1 00:00:10,520 --> 00:00:12,110 PROFESSOR: So now, let's begin talking 2 00:00:12,110 --> 00:00:15,320 about the spread of disease, initially focusing 3 00:00:15,320 --> 00:00:18,110 on a population of individuals. 4 00:00:18,110 --> 00:00:20,420 So the type of modeling, which we'll be discussing, 5 00:00:20,420 --> 00:00:22,970 is sometimes referred to as compartmental modeling 6 00:00:22,970 --> 00:00:26,180 because a population is divided into different compartments. 7 00:00:26,180 --> 00:00:29,450 Such as, for example, a set of susceptible people that 8 00:00:29,450 --> 00:00:33,000 have yet not been infected, a set of infected people, 9 00:00:33,000 --> 00:00:36,110 and finally a compartment of recovered people. 10 00:00:36,110 --> 00:00:39,290 Additional compartments could be added, for example, 11 00:00:39,290 --> 00:00:44,450 for different age groups or sub-populations, for incubation 12 00:00:44,450 --> 00:00:46,760 prior to infection by the disease, 13 00:00:46,760 --> 00:00:51,720 and, for example, death and separated from recovery. 14 00:00:51,720 --> 00:00:55,020 This type of modeling based on population compartments 15 00:00:55,020 --> 00:00:57,360 was introduced by Kermack and McKendrick 16 00:00:57,360 --> 00:01:00,930 in the simplest case of what is called the SIR model, where 17 00:01:00,930 --> 00:01:03,610 S is the number of susceptible, I number infected, 18 00:01:03,610 --> 00:01:07,470 and R the number of recovered individuals in a population. 19 00:01:07,470 --> 00:01:09,450 And the dynamics take a simple form 20 00:01:09,450 --> 00:01:14,950 of a set of coupled nonlinear Ordinary Differential Equations. 21 00:01:14,950 --> 00:01:18,030 So first of all, the rate of change 22 00:01:18,030 --> 00:01:20,130 of the number of susceptible people 23 00:01:20,130 --> 00:01:27,660 is minus the transmission rate beta times S times I 24 00:01:27,660 --> 00:01:30,420 because SI base refers to how many pairs 25 00:01:30,420 --> 00:01:33,900 of susceptible and individual, or infected persons there are, 26 00:01:33,900 --> 00:01:39,180 and beta is the transmission rate per such individual 27 00:01:39,180 --> 00:01:39,680 pair. 28 00:01:48,950 --> 00:01:53,450 And then, next, we look at the dynamics of the number 29 00:01:53,450 --> 00:01:55,160 of infected persons. 30 00:01:55,160 --> 00:02:00,450 So that starts by a conversion from susceptible to infected. 31 00:02:00,450 --> 00:02:04,400 So beta*S*I is the rate of producing new infected persons. 32 00:02:04,400 --> 00:02:08,699 And then, we introduce another rate, constant gamma, 33 00:02:08,699 --> 00:02:10,400 which is the removal rate. 34 00:02:13,720 --> 00:02:17,400 So this could be people are removed 35 00:02:17,400 --> 00:02:20,579 from the infected compartment either by recovering 36 00:02:20,579 --> 00:02:26,070 or, potentially, we could lump into that, dying. 37 00:02:26,070 --> 00:02:29,040 So we finally complete the balance here 38 00:02:29,040 --> 00:02:33,890 by writing the number of recovered, changing as gamma*I. 39 00:02:33,890 --> 00:02:35,310 So basically, we have a model here 40 00:02:35,310 --> 00:02:39,430 with three compartments and two rate constants. 41 00:02:39,430 --> 00:02:42,370 Now the important aspect, really, here 42 00:02:42,370 --> 00:02:45,590 is the rate of change of the number of infected individuals. 43 00:02:45,590 --> 00:02:48,930 So I'll write that equation over here, which 44 00:02:48,930 --> 00:02:54,840 is dI/dt equals, and let's factor out gamma 45 00:02:54,840 --> 00:02:57,990 and write the prefactor here on the rate 46 00:02:57,990 --> 00:03:04,050 as (beta*S/gamma-1) times gamma*I. 47 00:03:04,050 --> 00:03:11,120 And if we look now at early times, 48 00:03:11,120 --> 00:03:13,280 then the number of susceptible people 49 00:03:13,280 --> 00:03:18,290 is approximately equal to the initial number, at t=0. 50 00:03:18,290 --> 00:03:20,690 So that's essentially the size of the entire population, 51 00:03:20,690 --> 00:03:22,040 typically. 52 00:03:22,040 --> 00:03:29,240 And so we would then write this as beta*S0/(gamma-1), 53 00:03:29,240 --> 00:03:31,190 times gamma*I. 54 00:03:31,190 --> 00:03:34,250 So now this is just a formula that at early times 55 00:03:34,250 --> 00:03:35,940 gives you an exponential increase. 