We use a stochastic branching process model, structured by age and level of healthcare access, to look at the heterogeneous spread of COVID-19 within a population. We examine the effect of control scenarios targeted at particular groups, such as school closures or social distancing by older people. Although we currently lack detailed empirical data about contact and infection rates between age groups and groups with different levels of healthcare access within New Zealand, these scenarios illustrate how such evidence could be used to inform specific interventions. We find that an increase in the transmission rates among children from reopening schools is unlikely to significantly increase the number of cases, unless this is accompanied by a change in adult behaviour. We also find that there is a risk of undetected outbreaks occurring in communities that have low access to healthcare and that are socially isolated from more privileged communities. The greater the degree of inequity and extent of social segregation, the longer it will take before any outbreaks are detected. A well-established evidence for health inequities, particularly in accessing primary healthcare and testing, indicates that Māori and Pacific peoples are at a higher risk of undetected outbreaks in Aotearoa New Zealand. This highlights the importance of ensuring that community needs for access to healthcare, including early proactive testing, rapid contact tracing and the ability to isolate, are being met equitably. Finally, these scenarios illustrate how information concerning contact and infection rates across different demographic groups may be useful in informing specific policy interventions.

中文翻译：

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COVID-19 传播的结构化模型：建模年龄和医疗保健不平等

我们使用按年龄和医疗保健访问水平构建的随机分支过程模型来研究 COVID-19 在人群中的异质传播。我们研究了针对特定群体的控制情景的影响，例如学校停课或老年人的社交距离。尽管我们目前缺乏关于新西兰境内不同年龄组和不同医疗保健使用水平的群体之间的接触率和感染率的详细经验数据，但这些情景说明了如何利用这些证据为具体干预措施提供信息。我们发现，重新开学后儿童之间的传播率增加不太可能显着增加病例数量，除非这伴随着成人行为的改变。我们还发现，在难以获得医疗保健的社区以及在社会上与更多特权社区隔离的社区中，存在未发现疫情的风险。不平等程度和社会隔离程度越大，发现任何疫情爆发所需的时间就越长。一项关于健康不公平的明确证据，特别是在获得初级保健和检测方面的证据表明，毛利人和太平洋人在新西兰奥特阿罗亚爆发未发现疫情的风险更高。这凸显了确保公平满足社区获得医疗保健需求的重要性，包括早期主动检测、快速接触者追踪和隔离能力。最后，