Benefits of COVID-19 non-pharmaceutical interventions on the prevention of other notifiable infectious diseases

Abstract

COVID-19-targeted non-pharmaceutical interventions (NPIs) have been demonstrated to be effective in containing the pandemic [[1]Lai S Ruktanonchai NW Zhou L Prosper O Luo W Floyd JR Wesolowski A Santillana M Zhang C Du X Yu H. Effect of non-pharmaceutical interventions to contain COVID-19 in China.Nature. Sep 2020; 585: 410-413Crossref PubMed Scopus (603) Google Scholar], while they often come at the expense of harmful effects on the health and economy because of the interrupted and delayed health care, increased risk of mental diseases and domestic violence, and elevated unemployment, inequity, poverty, and social disruptions [[2]Müller O Razum O Jahn A. Effects of non-pharmaceutical interventions against COVID-19 on the incidence of other diseases.The Lancet Regional Health–Europe. 2021 Jul 1; 6Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar]. These negative effects have led to the relaxation of NPIs in several well-vaccinated countries, such as U.K. and U.S., even with rising COVID-19 cases. However, the population-wide COVID-19 vaccination program is only available in a few developed countries [[3]Walker PG Whittaker C Watson OJ Baguelin M Winskill P Hamlet A Djafaara BA Cucunubá Z Mesa DO Green W Thompson H. The impact of COVID-19 and strategies for mitigation and suppression in low-and middle-income countries.Science. 2020 Jul 24; 369: 413-422Crossref PubMed Scopus (398) Google Scholar]. The latest research showed that several viral mutations in SARS-Cov-2 can escape antibody binding and reduce the efficacy of vaccines [[4]Madhi SA Baillie V Cutland CL Voysey M Koen AL Fairlie L Padayachee SD Dheda K Barnabas SL Bhorat QE Briner C. Efficacy of the ChAdOx1 nCoV-19 Covid-19 vaccine against the B. 1.351 variant.New England Journal of Medicine. 2021 May 20; 384: 1885-1898Crossref PubMed Scopus (693) Google Scholar]. As a result, NPIs will still be inevitable in many countries, particularly low- and middle-income countries [[5]Kissler SM Tedijanto C Goldstein E Grad YH Lipsitch M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period.Science. 2020 May 22; 368: 860-868Crossref PubMed Scopus (1466) Google Scholar]. It is therefore important to examine not only the negative effects, but also the positive effects of COVID-19-targeted NPIs in addition to the pandemic control. Recent studies have shown that several infectious diseases, such as influenza, were suppressed during the pandemic [[2]Müller O Razum O Jahn A. Effects of non-pharmaceutical interventions against COVID-19 on the incidence of other diseases.The Lancet Regional Health–Europe. 2021 Jul 1; 6Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar,[6]Sakamoto H Ishikane M Ueda P. Seasonal influenza activity during the SARS-CoV-2 outbreak in Japan.JAMA. 2020 May 19; 323: 1969-1971Crossref PubMed Scopus (169) Google Scholar,[7]Feng L Zhang T Wang Q Xie Y Peng Z Zheng J Qin Y Zhang M Lai S Wang D Feng Z. Impact of COVID-19 outbreaks and interventions on influenza in China and the United States.Nature Communications. 2021 May 31; 12: 1-8Crossref PubMed Scopus (62) Google Scholar]. However, there is a lack of detailed characterisation of demographics and the spatiotemporal scales in a large population, which could be heterogeneous in benefiting from NPIs. In this issue of The Lancet Regional Health – Western Pacific, Jianpeng Xiao and colleagues present findings on the co-benefits of COVID-19-targeted NPIs on notifiable infectious diseases (NIDs) in Guangdong, a province with 126 million population in China [[8]Xiao J, Dai J, Hu J, Liu T, Gong D, Li X, Kang M, Zhou Y, Li Y, Quan Y, He G, Zhong R, Zhu Z, Huang Q, Zhang Y, Huang J, Du Q, Li Y, Song T, Hu W, Zhong H, Ma W. Co-benefits of nonpharmaceutical intervention against COVID-19 on infectious diseases in China: A large population-based observational study. The Lancet Regional Health–Western Pacific. 2021 Sep 22. doi:10.1016/j.lanwpc.2021.100282.Google Scholar]. The authors harnessed the NIDs data from the Notifiable Infectious Diseases Surveillance System, an internet-based reporting system developed by the China Center for Disease Control and Prevention, and the demographic data from Guangdong Statistics Yearbook. China has undergone one of the most stringent NPIs, which are a combination of mass testing, intensive surveillance, domestic and international travel restrictions, border control, quarantine, manual and digital contact tracing, school closure, mandatory mask-wearing, and repeated lockdowns [[1]Lai S Ruktanonchai NW Zhou L Prosper O Luo W Floyd JR Wesolowski A Santillana M Zhang C Du X Yu H. Effect of non-pharmaceutical interventions to contain COVID-19 in China.Nature. Sep 2020; 585: 410-413Crossref PubMed Scopus (603) Google Scholar]. The authors compared the incidence of NIDs during the emergency response period in 2020 with that in the same period of 2015-2019, as well as with the expected incidence as predicted by a Bayesian structural time series model. Results showed that the stringent NPIs deployed in Guangdong had significant co-benefits in reducing the incidence of NIDs with