Publications

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When designing measures to control infectious disease spread, it is crucial to understand the structure of the population for which interventions are being implemented. Recent work has highlighted the need for models that incorporate demographic heterogeneity not just in age structure but also by socioeconomic status (SES). Appropriately capturing additional sources of population heterogeneity requires considerable data and model development. To understand the potential disagreement between SES-explicit or SES-agnostic disease models, we adapted Sandia’s Adaptive Recovery Model (ARM) model to consider differences in contact structure and mortality by Social Vulnerability Index (SVI) on a theoretical network. We also incorporated an Average network that did not consider SVI. By exploring disparities in vaccine and PPE uptake by SES and comparing to Average networks, as well as analyzing the influence of global vs. local contact, we found that the two model constructions often predicted different outcomes. Whether these differences are truly reflective of incorporating SES, and which model most closely represents reality, merits further investigation.

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As social distancing policies and recommendations went into effect in response to COVID-19, people made rapid changes to the places they visit. These changes are clearly seen in mobility data, which records foot traffic using location trackers in cell phones. While mobility data is often used to extract the number of customers that visit a particular business or business type, it is the frequency and duration of concurrent occupancy at those sites that governs transmission. Understanding the way people interact at different locations can help target policies and inform contact tracing and prevention strategies. This paper outlines methods to extract interactions from mobility data and build networks that can be used in epidemiological models. Several measures of interaction are extracted: interactions between people, the cumulative interactions for a single person, and cumulative interactions that occur at particular businesses. Network metrics are computed to identify structural trends which show clear changes based on the timing of stay-at-home orders. Measures of interaction and structural trends in the resulting networks can be used to better understand potential spreading events, the percent of interactions that can be classified as close contacts, and the impact of policy choices to control transmission.

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Producing and distributing COVID-19 vaccine during the pandemic is a major logistical challenge requiring careful planning and efficient execution. This report presents information on logistical, policy and technical issues relevant to rapidly fielding a COVID-19 vaccination program. For this study we (a) conducted literature review and subject matter expert elicitation to understand current vaccine manufacturing and distribution capabilities and vaccine allocation strategies, (b) designed a baseline vaccine distribution strategy and modeling strategy to provide insight into the potential for targeted distribution of limited initial vaccine supplies, and (c) developed parametric interfaces to enable vaccine distribution scenarios to be analyzed in depth with Sandias Adaptive Recovery Model that will allow us evaluate the additional sub- populations and alternative distribution scenarios from a public health benefit and associated economic disruption Principal issues, challenges, and complexities that complicate COVID-19 vaccine delivery identified in our literature and subject matter expert investigation include these items: The United States has not mounted an urgent nationwide vaccination campaign in recent history. The existing global manufacturing and distribution infrastructure are not able to produce enough vaccine for the population immediately. Vaccines, once available will be scarce resources. Prioritization for vaccine allocation will be built on existing distribution networks. Vaccine distribution may not have a universal impact on disease transmission and morbidity because of scarcity, priority population demographics, and underlying disease transmission rates. Considerations for designing a vaccine distribution strategy are discussed. A baseline distribution strategy is designed and tested using the Adaptive Recovery Model, which couples a deterministic compartmental epidemiological model and a stochastic network model. We show the impact of this vaccine distribution strategy on hospitalizations, mortality, and contact tracing requirements. This model can be used to quantitatively evaluate alternative distribution scenarios, guiding policy decisions as vaccine candidates are narrowed down.

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This report documents a new approach to designing disease control policies that allocate scarce testing, contact tracing, and vaccination resources to better control community transmission of COVID19 or similar diseases. The Adaptive Recovery Model (ARM) combines a deterministic compartmental disease model with a stochastic network disease propagation model to enable us to simulate COVID-19 community spread through the lens of two complementary modeling motifs. ARM contact networks are derived from cell-phone location data that have been anonymized and interpreted as individual arrivals to specic public locations. Modeling disease spread over these networks allows us to identify locations within communities conducive to rapid disease spread. ARM applies this model- and data-derived abstractions of community transmission to evaluate the effectiveness of disease control measures including targeted social distancing, contact tracing, testing and vaccination. The architecture of ARM provides a unique capacity to help decision makers understand how best to deploy scarce testing, tracing and vaccination resources to minimize disease-spread potential in a community. This document details the novel mathematical formulations underlying ARM, presents a dynamical stability analysis of the deterministic model components, a sensitivity analysis of control parameters and network structure, and summarizes a process for deriving contact networks from cell-phone location data. An example use case steps through applying ARM to evaluate three targeted social distancing policies using Bernalillo County, New Mexico as an exemplar test locale. This step-by-step analysis demonstrates how ARM can be used to measure the relative performance of competing public health policies. Initial scenario tests of ARM shows that ARMs design focus on resource utilization rather than simple incidence prediction can provide decision makers with additional quantitative guidance for managing ongoing public health emergencies and planning future responses.

