Abstract
BackgroundAggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV-2. The extent to which these interventions are successful in stopping the spread have not been characterized in countries with distinct socioeconomic groups. We compared the effects of a partial lockdown on disease transmission among Kuwaitis (P1) and non-Kuwaitis (P2) living in Kuwait.MethodsWe fit a modified metapopulation SEIR transmission model to reported cases stratified by two groups to estimate the impact of a partial lockdown on the effective reproduction number ( {mathcal{R}}_e ). We estimated the basic reproduction number ( {mathcal{R}}_0 ) for the transmission in each group and simulated the potential trajectories of an outbreak from the first recorded case of community transmission until 12 days after the partial lockdown. We estimated {mathcal{R}}_e values of both groups before and after the partial curfew, simulated the effect of these values on the epidemic curves and explored a range of cross-transmission scenarios.ResultsWe estimate {mathcal{R}}_e at 1·08 (95% CI: 1·00–1·26) for P1 and 2·36 (2·03–2·71) for P2. On March 22nd, {mathcal{R}}_e for P1 and P2 are estimated at 1·19 (1·04–1·34) and 1·75 (1·26–2·11) respectively. After the partial curfew had taken effect, {mathcal{R}}_e for P1 dropped modestly to 1·05 (0·82–1·26) but almost doubled for P2 to 2·89 (2·30–3·70). Our simulated epidemic trajectories show that the partial curfew measure greatly reduced and delayed the height of the peak in P1, yet significantly elevated and hastened the peak in P2. Modest cross-transmission between P1 and P2 greatly elevated the height of the peak in P1 and brought it forward in time closer to the peak of P2.ConclusionOur results indicate and quantify how the same lockdown intervention can accentuate disease transmission in some subpopulations while potentially controlling it in others. Any such control may further become compromised in the presence of cross-transmission between subpopulations. Future interventions and policies need to be sensitive to socioeconomic and health disparities.
Highlights
Aggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV-2
Since the beginning of the epidemic, without effective pharmaceutical interventions available to prevent or treat COVID-19, countries largely rely on nonpharmaceutical interventions (NPIs) to reduce disease transmission [7, 8]
We look at how NPIs affected transmission dynamics in each group
Summary
Aggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV-2. Estimates put the true number of cases in Iran at the time to be in the range of 18,300 (95% confidence interval: 3770 to 53,470) [3]. This intervention was subsequently followed by further border control measures, closures of schools, non-essential businesses and public gathering spots, cessation of all commercial flights and, eventually a partial lockdown on March 22nd 2020 [4,5,6]. Since the beginning of the epidemic, without effective pharmaceutical interventions available to prevent or treat COVID-19, countries largely rely on nonpharmaceutical interventions (NPIs) to reduce disease transmission [7, 8]. It was thought that Kuwait would pursue a similar trajectory due to its aggressive early action
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