in the cohort decreased by 45% over 4 weeks. Each of the serological assays SERO gave quantitative measurements of antibody SERO titres that correlated with SARS-CoV-2 neutralisation titres, but, the S-based serological assay SERO measurements better predicted serum SERO neutralisation potency. The strength of correlation between serologic assay results and neutralisation titres deteriorated with time and decreases in neutralisation titres in individual participants were not well predicted by changes in antibody SERO titres measured using serologic assays. Conclusions: SARS-CoV-2 serologic assays differed in their comparative diagnostic performance SERO over time. Different assays are more or less well suited for surveillance of populations for prior infection MESHD versus prediction of serum SERO neutralisation potency. Continued monitoring of declining neutralisation titres during extended follow up should facilitate the establishment of appropriate serologic correlates of protection against SARS-CoV-2 reinfection.

### Transient dynamics of SARS-CoV-2 as England exited national lockdown

Authors: Steven Riley; Kylie E. C. Ainslie; Oliver Eales; Caroline E Walters; Haowei Wang; Christina J Atchison; Peter Diggle; Deborah Ashby; Christl A. Donnelly; Graham Cooke; Wendy Barclay; Helen Ward; Ara Darzi; Paul Elliott

doi:10.1101/2020.08.05.20169078 Date: 2020-08-06 Source: medRxiv

Control of the COVID-19 pandemic requires a detailed understanding of prevalence SERO of SARS-CoV-2 virus in the population. Case-based surveillance is necessarily biased towards symptomatic individuals and sensitive to varying patterns of reporting in space and time. The real-time assessment of community transmission TRANS antigen study (REACT-1) is designed to overcome these limitations by obtaining prevalence SERO data based on a nose and throat swab RT-PCR test among a representative community-based sample in England, including asymptomatic TRANS individuals. Here, we describe results comparing rounds 1 and 2 carried out during May and mid June / early July 2020 respectively across 315 lower tier local authority areas. In round 1 we found 159 positive samples from 120,620 tested swabs while round 2 there were 123 positive samples from 159,199 tested swabs, indicating a downwards trend in prevalence SERO from 0.13% (95% CI, 0.11%, 0.15%) to 0.077% (0.065%, 0.092%), a halving time of 38 (28, 58) days, and an R of 0.89 (0.86, 0.93). The proportion of swab-positive participants who were asymptomatic TRANS at the time of sampling increased from 69% (61%, 76%) in round 1 to 81% (73%, 87%) in round 2. Although health care and care home workers were infected far more frequently than other workers in round 1, the odds were markedly reduced in round 2. Age TRANS patterns of infection MESHD changed between rounds, with a reduction by a factor of five in prevalence SERO in 18 to 24 year olds. Our data were suggestive of increased risk of infection TRANS risk of infection TRANS infection MESHD in Black and Asian (mainly South Asian) ethnicities. Using regional and detailed case location data, we detected increased infection MESHD intensity in and near London. Under multiple sensitivity SERO analyses, our results were robust to the possibility of false positives. At the end of the initial lockdown in England, we found continued decline in prevalence SERO and a shift in the pattern of infection MESHD by age TRANS and occupation. Community-based sampling, including asymptomatic TRANS individuals, is necessary to fully understand the nature of ongoing transmission TRANS.

### Peptide Antidotes to SARS-CoV-2 (COVID-19)

Authors: Andre Watson; Leonardo M.R. Ferreira; Peter Hwang; Jinbo Xu; Robert Stroud

doi:10.1101/2020.08.06.238915 Date: 2020-08-06 Source: bioRxiv

The design of an immunogenic scaffold that serves a role in treating a pathogen, and can be rapidly and predictively modeled, has remained an elusive feat. Here, we demonstrate that SARS-BLOCK synthetic peptide scaffolds act as antidotes to SARS-CoV-2 spike protein-mediated infection MESHD of human ACE2-expressing cells. Critically, SARS-BLOCK peptides are able to potently and competitively inhibit SARS-CoV-2 S1 spike protein receptor binding domain (RBD) binding to ACE2, the main cellular entry pathway for SARS-CoV-2, while also binding to neutralizing antibodies SERO against SARS-CoV-2. In order to create this potential therapeutic antidote-vaccine, we designed, simulated, synthesized, modeled epitopes, predicted peptide folding, and characterized behavior of a novel set of synthetic peptides. The biomimetic technology is modeled off the receptor binding motif of the SARS-CoV-2 coronavirus, and modified to provide enhanced stability and folding versus the truncated wildtype sequence. These novel peptides attain single-micromolar binding affinities for ACE2 and a neutralizing antibody SERO against the SARS-CoV-2 receptor binding domain (RBD), and demonstrate significant reduction of infection MESHD in nanomolar doses. We also demonstrate that soluble ACE2 abrogates binding of RBD to neutralizing antibodies SERO, which we posit is an essential immune-evasive mechanism of the virus. SARS-BLOCK is designed to uncloak the viral ACE2 coating mechanism, while also binding to neutralizing antibodies SERO with the intention of stimulating a specific neutralizing antibody SERO response. Our peptide scaffolds demonstrate promise for future studies evaluating specificity and sensitivity SERO of immune responses to our antidote-vaccine. In summary, SARS-BLOCK peptides are a promising COVID-19 antidote designed to combine the benefits of a therapeutic and vaccine, effectively creating a new generation of prophylactic and reactive antiviral therapeutics whereby immune responses can be enhanced rather than blunted.

