Projected impact of COVID-19 mitigation strategies on hospital services in the Mexico City Metropolitan Area

Zachary Fowler; Ellie Moeller; Lina Roa; Isaac Deneb Castañeda-Alcántara; Tarsicio Uribe-Leitz; John G. Meara; Arturo Cervantes-Trejo

doi:10.1371/journal.pone.0241954

Peer Review History

Original SubmissionJune 2, 2020
7 Sep 2020 Decision Letter - Chiara Lazzeri, Editor PONE-D-20-16750 Projected demand for hospital services in the Mexico City Metropolitan Area during the first wave of the COVID-19 pandemic PLOS ONE Dear Dr. Fowler, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The study design is quite intersting, but major issues can be raised. The rational should be better described in the introduction section, taking into account recent papers (which should be cited and discussed). We suggest that each scenario should be explained in details. Please submit your revised manuscript by Oct 22 2020 11:59PM. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This research describes the potential impacts of COVID-19 in this region and to model possible benefits of mitigation efforts. The COVID-19 Hospital Impact Model for Epidemics was used to estimate the probable evolution of COVID-19 in three scenarios: (i) no social distancing, (ii) social distancing in place at 50% effectiveness, and (iii) social distancing in place at 60% effectiveness. The research topic presented in the present paper is interesting, , and relatively well written. In my opinion, the paper can be published after making some major revisions and some improvements in the presentation of the article, which are as follows: 1. Explain the model parameter in more detail. 2. Title should be modified. 3. Adding some finding in abstract. 4. Rewrite introduction part and adding some recent references in the introductory part. Also add the recent references in the introduction part. For example, DOI: https://doi.org/10.1016/j.chaos.2020.109932 5. if possible then rewrite the conclusion part in bullet form. ****** 6. 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Revision 1
21 Oct 2020 Author Response EDITOR COMMENT: Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The study design is quite interesting, but major issues can be raised. The rational should be better described in the introduction section, taking into account recent papers (which should be cited and discussed). We suggest that each scenario should be explained in detail. RESPONSE: Thank you for reviewing our manuscript and providing valuable feedback and insight. We hope that our revisions have addressed the points raised by the reviewers and appreciate the opportunity to resubmit our manuscript. Our responses to the reviewer comments are listed below: Reviewer #1: This research describes the potential impacts of COVID-19 in this region and to model possible benefits of mitigation efforts. The COVID-19 Hospital Impact Model for Epidemics was used to estimate the probable evolution of COVID-19 in three scenarios: (i) no social distancing, (ii) social distancing in place at 50% effectiveness, and (iii) social distancing in place at 60% effectiveness. The research topic presented in the present paper is interesting, , and relatively well written. In my opinion, the paper can be published after making some major revisions and some improvements in the presentation of the article, which are as follows: COMMENT 1. Explain the model parameter in more detail. RESPONSE: Thank you for this comment. We agree with the reviewer that more details of the model parameters should be given. We have modified our reporting of the methods to include sections on “Model parameters” and “Model inputs”. In “Model parameters” we now describe the variables and the equations used to calculate our findings (revised manuscript with track changes, Word document, page 6, lines 170-195). The parameters used include effective contact rate, inverse mean recovery time, doubling time, and growth rate. These are used to model SIR dynamics (susceptible, infected, recovered). In “Model inputs” we have provided additional information on the numbers used in our model and our rationale for using them (revised manuscript with track changes, Word document, page 7, lines 206-221). The following inputs are used in the calculations and are better described now in this section: regional population, hospital market share, number of patients currently hospitalized with COVID-19, date of the first hospitalization, social distancing, hospitalization rate, ICU admission rate, mechanical ventilation rate, infectious days, average length of hospital stay, average length of ICU stay, and average length of ventilator use. Inputs were based on data reported in Mexico (regional population, hospital market share, number of patients currently hospitalized with COVID-19, date of the first hospitalization, social distancing), from estimates reported by Penn Medicine hospitals in the United States (average length of hospital stay, average length of ICU stay, and average length of ventilator use) and by Verity et al in Lancet Infectious Diseases (hospitalization rate, ICU admission rate, mechanical ventilation rate). We have also provided our rationale for selecting the three mitigation strategies (revised manuscript with track changes, Word document, page 7, lines 200-202). This is based on estimates of mitigation level needed to reverse the epidemic and is consistent with strategies used in other prediction models (Anderson et al 2020, Kissler et al 2020, Bhat et al 2020). We have added an explanation for our inclusion of the entire metropolitan area in our study, rather than limiting it to Mexico City (revised manuscript with track changes, Word document, page 17, lines 422-425). This now reads as follows (additions are underlined): Ultimately, this may enable careful resource utilization and swift public health responses that protect the entire MCMA, for which data reporting and public health management are often approached individually by each of the three states within their respective administrative boundaries. Analyses and prediction models that include all municipalities in the metropolitan area can lead to more comprehensive and efficient policies. COMMENT 2. Title should be modified. RESPONSE: Thank you for this suggestion. We have modified the title as follows: “Projected impact of COVID-19 mitigation strategies on hospital services in the Mexico City Metropolitan Area.” This title better reflects our aim to compare the impact of various mitigation strategies on hospital service demand (original title: “Projected demand for hospital services in the Mexico City Metropolitan Area during the first wave of the COVID-19 pandemic”). COMMENT 3. Adding some finding in abstract. RESPONSE: We agree that it would be important to include more of our findings in the abstract. We have revised the abstract to include additional results from our study. We now report the impact of social distancing on daily hospital admissions, peak intensive care unit occupancy, and peak ventilator demand in the abstract (revised manuscript with track changes, Word document, page 2, lines 49-52). COMMENT 4. Rewrite introduction part and adding some recent references in the introductory part. Also add the recent references in the introduction part. For example, DOI: https://doi.org/10.1016/j.chaos.2020.109932 RESPONSE: We have revised the introduction to include updated information about the COVID-19 burden in Mexico. This includes new data on confirmed COVID-19 cases in Mexico and globally, positivity rates, case fatality rates, requirements for mechanical ventilation, and excess mortality in Mexico City (revised manuscript with track changes, Word document, page 3, lines 72-98). Information was obtained from recently published academic papers as well as Ministry of Health documents. We have also provided an overview of the types of COVID-19 predictive models that are now in use, including the suggested paper (revised manuscript with track changes, Word document, page 4, lines 115-133). We feel that this will provide readers with a better understanding of the tools available to health policy makers and the need to apply them in Mexico. We have also now referenced in the discussion other articles that describe predictions using this model in other parts of the world (revised manuscript with track changes, Word document, page 17, lines 440-441). COMMENT 5. if possible then rewrite the conclusion part in bullet form. RESPONSE: Thank you for this suggestion. We have rewritten the conclusion using bullet points to better organize our message (revised manuscript with track changes, Word document, page 18, lines 464-479). Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0241954.r002
26 Oct 2020 Decision Letter - Chiara Lazzeri, Editor Projected impact of COVID-19 mitigation strategies on hospital services in the Mexico City Metropolitan Area PONE-D-20-16750R1 Dear Dr. Fowler, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Chiara Lazzeri Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0241954.r003
Formally Accepted
30 Oct 2020 Acceptance Letter - Chiara Lazzeri, Editor PONE-D-20-16750R1 Projected impact of COVID-19 mitigation strategies on hospital services in the Mexico City Metropolitan Area Dear Dr. Fowler: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Chiara Lazzeri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0241954.r004

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