Abstract
To constrain propagation and mitigate the burden of COVID-19, most countries initiated and continue to implement several non-pharmaceutical interventions (NPIs), including national and regional lockdowns. In the Republic of Ireland, the first national lockdown was decreed on 23rd of March 2020, followed by a succession of restriction increases and decreases (phases) over the following year. To date, the effects of these interventions remain unclear, and particularly within differing population subsets. The current study sought to assess the impact of individual NPI phases on COVID-19 transmission patterns within delineated population subgroups in the Republic of Ireland. Confirmed, anonymised COVID-19 cases occurring between the 29th of February 2020 and 30th November 2020 (n = 72,654) were obtained. Segmented modelling via breakpoint regression with multiple turning points was employed to identify structural breaks across sub-populations, including primary/secondary infections, age deciles, urban/commuter/rural areas, patients with underlying health conditions, and socio-demographic profiles. These were subsequently compared with initiation dates of eight overarching NPI phases. Five distinct breakpoints were identified. The first breakpoint, associated with a decrease in the daily COVID-19 incidence, was reported within 14 days of the first set of restrictions in mid-March 2020 for most population sub-groups. Results suggest that moderately strict NPIs were more effective than the strictest Phase 5 (National Lockdown). Divergences were observed across population sub-groups; lagged response times were observed among populations >80 years, residents of rural/ commuter regions, and cases associated with a below-median deprivation score. Study findings suggest that many NPIs have been successful in decreasing COVID-19 incidence rates, however the strictest Phase 5 NPI was not. Moreover, NPIs were not equally successful across all sub-populations, with differing response times noted. Future strategies and interventions may need to be increasingly bespoke, based on sub-population profiles and required responses.
Highlights
Since its identification in late-2019 in Wuhan China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus associated with coronavirus disease 2019 (COVID-19), has rapidly spread across the world [1]
Study findings suggest that many non-pharmaceutical interventions (NPIs) have been successful in decreasing COVID-19 incidence rates, the strictest Phase 5 NPI was not
Anonymised notified COVID-19 case data were obtained from the Computerised Infectious Disease Reporting (CIDR) database, an information system used for the collation of notifiable infection data in Ireland [12]
Summary
Since its identification in late-2019 in Wuhan China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus associated with coronavirus disease 2019 (COVID-19), has rapidly spread across the world [1]. As of late March 2021, almost 127 million cases had been reported, resulting in approximately 2.8 million deaths [2] including 234,000 cases and 4,650 deaths in the Republic of Ireland (ROI) [3], representing unprecedented rates of hospitalisation and subsequent pressure on critical care services, both nationally and globally [4, 5]. On March 11th 2020, the World Health Organization declared COVID-19 a global pandemic, almost immediately after which a multi-faceted approach was adopted by the Irish government to reduce the impacts of the crisis and “flatten the (epidemic) curve”. To constrain propagation and mitigate the burden of COVID-19, most countries initiated and continue to implement several non-pharmaceutical interventions (NPIs), including national and regional lockdowns. The current study sought to assess the impact of individual NPI phases on COVID-19 transmission patterns within delineated population subgroups in the Republic of Ireland
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