This report summarizes the goals and findings of eight research projects conducted under the Computing and Information Sciences (CIS) Research Foundation and related to the COVID- 19 pandemic. The projects were all formulated in response to Sandia's call for proposals for rapid-response research with the potential to have a positive impact on the global health emergency. Six of the projects in the CIS portfolio focused on modeling various facets of disease spread, resource requirements, testing programs, and economic impact. The two remaining projects examined the use of web-crawlers and text analytics to allow rapid identification of articles relevant to specific technical questions, and categorization of the reliability of content. The portfolio has collectively produced methods and findings that are being applied by a range of state, regional, and national entities to support enhanced understanding and prediction of the pandemic's spread and its impacts.

One challenge of using compartmental SEIR models for public health planning is the difficulty in manually tuning parameters to capture behavior reflected in the real-world data. This team conducted initial, exploratory analysis of a novel technique to use physics-informed machine learning tools to rapidly develop data-driven models for physical systems. This machine learning approach may be used to perform data assimilation of compartment models which account for unknown interactions between geospatial domains (i.e. diffusion processes coupling across neighborhoods/counties/states/etc.). Results presented here are early, proof-of-concept ideas that demonstrate initial success in using a physically informed neural network (PINN) model to assimilate data in a compartmental epidemiology model. The results demonstrate initial success and warrant further research and development.

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Sandia National Laboratories currently has 27 COVID-related Laboratory Directed Research & Development (LDRD) projects focused on helping the nation during the pandemic. These LDRD projects cross many disciplines including bioscience, computing & information sciences, engineering science, materials science, nanodevices & microsystems, and radiation effects & high energy density science.

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This study developed and tested biologically inspired computational methods to detect anomalous signals in data streams that could indicate a pending outbreak or bio-weapon attack. Current large-scale biosurveillance systems are plagued by two principal deficiencies: (1) timely detection of disease-indicating signals in noisy data and (2) anomaly detection across multiple channels. Anomaly detectors and data fusion components modeled after human immune system processes were tested against a variety of natural and synthetic surveillance datasets. A pilot scale immune-system-based biosurveillance system performed at least as well as traditional statistical anomaly detection data fusion approaches. Machine learning approaches leveraging Deep Learning recurrent neural networks were developed and applied to challenging unstructured and multimodal health surveillance data. Within the limits imposed of data availability, both immune systems and deep learning methods were found to improve anomaly detection and data fusion performance for particularly challenging data subsets.

The research and development of new algorithmic and statistical methods of outbreak detection is an ongoing research priority in the field of biosurveillance. The early detection of emergent disease outbreaks is crucial for effective treatment and mitigation. New detection methods must be compared to established approaches for proper evaluation. This comparison requires biosurveillance test data that accurately reflects the complexity of the real-world data it will be applied to. While the test and evaluation of new detection methods is best performed on real data, it is often impractical to obtain such data as it is either proprietary or limited in scope. Thus, scientists must turn to synthetic data generation to provide enough data to properly eval- uate new detection methodologies. This paper evaluates three such synthetic data sources: The WSARE dataset, the Noufilay equation-based approach, and the Project Mimic data generator.