demographic, spatiotemporal and disease-specific heterogeneity. The reduction in NIDs was the largest in natural focal diseases and insect-borne infectious diseases (89•4%), followed by respiratory infectious diseases (87•4%) and intestinal infectious diseases (59•4%). The reduction in blood-borne and sexually transmitted infections was smaller (18•2%), but still noticeably higher than that in other countries. Children and the residents in more economically developed cities were found to benefit from NPIs more than other populations. Xiao et al. [[8]Xiao J, Dai J, Hu J, Liu T, Gong D, Li X, Kang M, Zhou Y, Li Y, Quan Y, He G, Zhong R, Zhu Z, Huang Q, Zhang Y, Huang J, Du Q, Li Y, Song T, Hu W, Zhong H, Ma W. Co-benefits of nonpharmaceutical intervention against COVID-19 on infectious diseases in China: A large population-based observational study. The Lancet Regional Health–Western Pacific. 2021 Sep 22. doi:10.1016/j.lanwpc.2021.100282.Google Scholar] make unique additions to the growing evidence that COVID-19-targeted NPIs can prevent other NIDs from the unique perspective of NPIs’ heterogeneous demographic, spatiotemporal and disease-specific effects on a large population of 126 million, indicating that certain groups of people may benefit more from COVID-19-targeted NPIs. Such a more detailed understanding of NPIs’ benefits has the potential to inform public health policies on the prevention of NIDs during and after the pandemic. In the future, when COVID-19 or similar infectious disease-targeted NPIs are being deployed, clinicians and public health professionals will be equipped with the data-driven insights to make better resource allocation in anticipation, rather than in response to the upcoming demand of health care resources. The findings also set a benchmark for evaluating the effectiveness of various NPIs in preventing NIDs. Several important questions remain unanswered in [[8]Xiao J, Dai J, Hu J, Liu T, Gong D, Li X, Kang M, Zhou Y, Li Y, Quan Y, He G, Zhong R, Zhu Z, Huang Q, Zhang Y, Huang J, Du Q, Li Y, Song T, Hu W, Zhong H, Ma W. Co-benefits of nonpharmaceutical intervention against COVID-19 on infectious diseases in China: A large population-based observational study. The Lancet Regional Health–Western Pacific. 2021 Sep 22. doi:10.1016/j.lanwpc.2021.100282.Google Scholar]. First, as admitted by the authors, there were likely under-reporting problems in the NIDs data, because of people's hesitation to visit the hospital and limited health care resources during the pandemic. Second, the susceptible population for other NIDs increased while COVID-19-targeted NPIs were in place, and thus might pose a greater risk of future outbreaks of NIDs following NPIs [[9]Baker RE Park SW Yang W Vecchi GA Metcalf CJ Grenfell BT. The impact of COVID-19 nonpharmaceutical interventions on the future dynamics of endemic infections.Proceedings of the National Academy of Sciences. 2020 Dec 1; 117: 30547-30553Crossref PubMed Scopus (159) Google Scholar]. Decision-makers and public health professionals should consider not only the reduced incidence but also the heavier burden on healthcare systems because of the increased susceptible population while lifting up NPIs and reopening borders. Third, social and economic factors were not considered in this study. How to balance the benefits of NPIs and the cost of economy is a new question that yet to be answered. Fourth, the results should be further validated by a prospective longitudinal study. Fifth, domestic, inter-provincial and international human mobility data could have been better incorporated in such observational study, so that the effect of individual measures, such as travel restrictions, can be better characterized. To answer these questions, scientists in all disciplines should join forces in identifying novel data and developing advanced data science techniques to integrate and analyse the multi-source and multi-aspect data [[10]Zhang Q Gao J Wu JT Cao Z Zeng DD. Data Science Approaches to Confronting the COVID-19 Pandemic: A Narrative Review.Philosophical Transactions of the Royal Society A. 2021 Nov 22; (In press)https://doi.org/10.1098/rsta.2021.0127Crossref Scopus (11) Google Scholar]. The authors declare no conflict of interest. Co-benefits of nonpharmaceutical intervention against COVID-19 on infectious diseases in China: A large population-based observational studyBackground: Nonpharmaceutical interventions (NPIs) are public health measures that aim to suppress the transmission of infectious diseases, including border restrictions, quarantine and isolation, community management, social distancing, face mask usage, and personal hygiene. This research aimed to assess the co-benefits of NPIs against COVID-19 on notifiable infectious diseases (NIDs) in Guangdong Province, China.Methods: Based on NID data from the Notifiable Infectious Diseases Surveillance System in Guangdong, we first compared the incidence of NIDs during the emergency response period (weeks 4–53 of 2020) with those in the same period of 2015–2019 and then compared that with the expected incidence during the synchronous period of 2020 for each city by using a Bayesian structural time series model. Full-Text PDF Open Access