The Impact of Public Health Interventions on Delaying and Mitigating against Replacement by SARS-CoV-2 Variants of Concern

Background. Public Health interventions have succeeded marginally to flatten the COVID-19 epidemic curve of the most recent wave in many regions. Several highly transmissible COVID-19 Variants of Concern (VOCs) have emerged internationally, with variable virulence and as-yet unclear antigenicity. Growing public fatigue highlights the importance of accurately quantifying the speed at which VOCs can replace the resident strain, to inform precise decision-making in terms of both timing and scale of interventions. Methods. Using a simple Susceptible-Infected-Removed (SIR) model, we derive a formula calculating the duration for a VOC to increase its frequency from one level to another. We evaluate the impact of interventions on VOC-related variables. Findings. After introduction of a VOC with a higher transmissibility than the resident strain, its prevalence increases exponentially, leading to eventual replacement by the VOC. Even if the outbreak caused by the resident strain has previously been brought under control, the epidemic is eventually going to increase exponentially, possibly after a transient declining phase. The initial VOC frequency, epidemic mean generation time, and reproduction number of the resident strain all contribute to determining the speed of VOC replacement and the resulting epidemic growth. Interpretation. Following the introduction of a VOC, the risk of a sudden surge of the total cases is hidden behind a transient decline. Maintaining or enhancing Public Health interventions are vital to slowing down the VOC replacement, curbing the epidemic growth, and increasing VOC doubling time.