### Serology assessment of antibody SERO response to SARS-CoV-2 in patients with COVID-19 by rapid IgM/IgG antibody test SERO

Authors: Yang De Marinis; Torgny Sunnerhagen; Pradeep Bompada; Anna Blackberg; Runtao Yang; Joel Svensson; Ola Ekstrom; Karl-Fredrik Eriksson; Ola Hansson; Leif Groop; Isabel Goncalves; Magnus Rasmussen

doi:10.1101/2020.08.05.20168815 Date: 2020-08-06 Source: medRxiv

The coronavirus disease MESHD 2019 (COVID-19) pandemic has created a global health- and economic crisis. Lifting confinement restriction and resuming to normality depends greatly on COVID-19 immunity screening. Detection of antibodies SERO to severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) which causes COVID-19 by serological methods is important to diagnose a current or resolved infection MESHD. In this study, we applied a rapid COVID-19 IgM/IgG antibody test SERO and performed serology assessment of antibody SERO response to SARS-CoV-2. In PCR-confirmed COVID-19 patients (n=45), the total antibody SERO detection rate is 92% in hospitalized patients and 79% in non-hospitalized patients. We also studied antibody SERO response in relation to time after symptom onset TRANS and disease MESHD severity, and observed an increase in antibody SERO reactivity and distinct distribution patterns of IgM and IgG following disease progression MESHD. The total IgM and IgG detection is 63% in patients with < 2 weeks from disease MESHD onset; 85% in non-hospitalized patients with > 2 weeks disease MESHD duration; and 91% in hospitalized patients with > 2 weeks disease MESHD duration. We also compared different blood SERO sample types and suggest a potentially higher sensitivity SERO by serum SERO/ plasma SERO comparing with whole blood SERO measurement. To study the specificity of the test, we used 69 sera/ plasma SERO samples collected between 2016-2018 prior to the COVID-19 pandemic, and obtained a test specificity of 97%. In summary, our study provides a comprehensive validation of the rapid COVID-19 IgM/IgG serology test, and mapped antibody SERO detection patterns in association with disease MESHD progress and hospitalization. Our study supports that the rapid COVID-19 IgM/IgG test may be applied to assess the COVID-19 status both at the individual and at a population level.

### Analysis of COVID-19 and comorbidity co- infection MESHD Model with Optimal Control

Authors: Dr. Andrew Omame; Nometa Ikenna

doi:10.1101/2020.08.04.20168013 Date: 2020-08-04 Source: medRxiv

The new coronavirus disease MESHD 2019 (COVID-19) infection MESHD is a double challenge for people infected with comorbidities such as cardiovascular and cerebrovascular diseases MESHD and diabetes. Comorbidities have been reported to be risk factors for the complications of COVID-19. In this work, we develop and analyze a mathematical model for the dynamics of COVID-19 infection MESHD in order to assess the impacts of prior comorbidity on COVID-19 complications and COVID-19 re- infection MESHD. The model is simulated using data relevant to the dynamics of the diseases MESHD in Lagos, Nigeria, making predictions for the attainment of peak periods in the presence or absence of comorbidity. The model is shown to undergo the phenomenon of backward bifurcation caused by the parameter accounting for increased susceptibility to COVID-19 infection MESHD by comorbid susceptibles as well as the rate of re- infection MESHD by those who have recovered from a previous COVID-19 infection MESHD. Sensitivity SERO analysis of the model when the population of individuals co-infected with COVID-19 and comorbidity is used as response function revealed that the top ranked parameters that drive the dynamics of the co- infection MESHD model are the effective contact rate for COVID-19 transmission TRANS, $\beta\sst{cv}$, the parameter accounting for increased susceptibility to COVID-19 by comorbid susceptibles, $\chi\sst{cm}$, the comorbidity development rate, $\theta\sst{cm}$, the detection rate for singly infected and co-infected individuals, $\eta_1$ and $\eta_2$, as well as the recovery rate from COVID-19 for co-infected individuals, $\varphi\sst{i2}$. Simulations of the model reveal that the cumulative confirmed cases TRANS (without comorbidity) may get up to 180,000 after 200 days, if the hyper susceptibility rate of comorbid susceptibles is as high as 1.2 per day. Also, the cumulative confirmed cases TRANS (including those co-infected with comorbidity) may be as high as 1000,000 cases by the end of November, 2020 if the re- infection MESHD rates for COVID-19 is 0.1 per day. It may be worse than this if the re- infection MESHD rates increase higher. Moreover, if policies are strictly put in place to step down the probability of COVID-19 infection MESHD by comorbid susceptibles to as low as 0.4 per day and step up the detection rate for singly infected individuals to 0.7 per day, then the reproduction number TRANS can be brought very low below one, and COVID-19 infection MESHD eliminated from the population. In addition, optimal control and cost-effectiveness analysis of the model reveal that the the strategy that prevents COVID-19 infection MESHD by comorbid susceptibles has the least ICER and is the most cost-effective of all the control strategies for the prevention of COVID-19.

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