To assess the combined role of anti-viral monoclonal antibodies (mAbs) and vaccines in reducing severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) transmission and mortality in the United States, an agent-based model was developed that accounted for social contacts, movement/travel, disease progression, and viral shedding. The model was calibrated to coronavirus disease 2019 (COVID-19) mortality between October 2020 and April 2021 (aggressive pandemic phase), and projected an extended outlook to estimate mortality during a less aggressive phase (April–August 2021). Simulated scenarios evaluated mAbs for averting infections and deaths in addition to vaccines and aggregated non-pharmaceutical interventions. Scenarios included mAbs as a treatment of COVID-19 and for passive immunity for postexposure prophylaxis (PEP) during a period when variants were susceptible to the mAbs. Rapid diagnostic testing paired with mAbs was evaluated as an early treatment-as-prevention strategy. Sensitivity analyses included increasing mAb supply and vaccine rollout. Allocation of mAbs for use only as PEP averted up to 14% more infections than vaccine alone, and targeting individuals ≥ 65 years averted up to 37% more deaths. Rapid testing for earlier diagnosis and mAb use amplified these benefits. Doubling the mAb supply further reduced infections and mortality. mAbs provided benefits even as proportion of the immunized population increased. Model projections estimated that ~ 42% of expected deaths between April and August 2021 could be averted. Assuming sensitivity to mAbs, their use as early treatment and PEP in addition to vaccines would substantially reduce SARS-CoV-2 transmission and mortality even as vaccination increases and mortality decreases. These results provide a template for informing public health policy for future pandemic preparedness.

中文翻译：

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评估药物干预措施对大流行传播和死亡率的综合公共卫生影响：以 SARS CoV-2 为例


为了评估抗病毒单克隆抗体 (mAb) 和疫苗在减少美国严重急性呼吸综合征-冠状病毒 2 (SARS-CoV-2) 传播和死亡率方面的联合作用，开发了一种基于代理的模型，该模型考虑了社会接触、运动/旅行、疾病进展和病毒脱落。该模型根据 2020 年 10 月至 2021 年 4 月（严重流行阶段）期间的 2019 冠状病毒病 (COVID-19) 死亡率进行了校准，并预测了预测较不严重阶段（2021 年 4 月至 8 月）死亡率的扩展前景。除了疫苗和综合非药物干预措施之外，模拟情景还评估了单克隆抗体在避免感染和死亡方面的作用。场景包括使用 mAb 作为 COVID-19 的治疗方法，以及在变体对 mAb 敏感的时期用于暴露后预防 (PEP) 的被动免疫。快速诊断检测与单克隆抗体相结合被评估为一种早期治疗预防策略。敏感性分析包括增加单克隆抗体供应和疫苗推广。分配单克隆抗体仅用作 PEP 比单独使用疫苗可避免最多 14% 的感染，针对 ≥ 65 岁的个体可最多避免 37% 的死亡。早期诊断和单克隆抗体使用的快速检测放大了这些好处。单克隆抗体供应量加倍进一步降低了感染和死亡率。即使免疫人群比例增加，单克隆抗体也能带来好处。模型预测估计，2021 年 4 月至 8 月期间约 42% 的预期死亡是可以避免的。假设对单克隆抗体敏感，除了疫苗外，将单克隆抗体用作早期治疗和 PEP 将大大减少 SARS-CoV-2 的传播和死亡率，即使疫苗接种增加且死亡率下降。 这些结果为为未来大流行做好准备的公共卫生政策提供了一个模板。