A patient in the United States has been diagnosed with Ebola. Fear and panic kicks in across the country, and hospitals are inundated with hundreds of people, some infected with the highly contagious disease and others not. Blood tests are needed for positive diagnoses, but the diagnostic labs are overwhelmed with blood samples to test, and staff are overworked and stressed. Infected people need to be quarantined and treated, but it's hard to find rooms to quarantine so many patients. Sick people who need triage and regular care for other emergencies are afraid to go to hospitals for fear of Ebola, which has a 50% fatality rate. And since hospitals are so overwhelmed, sick people often stay home, infecting heathy people around them; the U.S. is now in the grips a full-blown Ebola outbreak. Sandia's high-performance computers simulated such a nightmare scenario recently, and with good reason. An Ebola outbreak in the United States could be devastating if hospitals are not prepared. When an Ebola outbreak in West Africa became a global concern in 2014, health advisers were alarmed at the length of time it took to properly diagnose infected people. In rural areas in Liberia, for example, blood samples from ailing people would be sent to a laboratory for testing, but the closest lab was hundreds of miles away through difficult and sometimes impassable roads. In more urban areas, blood samples would be sent to nearby labs, but those labs were often already overburdened by the sheer volume of samples to test. Staff at some treatment centers were unaware that a lab a little farther away might have the capacity to take in more samples. Meanwhile, undiagnosed infected people were unknowingly spreading the disease to many others around them, worsening the outbreak. The U.S. Defense Threat Reduction Agency (DTRA) and Centers for Disease Control and Prevention (CDC) posed a serious question: how do we improve blood-sample transportation routes in Liberia to ensure that samples taken from ill people are tested as quickly as possible, ensuring a proper diagnosis and faster treatment? Sandia scientists, already experts in transportation modeling for nuclear materials, quickly swarmed on this problem. The Sandia Ebola response team immediately set out to collect data from the region using available maps and local information, and transformed the raw data to GIS maps. Then, applying Sandia transportation routing algorithms, the team identified the optimal routes to get blood samples to the best laboratory for testing, even if that lab was not geographically the closest. The models also showed the best possible locations for mobile diagnostic laboratories that would better support the very rural regions that were most affected by the Ebola outbreak.

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The objective here is to obtain feedback and seek future directions for an ISDS initiative to establish and update research questions in Informatics, Analytics,Communications, and Systems Research with the greatest perceived impact for improving surveillance practice.Introduction Over the past fifteen years, syndromic surveillance (SyS) has evolved from a set of ad hoc methods used mostly in post-disaster settings, then expanded with broad support and development because of bioterrorism concerns, and subsequently evolved to a mature technology that runs continuously to detect and monitor a wide range of health issues. Continued enhancements needed to meet the challenges of novel health threats with increasingly complex information sources will require technical advances focused on day-to-day public health needs.Since its formation in 2005, the International Society for Disease Surveillance (ISDS) has sought to clarify and coordinate global priorities in surveillance research. As part of a practitioner-driven initiative to identify current research priorities in SyS, ISDS polled its members about capabilities needed by SyS practitioners that could be improved as a result of research efforts. A taskforce of the ISDS Research Committee, consisting of national and global subject matter experts (SMEs) in SyS and ISDS professional staff, carried out the project. This panel will discuss the results and the preferred means to determine and communicate priorities in the future.

Improved validation for models of complex systems has been a primary focus over the past year for the Resilience in Complex Systems Research Challenge. This document describes a set of research directions that are the result of distilling those ideas into three categories of research -- epistemic uncertainty, strong tests, and value of information. The content of this document can be used to transmit valuable information to future research activities, update the Resilience in Complex Systems Research Challenge's roadmap, inform the upcoming FY18 Laboratory Directed Research and Development (LDRD) call and research proposals, and facilitate collaborations between Sandia and external organizations. The recommended research directions can provide topics for collaborative research, development of proposals, workshops, and other opportunities.

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We applied modeling and simulation to examine the real-world tradeoffs between developingcountry public-health improvement and the need to improve the identification, tracking, and security of agents with bio-weapons potential. Traditionally, the international community has applied facility-focused strategies for improving biosecurity and biosafety. This work examines how system-level assessments and improvements can foster biosecurity and biosafety. We modeled medical laboratory resources and capabilities to identify scenarios where biosurveillance goals are transparently aligned with public health needs, and resource are distributed in a way that maximizes their ability to serve patients while minimizing security a nd safety risks. Our modeling platform simulates key processes involved in healthcare system operation, such as sample collection, transport, and analysis at medical laboratories. The research reported here extends the prior art by provided two key compone nts for comparative performance assessment: a model of patient interaction dynamics, and the capability to perform uncertainty quantification. In addition, we have outlined a process for incorporating quantitative biosecurity and biosafety risk measures. Two test problems were used to exercise these research products examine (a) Systemic effects of technological innovation and (b) Right -sizing of laboratory networks.

