Preparing for the Next Wave of COVID-19: Resilience in the Face of a Spreading Pandemic

Round 1

Reviewer 1 Report

The conclusion could be made more explicit.

Author Response

1. The conclusion could be made more explicit.

We agree with the referee, and have added the following on line 20, for further clarification:

“Specifically, using network scenarios, we demonstrate the substantial advantage of reintegrating health care workers with acquired COVID-19 immunity in epidemic hotspots, which would not only enable their safe contribution to the health care system but also drastically contain further spread.”

Reviewer 2 Report

Thank you for the opportunity to read your manuscript. It was very interesting.

I think this paper has promise with some editing to alter the structure and take away the numbering at each heading, this is confusing.

The super-spreader discussion was good until line 92 where you start to lose me. The discussion that follows about the scenarios is confusing. If this section could be clarified in the context of your targeted audience, it could provide some useful knowledge about the spread of COVID among HCP. 

This is an opinion piece and therefore should include a statement that further research is required. 

Author Response

1. Thank you for the opportunity to read your manuscript. It was very interesting. I think this paper has promise with some editing to alter the structure and take away the numbering at each heading, this is confusing.

We have removed the numbering at each heading, although they may be required per journal style, as they were added by the editorial office during formatting of our manuscript.

2. The super-spreader discussion was good until line 92 where you start to lose me. The discussion that follows about the scenarios is confusing. If this section could be clarified in the context of your targeted audience, it could provide some useful knowledge about the spread of COVID among HCP. 

Please see response to Reviewer 3 below (question 2).

3. This is an opinion piece and therefore should include a statement that further research is required. 

Thank you. We have added such statement on line 152-158:

In our network scenarios, we oversimplify real-world problems and the complexity of social interactions (for example, we do not include weighted interactions, probabilities of transmissions, or event-based interactions over time, and solid empirical data for COVID-19 are lacking to enable a precise parameterization of the models). They represent a first attempt for inter- and transdisciplinary explorations of network analytical social interactions in vulnerable subsystems such as health care providers. Future more in-depth systemic analyses with empirical data collected over time are needed.”

Reviewer 3 Report

The manuscript is undeniably dedicated to one of the most topical issues at the moment -the COVID-19 pandemic, reflecting the need to comprehend and evaluate the outbreak of the virus in order to more successfully overcome the next wave.

However, it is necessary to make adjustments in chapter 3 (Network Scenarios:The Super-spreaders) of the manuscript, because, at present, the information is presented chaotically.

Starting with line 96, the information on the scenarios must be presented sequentially, starting with a description of the circumstances of the scenario and the parties involved - common to scenarios 1 and 2 (location –ICU within a hospital…., parties involved, total number of participants, explanation of the symbols used in the graphics). Continue sequentially with Scenario 1a/b and then continue with Scenario 2a/b description to avoid duplication of writing, as is currently the case.

For example: In the manuscript, a paragraph beginning at line 121 partially overlaps with a paragraph beginning at line 109, while a paragraph beginning at line 130 (the last paragraph of chapter 3) practically overlaps with the information displayed in paragraph 96 starting at line 96.

Author Response

Response to Reviewer 3’s comments

1. The manuscript is undeniably dedicated to one of the most topical issues at the moment -the COVID-19 pandemic, reflecting the need to comprehend and evaluate the outbreak of the virus in order to more successfully overcome the next wave.

We thank the referee for their appreciation of our work, which we too, think is of great importance for future handling of outbreaks.

2. However, it is necessary to make adjustments in chapter 3 (Network Scenarios: The Super-spreaders) of the manuscript, because, at present, the information is presented chaotically. Starting with line 96, the information on the scenarios must be presented sequentially, starting with a description of the circumstances of the scenario and the parties involved - common to scenarios 1 and 2 (location –ICU within a hospital…., parties involved, total number of participants, explanation of the symbols used in the graphics). Continue sequentially with Scenario 1a/b and then continue with Scenario 2a/b description to avoid duplication of writing, as is currently the case. For example: In the manuscript, a paragraph beginning at line 121 partially overlaps with a paragraph beginning at line 109, while a paragraph beginning at line 130 (the last paragraph of chapter 3) practically overlaps with the information displayed in paragraph 96 starting at line 96.

Thank you for your constructive feedback! We completely revised the chapter to present the information in a clearer structure. As suggested, we provide an overview of the two scenarios and the two conditions (a) and (b). We continue with scenario 1a/b and then explain scenario 2a/b. We also shortened the caption. In the original version, the caption was very long (lines 109-120) and it seems that it was unintentionally displayed as continuous text. This has probably also led to more incomprehension. We hope that the revision has improved the comprehensibility of the text.

Reviewer 4 Report

1)Please present the reason for this observation: "To successfully eliminate a disease from a population, R0 needs to be <1". This question appears because you forgot to present a study or research You based on.

2)-About Your opinion: "few guiding principles can help define and better
understand the severity and uncertainties of any epidemic outbreak:", are just four: 1) basic reproduction number R0; 2) lethality associated with the pathogen; 3) duration of the incubation period and 4) level of immunity. What about  "Brownian motion" of individuals; "social distances"; "sanitary basic education norms"; the "bad and slow reaction of authorities" and last but not least the lack of correct information etc.?

3)-Your scenarios are far away to be very intuitive but is a good start of a discussion. ( I don't find the supplementary material)

Author Response

1. Please present the reason for this observation: "To successfully eliminate a disease from a population, R0 needs to be <1". This question appears because you forgot to present a study or research You based on.

We thank the editor for picking this up. What we actually meant was the effective reproduction number eR0, which is described in lines 74-76 (see below), and we have deleted the sentence referred to by the referee.

“Conversely, the herd immunity threshold (R₀-1)/R₀ is the proportion of a population that must be immune in order for an infectious disease to reach R₀<1 and thus stopping its spread.”

2. About Your opinion: "few guiding principles can help define and better
   understand the severity and uncertainties of any epidemic outbreak:", are just four: 1) basic reproduction number R0; 2) lethality associated with the pathogen; 3) duration of the incubation period and 4) level of immunity. What about  "Brownian motion" of individuals; "social distances"; "sanitary basic education norms"; the "bad and slow reaction of authorities" and last but not least the lack of correct information etc.?

Thank you for this interesting point. While we were focused on medical characteristics of the pathogen, the referee is correct in that there are additional factors that will modify the impact of these medical characteristics. These are one the one hand reflected by the “effective” R01, which is impacted for example also by social distancing, personal protective equipment and other measures, as outlined in lines 69-74:

“Of note, the proportion of susceptible in the population has implications for the R₀; the term “effective” reproduction number, eR₀, factors population susceptibility into the estimation of the number of new individuals that an infected person can infect. eR₀ can readily be estimated using the formula eR₀=R₀x, where x is the fraction of the host population that is susceptible. For example, if R₀ for measles is 12 where half of the population is immune, the eR₀ for measles is 12x0.5=6 (a single case of measles would produce an average of 6, not 12, new secondary cases).”

In addition, and perhaps more related to what the referee had in mind, population characteristics such as those mentioned (social distances, sanitary basic education norms, etc.) will influence the spread of a given pathogen and how it varies in different populations.

Line 78-79:

“Additional influencing factors include e.g., environmental factors, population density, cultural norms, health status, or average population age.”

3. Your scenarios are far away to be very intuitive but is a good start of a discussion. ( I don't find the supplementary material)

Thank you. We are sorry that supplemental materials were not accessible to you. We had submitted them, but apparently did not reach you. We are communicating with the editor to make sure that they will be included.