56 00:03:35,940 --> 00:03:41,480 So we would then find that I grows like the initial number 57 00:03:41,480 --> 00:03:42,320 of infected persons. 58 00:03:42,320 --> 00:03:46,700 It could be, for example, just 1 times 59 00:03:46,700 --> 00:03:48,430 e to this factor here times t. 60 00:03:48,430 --> 00:03:50,480 And I'm going to write it in a certain way, which 61 00:03:50,480 --> 00:03:55,750 is (R_0-1)*gamma*t. 62 00:03:55,750 --> 00:03:58,450 So this is the early times. 63 00:03:58,450 --> 00:04:00,070 And then we have put a little squiggle 64 00:04:00,070 --> 00:04:02,740 here to indicate that's the initial growth 65 00:04:02,740 --> 00:04:06,000 rate or the initial dependence, 66 00:04:06,000 --> 00:04:14,850 where R_0 is beta*S_0/gamma. 67 00:04:14,850 --> 00:04:19,360 And this is called the reproductive number 68 00:04:19,360 --> 00:04:24,500 of the disease, or of the epidemic, 69 00:04:24,500 --> 00:04:32,550 because we can see here that if R_0 is bigger than 1, 70 00:04:32,550 --> 00:04:34,470 then we have an exponential growth 71 00:04:34,470 --> 00:04:36,210 of the number infected persons. 72 00:04:36,210 --> 00:04:39,810 So then we essentially have an epidemic 73 00:04:39,810 --> 00:04:42,570 starting from an initial index case, 74 00:04:42,570 --> 00:04:46,290 or some set of cases, numbering I_0. 75 00:04:46,290 --> 00:04:54,720 Of course, if R_0 is less than 1, then we have no epidemic. 76 00:04:54,720 --> 00:04:57,330 In other words, there may be an infected person or two, 77 00:04:57,330 --> 00:05:00,250 but the number will exponentially decrease, 78 00:05:00,250 --> 00:05:02,230 and there won't be any growth. 79 00:05:02,230 --> 00:05:06,480 So the reproductive number is an important concept 80 00:05:06,480 --> 00:05:09,300 in epidemiology that comes directly from these models. 81 00:05:09,300 --> 00:05:13,230 Related to that is the concept of herd immunity, which 82 00:05:13,230 --> 00:05:16,260 is the point where enough members of the population 83 00:05:16,260 --> 00:05:18,960 are immune that the epidemic starts to die 84 00:05:18,960 --> 00:05:22,160 out and eventually disappear. 85 00:05:22,160 --> 00:05:29,550 Let's make a plot of the typical predictions of the SIR model. 86 00:05:29,550 --> 00:05:32,820 So as a function of time, the number of susceptible people 87 00:05:32,820 --> 00:05:38,630 starts at some value S_0, and it decreases. 88 00:05:38,630 --> 00:05:41,780 Initially, the number of infected persons 89 00:05:41,780 --> 00:05:44,270 starts at some small number I_0, which 90 00:05:44,270 --> 00:05:48,440 might even just be one index case, and as we showed here, 91 00:05:48,440 --> 00:05:51,710 it exponentially increases. 92 00:05:51,710 --> 00:05:56,090 The number of recovered starts at 0 93 00:05:56,090 --> 00:05:59,000 and increases as well, with some delay 94 00:05:59,000 --> 00:06:00,320 given by the recovery time. 95 00:06:05,190 --> 00:06:11,180 And what we then see is that as the number of susceptibles 96 00:06:11,180 --> 00:06:14,250 comes down-- let's look at this equation here. 97 00:06:14,250 --> 00:06:20,460 We can write this as (beta*S-gamma)*I. 98 00:06:20,460 --> 00:06:24,780 So initially, (beta*S-gamma) is positive. 99 00:06:24,780 --> 00:06:30,810 It starts, in fact, at the value (R_0-1)*gamma. 100 00:06:30,810 --> 00:06:33,870 But eventually, as the number of susceptible people comes down, 101 00:06:33,870 --> 00:06:36,690 there's a certain point where this factor goes to 0. 102 00:06:36,690 --> 00:06:39,970 And that would be leading to dI/dt equal to 0. 103 00:06:39,970 --> 00:06:42,600 So, in other words, a maximum of the number of infected people. 104 00:06:42,600 --> 00:06:47,400 So at some point, there's going to be a value where 105 00:06:47,400 --> 00:06:48,860 this will turn around. 106 00:06:48,860 --> 00:06:53,400 So dI/dt is equal to zero. 107 00:06:53,400 --> 00:06:57,480 And where that happens will be at a certain value of S_0, 108 00:06:57,480 --> 00:07:00,240 which we'll just put-- of S, I should say. 109 00:07:02,910 --> 00:07:08,220 I'll call that S_h for the value of herd immunity 110 00:07:08,220 --> 00:07:10,140 in the susceptible number. 111 00:07:10,140 --> 00:07:12,210 And that is when this factor 112 00:07:12,210 --> 00:07:15,030 beta*S-gamma is equal to 0. 