Abstract
In Italy, the COVID-19 epidemic curve started to flatten when the health system had already exceeded its capacity, raising concerns that the lockdown was indeed delayed. The aim of this study was to evaluate the health effects of late implementation of the lockdown in Italy. Using national data on the daily number of COVID-19 cases, we first estimated the effect of the lockdown, employing an interrupted time series analysis. Second, we evaluated the effect of an early lockdown on the trend of new cases, creating a counterfactual scenario where the intervention was implemented one week in advance. We then predicted the corresponding number of intensive care unit (ICU) admissions, non-ICU admissions, and deaths. Finally, we compared results under the actual and counterfactual scenarios. An early implementation of the lockdown would have avoided about 126,000 COVID-19 cases, 54,700 non-ICU admissions, 15,600 ICU admissions, and 12,800 deaths, corresponding to 60% (95%CI: 55% to 64%), 52% (95%CI: 46% to 57%), 48% (95%CI: 42% to 53%), and 44% (95%CI: 38% to 50%) reduction, respectively. We found that the late implementation of the lockdown in Italy was responsible for a substantial proportion of hospital admissions and deaths associated with the COVID-19 pandemic.
Highlights
In early January a novel strain of coronavirus, SARS-CoV-2, a virus which follows a human-tohuman transmission, was identified in the Hubei province of China as the causative agent for a new disease later defined as Coronavirus Disease 2019 (COVID-19), a respiratory disease which is often characterized by influenza-like symptoms but which can evolve (3–5% of the cases) into acute respiratory distress syndrome, or even sepsis, and multi-organ failure which might lead to death [1]
We modeled the time-series of daily new cases, Yt, using the following quasi-Poisson regression model, accounting for the possible overdispersion of data: log(Yt ) = α + β1 T + β2 Xt + β3 T2 + et where T is the time elapsed since the start of the study; T2 is the time elapsed since the implementation of lockdown; X is a dummy variable indicating the pre-lockdown period or the post-lockdown period; Y is the logarithm of the number of new cases at time
By the time the epidemic curve started to flatten, the health system had already exceeded its capacity in different areas of the country, raising concerns that the public health response was delayed
Summary
In early January a novel strain of coronavirus, SARS-CoV-2, a virus which follows a human-tohuman transmission, was identified in the Hubei province of China as the causative agent for a new disease later defined as Coronavirus Disease 2019 (COVID-19), a respiratory disease which is often characterized by influenza-like symptoms but which can evolve (3–5% of the cases) into acute respiratory distress syndrome, or even sepsis, and multi-organ failure which might lead to death [1]. World Health Organization (WHO) to declare the pandemic status on March 11th, 2020 when many countries had already introduced unprecedented physical distancing and containment measures to various extents [2]. As of May 28th, 2020 almost six million of COVID-19 cases and 361,836 deaths have been recorded worldwide [3]. Public Health 2020, 17, 5644; doi:10.3390/ijerph17165644 www.mdpi.com/journal/ijerph
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