Integrated Packages of Non-Pharmaceutical Interventions Increased Public Health Response Efficiency Against COVID-19 During the First European Wave: Evidence from 32 European Countries

Abstract

Since the emergence of SARS-CoV-2, governments have implemented a combination of public health responses based on non-pharmaceutical interventions (NPIs), with significant social and economic consequences. Quantifying the efficiency of different NPIs implemented by European countries to overcome the first epidemic wave could inform preparedness for forthcoming waves. We used a dataset compiled by the European Centre for Disease Control (ECDC) on daily COVID-19 incidence, mortality and NPI implementation in 32 European countries. We adapted a capture-recapture method to limit non-reporting bias in incidence data, which we fitted to an age-structured mathematical model coupled with Monte Carlo Markov Chain to quantify the efficiency of 258 public health responses (PHR, a combination of several NPIs) in reducing SARS-Cov-2 transmission rates. From these PHR efficiencies, we used time series analyses to isolate the effect of 13 NPIs at different levels of implementation (fully implemented vs. partially relaxed). Public health responses implemented in Europe led to a median decrease in viral transmission of 71%, enough to suppress the epidemic. PHR efficiency was positively associated with the number of NPIs implemented simultaneously. The largest effect among NPIs was observed for stay at home orders targeted at risk groups (b=0.24, 95%CI 0.16-0.32) and teleworking (b=0.23, 95%CI 0.15-0.31), followed by enforced stay at home orders for the general population, closure of non-essential businesses and services, bans on gatherings of 50 individuals or more, and closure of universities. Partial relaxation of most NPIs resulted in lower than average or non-significant changes in response efficiency. This large-scale estimation of NPI and PHR efficiency against SARS-COV-2 transmission in Europe suggests that a combination of NPIs targeting different population groups should be favored to control future epidemic waves.Funding Statement: HG and BR are supported by a grant from the “Agence Nationale de la Recherche” (ANRDigEpi).Declaration of Interests: The authors declare that they have no conflict of interests.Ethics Approval Statement: No ethics approval was necessary.