113 00:07:15,030 --> 00:07:24,740 Or in other words, S_h is gamma/beta. 114 00:07:24,740 --> 00:07:28,220 OK, and once we get to that point, 115 00:07:28,220 --> 00:07:31,730 then now dI/dt is going to change sign 116 00:07:31,730 --> 00:07:32,980 and will only be negative. 117 00:07:32,980 --> 00:07:36,260 So the number infected will only be decreasing. 118 00:07:36,260 --> 00:07:39,080 Notice S is strictly decreasing because this 119 00:07:39,080 --> 00:07:40,260 is a negative rate here. 120 00:07:40,260 --> 00:07:42,620 So S only continues to go down, which 121 00:07:42,620 --> 00:07:44,980 means that the prefactor here is always negative. 122 00:07:44,980 --> 00:07:47,180 So the number of infected people now, at this point, 123 00:07:47,180 --> 00:07:50,270 must also necessarily continue to go down, 124 00:07:50,270 --> 00:07:55,790 and ultimately the number of susceptibles 125 00:07:55,790 --> 00:07:59,720 will, from that point, tend towards 0. 126 00:07:59,720 --> 00:08:04,670 The number of recovered will tend, of course, 127 00:08:04,670 --> 00:08:08,160 with some lag to S_0. 128 00:08:08,160 --> 00:08:10,540 So this is the number of recovered. 129 00:08:10,540 --> 00:08:13,110 This is the number of susceptible. 130 00:08:13,110 --> 00:08:15,360 And the number of infected, of course, 131 00:08:15,360 --> 00:08:19,810 also goes to 0, something like this. 132 00:08:19,810 --> 00:08:23,550 And ultimately, in the long run, the decay-- 133 00:08:23,550 --> 00:08:27,960 because S is going to 0, dI/dt is minus gamma*I*t. 134 00:08:27,960 --> 00:08:33,090 So the final rate of drop here is -gamma*t. 135 00:08:33,090 --> 00:08:35,070 So basically, the recovery rate is really 136 00:08:35,070 --> 00:08:39,870 dominating how quickly people are being converted, basically, 137 00:08:39,870 --> 00:08:42,919 from, to create the recovered and remove 138 00:08:42,919 --> 00:08:46,030 the infected population. 139 00:08:46,030 --> 00:08:49,550 So the final result here that comes from these models, which 140 00:08:49,550 --> 00:08:51,990 is quite interesting, is to ask, what 141 00:08:51,990 --> 00:08:54,170 is this fraction of the population that 142 00:08:54,170 --> 00:08:57,240 needs to become immune, or what is 143 00:08:57,240 --> 00:09:00,210 this sort of threshold of susceptible 144 00:09:00,210 --> 00:09:02,320 in order to achieve herd immunity? 145 00:09:02,320 --> 00:09:06,060 So if we look at what is this S_h over the initial? 146 00:09:06,060 --> 00:09:09,120 So how far do we have to go down? 147 00:09:09,120 --> 00:09:14,070 Well, that would be gamma/(beta*S_0), 148 00:09:14,070 --> 00:09:16,140 and you'll recognize that that is 149 00:09:16,140 --> 00:09:20,310 nothing more than the inverse of the initial reproductive 150 00:09:20,310 --> 00:09:22,950 number. 151 00:09:22,950 --> 00:09:26,000 So essentially, herd immunity is reached 152 00:09:26,000 --> 00:09:31,140 at a value of the susceptible fraction becoming 1/R_0. 153 00:09:31,140 --> 00:09:32,690 And this is an interesting prediction 154 00:09:32,690 --> 00:09:35,870 of this very simple model, which is 155 00:09:35,870 --> 00:09:37,760 that more infectious diseases that 156 00:09:37,760 --> 00:09:42,320 have a very high value of R_0, for example, smallpox, 157 00:09:42,320 --> 00:09:45,590 leads to a situation that, when the epidemic finally 158 00:09:45,590 --> 00:09:48,860 ends, the number of susceptibles when you've reached herd 159 00:09:48,860 --> 00:09:51,290 immunity, well, when this starts to turn around, 160 00:09:51,290 --> 00:09:54,390 is actually quite low. 161 00:09:54,390 --> 00:09:57,170 So, in other words, you have to go very far 162 00:09:57,170 --> 00:10:00,590 in infecting the population to start to end the epidemic. 163 00:10:00,590 --> 00:10:04,190 Conversely, a disease that has a small value of R_0, 164 00:10:04,190 --> 00:10:08,450 even COVID-19, might be a value of say 3.5, 165 00:10:08,450 --> 00:10:11,090 then this fraction here might not be so [low]. 166 00:10:11,090 --> 00:10:18,110 It might be, maybe, only say, 20% or 30%. 167 00:10:18,110 --> 00:10:21,140 Where you can start to see then herd immunity being reached 168 00:10:21,140 --> 00:10:25,480 and the number of infected people going down dramatically.