Howard (Howie) Weiss: Sir Ronald Ross
Howard (Howie) Weiss: Sir Ronald Ross
MAT 2
Volum 2013, treball no. 3, 17 pp. ISSN: 1887-1097
Publicació electrònica de divulgació del Departament de Matemàtiques
de la Universitat Autònoma de Barcelona
www.mat.uab.cat/matmat
1 Introduction
“As a matter of fact, all epidemiology, concerned as it is with the vari-
ation of disease from time to time or from place to place, must be
considered mathematically, however many variables as implicated, if it
is to be considered scientifically at all.”
Sir Ronald Ross, MD
We introduce and analyze the most basic transmission model for a di-
rectly transmitted infectious disease caused by bacteria, viruses, or fungi.
Direct transmission occurs through individual-to-individual contact: through
a sneeze or cough, through skin-skin contact, or through exchange of body
2 The SIR model and the Foundations of Public Health
fluids. Examples in the American media this week are the H7N9 flu, whoop-
ing cough, mumps, tuberculosis, and MERS-CoV.
The SIR (susceptible-infected-removed) model, developed by Ronald Ross1 ,
William Hamer, and others in the early twentieth century [4], consists of a
system of three coupled non-linear ordinary differential equations, which does
not possess an explicit formula solution. However, simple tools from calculus
allow us to extract a great deal of information about the solutions. Along the
way we illustrate how this simple model helps to lay a theoretical foundation
for public health interventions and how several cornerstones of public health
required a similar model to discover.
The SIR disease transmission model is derived assuming several strong
assumptions. There are hundreds of papers (and some books) where the
authors extend this basic model in many directions by relaxing some as-
sumptions. The mathematical analysis quickly becomes significantly more
sophisticated and in this article we focus on one of the simplest models.
We begin with a population that can consist of humans (e.g., a school,
hospital, or city), animals (e.g., a pig farm, bat colony, or deer in a forest),
or plants (e.g., spruce forest, sod farm, or wheat field). We then partition
the population into three groups or compartments: susceptible individuals,
infected individuals, and removed individuals. We denote the sizes of these
subpopulations at time t by S(t), I(t), and R(t). There are many assump-
tions behind the model, including a large and closed population, the outbreak
is short lived; no natural births or natural deaths occur, the infection has zero
latent period (an individual becomes infectious as soon as they become in-
fected), recovering from infection confers lifetime immunity, and mass-action
mixing of individuals. Mass action mixing assumes that the rate of encounter
between susceptible and infected individuals is proportional to the product
of the population sizes. Doubling the size of either population results in
twice as many new infections per unit time. This requires that the members
of both populations are homogeneously distributed in space and thus do not
mix mostly in any smaller subgroups. Intuitively, every person will encounter
every other person per unit time with equal probability. But keep in mind
that the SIR model is deterministic and there are no probabilities2 .
Is the mass action mixing assumption reasonable? Most humans have
contacts with only a small fraction of individuals in their community, and are
more likely to have contacts with family members, neighbors, and classmates.
Children typically have many more contacts than seniors. A common and
1
Sir Ronald Ross received the second Noble Prize in Medicine and Physiology for his
discovery of the transmission of malaria by the mosquito. He was also a closet Mathe-
matician and published papers in several areas of pure and applied mathematics.
2
One can formulate a stochastic analog of the SIR model as a Markov chain.
Howard (Howie) Weiss 3
pragmatic view is that one should begin modeling with the simplest model
and latter add more complexity, if required. The next step is sometimes to use
multiple classes of susceptible and infected individuals and assume well mix-
ing between these sub-classes with different rates. Models with well-mixing
can serve as null models against the influence of more detailed mechanisms.
The well-mixing hypothesis also allows the use of ordinary differential equa-
tions (ODEs) instead of partial differential equations or agent based models,
which can be substantially more difficult to parametrize, simulate, and ana-
lyze.
2 Methods
2.1 The SIR Model
The SIR model is the following system of quadratic ODEs:
dS
= −β S I (1)
dt
dI
=βSI −νI (2)
dt
dR
= ν I, (3)
dt
where the disease transmission rate β > 0 and the recovery rate ν > 0 (or in
other words, the duration of infection D = 1/ν).