Open-source indicators have been proposed as a way of tracking and forecasting disease outbreaks. Some, such are meteorological data, are readily available as reanalysis products. Others, such as those derived from our online behavior (web searches, media article etc.) are gathered easily and are more timely than public health reporting. In this study we investigate how these datastreams may be combined to provide useful epidemiological information. The investigation is performed by building data assimilation systems to track influenza in California and dengue in India. The first does not suffer from incomplete data and was chosen to explore disease modeling needs. The second explores the case when observational data is sparse and disease modeling complexities are beside the point. The two test cases are for opposite ends of the disease tracking spectrum. We find that data assimilation systems that produce disease activity maps can be constructed. Further, being able to combine multiple open-source datastreams is a necessity as any one individually is not very informative. The data assimilation systems have very little in common except that they contain disease models, calibration algorithms and some ability to impute missing data. Thus while the data assimilation systems share the goal for accurate forecasting, they are practically designed to compensate for the shortcomings of the datastreams. Thus we expect them to be disease and location-specific.

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There is mounting evidence that alcohol use is significantly linked to lower HCV treatment response rates in interferon-based therapies, though some of the evidence is conflicting. Furthermore, although health care providers recommend reducing or abstaining from alcohol use prior to treatment, many patients do not succeed in doing so. The goal of this meta-analysis was to systematically review and summarize the Englishlanguage literature up through January 30, 2015 regarding the relationship between alcohol use and HCV treatment outcomes, among patients who were not required to abstain from alcohol use in order to receive treatment. Seven pertinent articles studying 1,751 HCV-infected patients were identified. Log-ORs of HCV treatment response for heavy alcohol use and light alcohol use were calculated and compared. We employed a hierarchical Bayesian meta-analytic model to accommodate the small sample size. The summary estimate for the log-OR of HCV treatment response was -0.775 with a 95% credible interval of (-1.397, -0.236). The results of the Bayesian meta-analysis are slightly more conservative compared to those obtained from a boot-strapped, random effects model. We found evidence of heterogeneity (Q = 14.489, p = 0.025), accounting for 60.28% of the variation among log-ORs. Meta-regression to capture the sources of this heterogeneity did not identify any of the covariates investigated as significant. This meta-analysis confirms that heavy alcohol use is associated with decreased HCV treatment response compared to lighter levels of alcohol use. Further research is required to characterize the mechanism by which alcohol use affects HCV treatment response.

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We present a model of behavioral dynamics that combines a social network-based opinion dynamics model with behavioral mapping. The behavioral component is discrete and history-dependent to represent situations in which an individual’s behavior is initially driven by opinion and later constrained by physiological or psychological conditions that serve to maintain the behavior. Individuals are modeled as nodes in a social network connected by directed edges. Parameter sweeps illustrate model behavior and the effects of individual parameters and parameter interactions on model results. Mapping a continuous opinion variable into a discrete behavioral space induces clustering on directed networks. Clusters provide targets of opportunity for influencing the network state; however, the smaller the network the greater the stochasticity and potential variability in outcomes. This has implications both for behaviors that are influenced by close relationships verses those influenced by societal norms and for the effectiveness of strategies for influencing those behaviors.

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Hospital evacuations that occur during, or as a result of, infrastructure outages are complicated and demanding. Loss of infrastructure services can initiate a chain of events with corresponding management challenges. This report describes a modeling case study of the 2001 evacuation of the Memorial Hermann Hospital in Houston, Texas (USA). The study uses a model designed to track such cascading events following loss of infrastructure services and to identify the staff, resources, and operational adaptations required to sustain patient care and/or conduct an evacuation. The model is based on the assumption that a hospital's primary mission is to provide necessary medical care to all of its patients, even when critical infrastructure services to the hospital and surrounding areas are disrupted. Model logic evaluates the hospital's ability to provide an adequate level of care for all of its patients throughout a period of disruption. If hospital resources are insufficient to provide such care, the model recommends an evacuation. Model features also provide information to support evacuation and resource allocation decisions for optimizing care over the entire population of patients. This report documents the application of the model to a scenario designed to resemble the 2001 evacuation of the Memorial Hermann Hospital, demonstrating the model's ability to recreate the timeline of an actual evacuation. The model is also applied to scenarios demonstrating how its output can inform evacuation planning activities and timing.

This report presents a mathematical model of the way in which a hospital uses a variety of resources, utilities and consumables to provide care to a set of in-patients, and how that hospital might adapt to provide treatment to a few patients with a serious infectious disease, like the Ebola virus. The intended purpose of the model is to support requirements planning studies, so that hospitals may be better prepared for situations that are likely to strain their available resources. The current model is a prototype designed to present the basic structural elements of a requirements planning analysis. Some simple illustrati ve experiments establish the mo del's general capabilities. With additional inve stment in model enhancement a nd calibration, this prototype could be developed into a useful planning tool for ho spital administrators and health care policy makers.

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