Fundamental limits on taming infectious disease epidemics

Abstract

Epidemic control frequently relies on adjusting interventions based on prevalence. But designing such policies is a highly non-trivial problem due to uncertain intervention effects, costs and the difficulty of quantifying key transmission mechanisms and parameters. Here, using exact mathematical and computational methods, we reveal a fundamental limit in epidemic control in that prevalence feedback policies are outperformed by a single optimally chosen constant control level. Specifically, we find no incentive to use prevalence based control under a wide class of cost functions that depend arbitrarily on interventions and scale with infections. We also identify regimes where prevalence feedback is beneficial. Our results challenge the current understanding that prevalence based interventions are required for epidemic control and suggest that, for many classes of epidemics, interventions should not be varied unless the epidemic is near the herd immunity threshold.