The bi-linear incidence term β S I for the number of new infected indi-
viduals per unit time corresponds to homogeneous mixing of the infected and
susceptible classes. The total population size should remain constant, and
this easily follows from the SIR system: that the sum of the left hand sides
of the three equations is the derivative of the total population size and the
sum of the right hand sides is zero. We denote the total population size by
N . Since R(t) = N − S(t) − I(t), the system can be reduced to a system of
two ODEs: (1) and (2).
Suppose that each infected individual has κ contacts (each sufficient for
transmission) per unit time and κ is independent of the population size. Then
κ S/N of these contacts are with susceptible individuals. If the fraction τ of
adequate contacts result in transmission, then each infected individual infects
κ τ S/N susceptible individuals per unit time. Thus β = b/N where b = κ τ .
The parameter τ is called the transmissibility of the infectious disease.
MATerials MATemàtics
MAT 2
Volum 2006, treball no. 1, 14 pp.
Publicació electrònica de divulgació del Departa
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4 The SIR model and the Foundations of Public Health
2. If Re > 1, then I(t) starts increasing, reaches its maximum, and then
decreases to zero as t → ∞. We call this scenario of increasing numbers
of infected individuals an epidemic.
It follows that an infection can invade and cause an epidemic in an entirely
susceptible population if R0 > 1 or b > ν.
Proof. Equation (2) and the discussion in Section 2.2.1 imply that dI/dt =
(β S − ν) I ≤ (β S(0) − ν) I = ν (Re − 1) I ≤ 0 for Re < 1. This observation
together with I(∞) = 0 (see Section 2.2.2) proves the first statement.
Equation (2) implies (dI/dt)(0) = ν (Re − 1) I(0) > 0 for Re > 1. Thus
I(t) is increasing at t = 0. Equation (2) also implies that I(t) has only one
Howard (Howie) Weiss 5
4
x 10
5
S
4.5 I
R
4
3.5
2.5
1.5
0.5
0
0 10 20 30 40 50 60 70 80 90 100
We stress that the existence of a threshold for infection is far from obvious
and was missed by many public health and infectious disease experts. The
reason is that such a threshold can not be discerned from data; it requires a
mathematical model to illuminate.
Above we observed that (dI/dt)(0) = ν (Re − 1) I(0), which implies that
the number of infected individuals initially starts growing/decreasing expo-
nentially at rate ν (Re − 1). The next section will provide strong intuition
for the exponential growth.
MATerials MATemàtics
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Volum 2006, treball no. 1, 14 pp.
Publicació electrònica de divulgació del Departa
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6 The SIR model and the Foundations of Public Health
(1 − ρ) S(0) β/ν ≤ 1.
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8 The SIR model and the Foundations of Public Health
humans are the only natural hosts of the smallpox virus, in 1967 the World
Health Organization (WHO) mounted a successful worldwide smallpox erad-
ication program. Smallpox is one of only a very small number of human
infectious diseases that has been almost completely irradiated around the
world. Even if a malaria vaccine that is 100% effective, since R0 > 100, it
would be necessary to vaccinate 99% of the population to prevent epidemics.
I(t) + S(t) − ν/β log S(t) = I(0) + S(0) − ν/β log S(0). (5)
Imax occurs when dI/dt = 0 which from (2) yields occurs when S = ν/β.
Applying (5) yields
Imax + ν/β − ν/β log ν/β = I(0) + S(0) − ν/β log S(0)
or
Imax = I(0) + S(0) − ν/β log S(0) − ν/β + ν/β log ν/β.
Figure 3: Parametric plots of I(t) verses S(t) with β = 1.66 and ν = 0.44
dS −β I S −β S
= = .
dR νI ν
This ODE is separable, since for S > 0 it can be rewritten as
−β
Z Z
1
dS = dR.
S ν
MATerials MATemàtics
MAT 2
Volum 2006, treball no. 1, 14 pp.
