Background: Knowing the number of undetected cases of COVID-19 is important for a better understanding of the spread of the disease. This study analyses the temporal dynamic of detected vs. undetected cases to provide guidance for the interpretation of prevalence studies performed with PCR or antibody tests to estimate the detection rate. Methods: We used an agent-based model to evaluate assumptions on the detection probability ranging from 0.1 to 0.9. For each general detection probability, we derived age-dependent detection probabilities and calibrated the model to reproduce the epidemic wave of COVID-19 in Austria from March 2020 to June 2020. We categorized infected individuals into presymptomatic, symptomatic unconfirmed, confirmed and never detected to observe the simulated dynamic of the detected and undetected cases. Results: The calculation of the age-dependent detection probability ruled values lower than 0.4 as most likely. Furthermore, the proportion of undetected cases depends strongly on the dynamic of the epidemic wave: during the initial upswing, the undetected cases account for a major part of all infected individuals, whereas their share decreases around the peak of the confirmed cases. Conclusions: The results of prevalence studies performed to determine the detection rate of COVID-19 patients should always be interpreted with regard to the current dynamic of the epidemic wave. Applying the method proposed in our analysis, the prevalence study performed in Austria in April 2020 could indicate a detection rate of 0.13, instead of the prevalent ratio of 0.29 between detected and estimated undetected cases at that time.

(1) Background: The Austrian supply of COVID-19 vaccine is limited for now. We aim to provide evidence-based guidance to the authorities in order to minimize COVID-19-related hospitalizations and deaths in Austria. (2) Methods: We used a dynamic agent-based population model to compare different vaccination strategies targeted to the elderly (65 ≥ years), middle aged (45–64 years), younger (15–44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW). First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed deriving a prioritization sequence for 2.45 million individuals, maximizing the reduction in total hospitalizations and deaths compared to no vaccination. We considered sterilizing and non-sterilizing immunity, assuming a 70% effectiveness. (3) Results: Maximum reduction of hospitalizations and deaths was achieved by starting vaccination with the elderly and vulnerable followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.45 million individuals yielded the same prioritization and avoided approximately one third of deaths and hospitalizations. Starting vaccination with HCW leads to slightly smaller reductions but maximizes occupational safety. (4) Conclusion: To minimize COVID-19-related hospitalizations and deaths, our study shows that elderly and vulnerable persons should be prioritized for vaccination until further vaccines are available.

Background: Many countries have successfully managed to stop the exponential spread of SARS-CoV-2. Still, the danger of a second wave of infections is omnipresent and it is clear that every containment policy must be carefully evaluated and possibly replaced by a different, less restrictive policy, before it can be lifted. Contact tracing and consequential breaking of infection-chains is a promising strategy to help contain the disease, although its precise impact on the epidemic is unknown. Objective: In this work we aim to quantify the impact of tracing on the containment of the disease. Design: We developed an agent-based simulation model that simulates the spread of the disease and allows for exploratory analysis of containment policies. We apply this model to quantify the impact of contact tracing in different characteristics in Austria and to derive general conclusions on contract tracing. Results: This modelling study displays the dynamics of the interplay between strictness of the tracing policies, isolated persons, and active COVID-19 infections. It shows that a strict tracing policy does not necessarily imply that the total number of quarantined persons is high as well, because the disease is better contained. Limitations: The results are limited by the validity of the modeling assumptions, model parameter estimates, and the quality of the parametrization data. Conclusions: The study shows that tracing is indeed an efficient measure to keep COVID-19 case numbers low but comes at the price of too many precautious quarantined people if the disease is not well contained. Therefore, contact tracing must be executed strictly and compliance within the population must be held up to prevent new disease outbreaks.

Psychiatric services have undergone profound changes over the last decades. CEPHOS-LINK is an EU-funded study project with the aim to compare readmission of patients discharged with psychiatric diagnoses using a registry-based observational record linkage study design and to analyse differences in the findings for five different countries. A range of different approaches is available for analysis of the available data. Although there are some studies that compare selected methods for evaluating questions on readmission, there are to our knowledge no published systematic literature reviews on commonly used methods and their comparison. This work shall therefore provide an overview of the methods in use, their evolution throughout history and new developments which can further improve the research quality in this area. Based on systematic literature reviews realized in the course of the CEPHOS-LINK study, this work is a systematic evaluation of mathematical (statistical and modelling) methods used in studies examining psychiatric readmission. The starting point were 502 papers, of which 407 were analysed in detail; Methods used were assigned to one of five categories with subcategories and analysed accordingly. Our particular interest next to survival analysis and regression models is modelling and simulation. As population sizes and follow-up times in the included studies varied widely, a range of methods was applied. Studies with bigger sample sizes conducted survival and regression analysis more often than studies with fewer patients did. These latter relied more on classical statistical tests (e.g. t-tests and Student Newman Keuls). Statistical strategies were often insufficiently described, posing a major problem for the evaluation. Almost all cases failed to provide and explanation of the rationale behind using certain methods. There is a discernible trend from classical parametric/nonparametric tests in older studies towards regression and survival analyses in more recent ones. Modelling and simulation were under-represented despite their high usability, as has been identified in other health applications and comparable research areas.

Continued model-based decision support is associated with particular challenges, especially in long-term projects. Due to the regularly changing questions and the often changing understanding of the underlying system, the models used must be regularly re-evaluated, -modelled and -implemented with respect to changing modelling purpose, system boundaries, and mapped causalities. Usually, this leads to models with continuously growing complexity and volume. In this work, we aim to reevaluate the idea of the model family, dating back to the 1990s, and use it to promote this as a mindset in the creation of decision support frameworks in large research projects. The idea is to generally not develop and enhance a single standalone model, but to divide the research tasks into interacting smaller models which specifically correspond to the research question. This strategy comes with many advantages, which we explain using the example of a family of models for decision support in the COVID-19 crisis and corresponding case studies. We describe the individual models, explain their role within the family, and how they are used—individually and with each other.