The global outbreak of COVID-19 has caused worrying concern amongst the public and health authorities. The first and foremost problem that many countries face during the outbreak is a shortage of medical resources. In order to investigate the impact of a shortage of hospital beds on the COVID-19 outbreak, we formulated a piecewise smooth model for describing the limitation of hospital beds. We parameterized the model while using data on the cumulative numbers of confirmed cases, recovered cases, and deaths in Wuhan city from 10 January to 12 April 2020. The results showed that, even with strong prevention and control measures in Wuhan, slowing down the supply rate, reducing the maximum capacity, and delaying the supply time of hospital beds all aggravated the outbreak severity by magnifying the cumulative numbers of confirmed cases and deaths, lengthening the end time of the pandemic, enlarging the value of the effective reproduction number during the outbreak, and postponing the time when the threshold value was reduced to 1. Our results demonstrated that establishment of the Huoshenshan, Leishenshan, and Fangcang shelter hospitals avoided 22,786 people from being infected and saved 6524 lives. Furthermore, the intervention of supplying hospital beds avoided infections in 362,360 people and saved the lives of 274,591 persons. This confirmed that the quick establishment of the Huoshenshan, Leishenshan Hospitals, and Fangcang shelter hospitals, and the designation of other hospitals for COVID-19 patients played important roles in containing the outbreak in Wuhan.

Background: The continuous emergence of novel SARS-CoV-2 variants with markedly increased transmissibility presents major challenges to the zero-COVID policy in China. It is critical to adjust aspects of the policy about non-pharmaceutical interventions (NPIs) by searching for and implementing more effective ways. We use a mathematical model to mimic the epidemic pattern of the Omicron variant in Shanghai to quantitatively show the control challenges and investigate the feasibility of different control patterns in avoiding other epidemic waves. Methods: We initially construct a dynamic model with a core step-by-step release strategy to reveal its role in controlling the spread of COVID-19, including the city-based pattern and the district-based pattern. We used the least squares method and real reported case data to fit the model for Shanghai and its 16 districts, respectively. Optimal control theory was utilized to explore the quantitative and optimal solutions of the time-varying control strength (i.e., contact rate) to suppress the highly transmissible SARS-CoV-2 variants. Results: The necessary period for reaching the zero-COVID goal can be nearly 4 months, and the final epidemic size was 629,625 (95%CI: [608,049, 651,201]). By adopting the city-based pattern, 7 out of 16 strategies released the NPIs more or earlier than the baseline and ensured a zero-resurgence risk at the average cost of 10 to 129 more cases in June. By adopting the district-based pattern, a regional linked release can allow resumption of social activity to ~ 100% in the boundary-region group about 14 days earlier and allow people to flow between different districts without causing infection resurgence. Optimal solutions of the contact rate were obtained with various testing intensities, and higher diagnosis rate correlated with higher optimal contact rate while the number of daily reported cases remained almost unchanged. Conclusions: Shanghai could have been bolder and more flexible in unleashing social activity than they did. The boundary-region group should be relaxed earlier and more attention should be paid to the centre-region group. With a more intensive testing strategy, people could return to normal life as much as possible but still ensure the epidemic was maintained at a relatively low level.

Several outbreaks of COVID-19 caused by imported cases have occurred in China following the successful control of the outbreak in early 2020. In order to avoid recurrences of such local outbreaks, it is important to devise an efficient control and prevention strategy. In this paper, we developed a stochastic discrete model of the COVID-19 epidemic in Guangzhou in 2021 to compare the effectiveness of centralized quarantine and compulsory home quarantine measures. The model was calibrated by using the daily reported cases and newly centralized quarantined cases. The estimated results showed that the home quarantine measure increased the accuracy of contact tracing. The estimated basic reproduction number was lower than that in 2020, even with a much more transmissible variant, demonstrating the effectiveness of the vaccines and normalized control interventions. Sensitivity analysis indicated that a sufficiently implemented contact tracing and centralized quarantine strategy in the initial stage would contain the epidemic faster with less infections even with a weakly implemented compulsory home quarantine measure. However, if the accuracy of the contact tracing was insufficient, then early implementation of the compulsory home quarantine with strict contact tracing, screening and testing interventions on the key individuals would shorten the epidemic duration and reduce the total number of infected cases. Particularly, 94 infections would have been avoided if the home quarantine measure had been implemented 3 days earlier and an extra 190 infections would have arisen if the home quarantine measure was implemented 3 days later. The study suggested that more attention should be paid to the precise control strategy during the initial stage of the epidemic, otherwise the key group-based control measure should be implemented strictly.