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Assessing the reliability of medical resource demand models in the context of COVID-19

Abstract Background Numerous medical resource demand models have been created as tools for governments or hospitals, aiming to predict the need for crucial resources like ventilators, hospital beds, personal protective equipment (PPE), and diagnostic kits during crises such as the COVID-19 pandemic. However, the reliability of these demand models remains uncertain. Methods Demand models typically consist of two main components: hospital use epidemiological models that predict hospitalizations or daily admissions, and a demand calculator that translates the outputs of the epidemiological model into predictions for resource usage. We conducted separate analyses to evaluate each of these components. In the first analysis, we validated various hospital use epidemiological models using a recent validation framework designed for epidemiological models. This allowed us to quantify the accuracy of the models in predicting critical aspects such as the date and magnitude of local COVID-19 peaks, among other factors. In the second analysis, we evaluated a range of demand calculators for ventilators, medical gowns, and COVID-19 test kits. To achieve this, we decoupled these demand calculators from the underlying epidemiological models and provided ground truth data for their inputs. This approach enabled a direct comparison of the demand calculators, comparing them against each other and actual usage data when available. The code is available athttps://doi.org/10.5281/zenodo.13712387. Results Performance varied greatly across the epidemiological models, with greater variability in COVID-19 hospital use predictions than for COVID-19 deaths as analyzed previously. Some models did not have any peaks. Among those that did, the models under-estimated date of peak approximately as often as they over-estimated, but were more likely to under-estimate magnitude of peak, with typical relative errors around 50%. Regarding demand calculator predictions, there was significant variability, including five-fold differences in predictions for gown models. Validation against actual or surrogate usage data illustrated the potential value of demand models while demonstrating their limitations. Conclusions The emerging field of demand modeling holds promise in averting medical resource shortages during future public health emergencies. However, achieving this potential necessitates focused efforts on standardization, transparency, and rigorous model validation before placing reliance on demand models in critical public health decision-making.

Medical Informatics↗

Zirconium-Based Metal–Organic Frameworks as Reusable Antibacterial Peroxide Carriers for Protective Textiles

Countries around the world have sought efficient protective coverings, including masks, gowns, and fabrics, for air purification to protect people against infectious diseases. However, the demand for significant quantities of disposable protective textiles poses a global challenge, especially when the production of protective gear is suspended due to COVID-19 outbreaks in factories and along supply lines. Therefore, the development of reusable, self-decontaminating protective masks and coverings loaded with disinfectants, such as antibacterial peroxide species, presents an attractive strategy to fight against bacteria risks. In this work, we incorporated persulfate ions, which serve as stable active peroxide precursors, into two porous zirconium-based metal–organic frameworks (Zr-MOFs), enabling these materials to act as regenerable reservoirs for the slow release of biocidal hydrogen peroxide upon hydrolysis by contact with humid air. Single-crystal X-ray diffraction studies reveal the two different coordination motifs for the persulfate ions, which can either bridge between two adjacent nodes or coordinate to a single node depending on both the node connectivity and the distances between open metal sites. The active peroxide precursors within the porous Zr-MOF carriers are stable during storage and easily regenerated once consumed. Importantly, these persulfate-loaded Zr-MOFs can be integrated onto textiles using a facile aqueous in-situ growth procedure, and these composites demonstrate potent and reusable biocidal activity against both Gram-negative bacteria and Gram-positive bacteria. Altogether, this approach presents a viable strategy to develop robust protective textiles capable of rapidly deactivating pathogens.

36 MATERIALS SCIENCE↗

Photocatalytic Biocidal Coatings Featuring Zr 6 Ti 4 -Based Metal–Organic Frameworks

The world is currently suffering socially, economically, and politically from the recent pandemic outbreak due to the Coronavirus Disease 2019 (COVID-19), and those in hospitals, schools, and elderly nursing homes face enhanced threats. Healthcare textiles, such as masks and medical staff gowns, are susceptible to contamination of various pathogenic microorganisms, including bacteria and viruses. Here, metal–organic frameworks (MOFs) can potentially address these challenges due to their tunable reactivity and ability to be incorporated as porous coatings on textile materials. Here, we report how incorporating titanium into the zirconium-pyrene-based MOF NU-1000, denoted as NU-1012, generates a highly reactive biocidal photocatalyst. This MOF features a rare ligand migration phenomenon, and both the Ti/Zr center and the pyrene linker act synergistically as dual active centers and widen the absorption band for this material that results in enhanced reactive oxygen species (ROS) generation upon visible light irradiation. Additionally, we found the ligand migration process is generally applicable to other csq topology Zr-MOFs. Importantly, NU-1012 can be easily incorporated onto cotton textile cloths as a coating, and the resulting composite material demonstrates fast and potent biocidal activity against Gram-negative bacteria (E. coli), Gram-positive bacteria (S. epidermidis), and T7 bacteriophage virus with up to a 7-log (99.99999%) reduction within one hour under simulated daylight.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Uncertainty analysis of Resource Demand Model for Covid-19

