Approximating Peak Prevalence in Multistage SIR Epidemics

Estimating peak prevalence is a central problem in epidemic modeling because it determines the period of greatest infectious burden and is closely linked to health-care demand. In multistage SIR models, however, peak prevalence is generally less tractable than in the classical model with exponentially distributed infectious periods. Motivated by the use of weighted infectious-stage aggregates as surrogates for prevalence, we investigate the relationship between the prevalence peak and the maximum of a weighted stage functional in a deterministic SIR-like epidemic model with k identical infectious stages, which we call an SI(k)R model. We show that this relationship depends critically on how the stage-progression rate is scaled as the number of infectious stages increases. Under naive scaling, in which the progression rate remains fixed, the weighted peak is asymptotically equivalent to the prevalence peak and the commonly used factor-two approximation fails. Under Erlang scaling, which preserves the mean infectious period, the multistage model converges to a delay formulation in which prevalence and the weighted stage functional become unweighted and triangularly weighted moving averages of incidence. This limiting representation provides a theoretical basis for the factor-two approximation and identifies the regimes in which it is accurate. It also explains why this approximation deteriorates as epidemic waves become more sharply peaked. We derive analytical error bounds and develop curvature-based and parameter-based corrections that substantially improve accuracy. Numerical studies confirm these improvements across a broad range of epidemiological parameters. Overall, the results show when weighted-stage peaks can be used reliably as proxies for peak prevalence and how the resulting estimates can be refined when the standard approximation loses accuracy.