Publicació electrònica de divulgació del Departa
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10 The SIR model and the Foundations of Public Health
Since 0 ≤ R(t) − R(0) ≤ N it follows that S(t) ≥ S(0) exp(−β N/ν) and
thus
S(∞) ≥ S(0) exp(−β N/ν) = S(0) exp(−R0 ) > 0.3
Equation (6) easily yields a transcendental equation for S(∞), which when
R(0) = 0, reduces to
SH¥LN verses R0
1.0
0.8
0.6
0.4
0.2
0.0
1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5
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MAT 2
Volum 2006, treball no. 1, 14 pp.
Publicació electrònica de divulgació del Departa
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12 The SIR model and the Foundations of Public Health
so far obtained were discovered without parametrizing the model with any
data.
In practice, the transmission rate β, being a complicated function of con-
tact rate κ and transmissibility τ , is difficult to estimate directly and usually
requires data to estimate. However, the duration of infectiousness D = 1/ν
can usually be estimated independently of data (e.g., by measuring the virus
shedding of infected individuals over time).
The main model parametrization methods are the method of least squares,
the method of maximal likelihood, and Bayesian methods. There are other
statistical challenges when parametrizing models, for example, under-re-
porting. Not all infected individuals are officially counted. For example,
most people who have the flu suffer at home and do not visit a doctor and
have their diagnosis confirmed by a laboratory. One needs to estimate the
underreporting rate. At the beginning of the 2009 H1N1 flu pandemic the
under-reporting rate in the U.S. was estimated to be about 80 to 1 ([13]).
Figure 5: SIR model predictions of Dengue fever outbreaks in (a) Venezuela (2000) (b)
Santiago de Cuba (1997)
Howard (Howie) Weiss 13
Figure 7: SIR model prediction of classical swine fever virus outbreak in the Netherlands
MATerials MATemàtics
MAT 2
Volum 2006, treball no. 1, 14 pp.
Publicació electrònica de divulgació del Departa
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14 The SIR model and the Foundations of Public Health
exposure. Norovirus symptoms may last a few days, but most people recover
completely without treatment.
Figure 8 shows the number of norovirus infections in a Brussels long-term
care facility during 2007 [16] along with a parametrized SIR model.
Figure 8: SIR model prediction of norovirus outbreak in Brussels long-term care facility
2007
4 Concluding remarks
What have we learned? Mathematically, we learned how we can extract many
useful properties of solutions of nonlinear ODEs even though the system has
Howard (Howie) Weiss 15
Figure 9: Number of pandemic H1N1 viral isolates tested the United States from April
2009 through March 2010.
Notice the two peaks. If all the assumptions of the SIR model held for
this outbreak, Theorem 2.1 would imply there would be only one peak. Also,
the US experienced one peak every year except during the pandemic years
1918, 1958, 1968, 2009, when it experienced two or more waves. What is
the mechanism(s) that is generating the multiple peaks? Nobody knows.
Recently in [10], we used relatively simple extensions of the SIR model to
exhibit five plausible mechanisms, each of which could have generated the
two peaks during 2009, both quantitatively and qualitatively.
The first two mechanisms capture changes in virus transmissibility and
behavioral changes. The third mechanism involves population heterogeneity
where each wave spreads through one sub-population. The fourth mechanism
is virus mutation which causes delayed susceptibility of individuals. The fifth
mechanism is waning immunity. We use the models to examine the effects
of border control at the beginning of the outbreak and the timing of and
amount of available vaccinations.
MATerials MATemàtics
MAT 2
Volum 2006, treball no. 1, 14 pp.
Publicació electrònica de divulgació del Departa
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16 The SIR model and the Foundations of Public Health
We also use the models to try to understand why China, which instituted
strict border control at the onset of the outbreak, had only one peak and
the US had two peaks. The models indicate that had the US also instituted
strong border control at the onset of the outbreak, they would have also
experienced a single peak of infections. However, the models also indicate
that strong border control would not have decreased the total number of
infections.
References
[1] Linda JS Allen. An introduction to stochastic processes with applications
to biology. Pearson Education New Jersey, 2003.
Mathematics Department
Georgia Institute of Technology
Atlanta, Georgia, USA
weiss@math.gatech.edu
MATerials MATemàtics
MAT 2
Volum 2006, treball no. 1, 14 pp.
Publicació electrònica de divulgació del Departa
de la Universitat Autònoma de Barcelona
www.mat.uab.cat/matmat