As part of the Department of Energy response to the novel coronavirus pandemic of 2020, a modeling effort was sponsored by the DOE Office of Science. One task of this modeling effort at Sandia was to develop a model to predict medical resource needs given various patient arrival scenarios. Resources needed include personnel resources (nurses, ICU nurses, physicians, respiratory therapists), fixed resources (regular or ICU beds and ventilators), and consumable resources (masks, gowns, gloves, face shields, sedatives). This report documents the uncertainty analysis that was performed on the resource model. The uncertainty analysis involved sampling 26 input parameters to the model. The sampling was performed conditional on the patient arrival streams that also were inputs to the model. These patient arrival streams were derived from various epidemiology models and had a significant effect on the projected resource needs. In this report, we document the sampling approach, the parameter ranges used, and the computational workflow necessary to perform large-scale uncertainty studies for every county and state in the United States.

59 BASIC BIOLOGICAL SCIENCES↗

Robotic Assembly of SRF Cavity Pair

Superconducting Radio Frequency (SRF) cavities for particle accelerators require tight tolerances, ultrahigh vacuum, and strict cleanliness during assembly. As in the semiconductor industry, defects such as particles and residues are deleterious to performance, possibly rendering a cavity unfit for use. This problem is addressed primarily through cleanroom assembly during sensitive steps and rigorous chemical processing to prevent and remove such defects. Human workers are often the largest source of contamination, even with proper gowning and practices. The semiconductor industry has long integrated robots in cleanroom operation, but this has not occurred for SRF cavity production; SRF cavities, unlike wafers, are complex shapes, require more hands-on mechanical assembly, and are low-volume production items. At Jefferson Laboratory, a co-operative robot (cobot) has been setup to overcome these problems. Cobots are safe for use alongside human workers and can integrate new tools such as a 3D camera part detection and gripper for item manipulation. Therefore, cobots represent a promising avenue for reducing particulate generated during a variety of assembly tasks. A mockup of a cavity pair and coupler was setup and the cobot programmed to automatically pick up the coupler and place on the mating cavity flange. Particle counting methods were setup to measure human vs cobot assembly particulate generation inside a cavity mockup. Other potential uses will be discussed for further improving SRF cavity assembly steps, where a cobot can replace or assist a human operator, and what potential gains are expected.

Duzik, Adam [Thomas Jefferson National Accelerator↗

Ozone Gas: Scientific Justification and Practical Guidelines for Improvised Disinfection using Consumer-Grade Ozone Generators and Plastic Storage Boxes

Here, we describe direct measurements of ozone concentration achievable in small enclosed containers (plastic storage boxes) for use as improvised decontamination systems for small articles such as disposable PPE (N95 masks, nitrile gloves, etc.), clothing, mail and small packages, food, and other miscellaneous articles. The emphasis is on the reliable and sustained generation of ozone gas concentrations of sufficient concentration and duration to create an effective virucidal environment to achieve more than 95% to 99% viral inactivation, based upon the data already published in the peer-review literature on this topic. The suggestion that ozone be used to inactivate virus is certainly not a new idea. Our objective in this report is to make clear that the necessary levels of ozone can be improvised using simple, easy-to-use, inexpensive, and widely available supplies, and that there is every theoretical and experimental reason to believe that this approach is as highly effective in viral inactivation by ozone as are the far more expensive, complex, cumbersome, and less available equivalent ozone (and other) disinfectant systems that have themselves become unavailable during times of pandemic crisis. Using multiple types of readily available commercial ozone generators, concentration in the tested improvised enclosure is tracked over time to assess ozone charging and decay rates, and the ozone quenching effects of items placed in the box. Generator performance is compared against published ozone dosage values for virucidal and antimicrobial activity. Bubbler and box-fan-type ozone generators were found to be effective at achieving and maintaining target concentrations of 10ppm ozone or higher, whereas automotive cigarette lighter and universal serial bus type plug in “air freshener” ozone generators could not achieve the target concentrations in these experiments. Calculations and practical guidelines for assembly and effective use of an ozone box for improvised decontamination are offered. The majority of this report is directed toward the scientific justification and rationale for this approach. The end of the document summarizes the findings and offers simplified designs for the construction and use of ozone boxes as an improvised method of disinfection.

60 APPLIED LIFE SCIENCES↗