Abstract
BackgroundThe transmission dynamics and severity of coronavirus disease 2019 (COVID-19) pandemic is different across countries or regions. Differences in governments’ policy responses may explain some of these differences. We aimed to compare worldwide government responses to the spread of COVID-19, to examine the relationship between response level, response timing and the epidemic trajectory.MethodsFree publicly-accessible data collected by the Coronavirus Government Response Tracker (OxCGRT) were used. Nine sub-indicators reflecting government response from 148 countries were collected systematically from January 1 to May 1, 2020. The sub-indicators were scored and were aggregated into a common Stringency Index (SI, a value between 0 and 100) that reflects the overall stringency of the government’s response in a daily basis. Group-based trajectory modelling method was used to identify trajectories of SI. Multivariable linear regression models were used to analyse the association between time to reach a high-level SI and time to the peak number of daily new cases.ResultsOur results identified four trajectories of response in the spread of COVID-19 based on when the response was initiated: before January 13, from January 13 to February 12, from February 12 to March 11, and the last stage—from March 11 (the day WHO declared a pandemic of COVID-19) on going. Governments’ responses were upgraded with further spread of COVID-19 but varied substantially across countries. After the adjustment of SI level, geographical region and initiation stages, each day earlier to a high SI level (SI > 80) from the start of response was associated with 0.44 (standard error: 0.08, P < 0.001, R2 = 0.65) days earlier to the peak number of daily new case. Also, each day earlier to a high SI level from the date of first reported case was associated with 0.65 (standard error: 0.08, P < 0.001, R2 = 0.42) days earlier to the peak number of daily new case.ConclusionsEarly start of a high-level response to COVID-19 is associated with early arrival of the peak number of daily new cases. This may help to reduce the delays in flattening the epidemic curve to the low spread level.Graphic abstract
Highlights
The transmission dynamics and severity of coronavirus disease 2019 (COVID-19) pandemic is differ‐ ent across countries or regions
Stages when a country initiated a response By plotting distribution of first day of response (i.e., Stringency Index (SI) > 0) among 148 countries from January 1, 2020 to May 1, 2020, four initiation stages were observed (Fig. 1)
The third stage is from February 12 to March 11, and there are 45 of 148 countries started a response at this stage
Summary
The transmission dynamics and severity of coronavirus disease 2019 (COVID-19) pandemic is differ‐ ent across countries or regions. Differences in governments’ policy responses may explain some of these differences. We aimed to compare worldwide government responses to the spread of COVID-19, to examine the relationship between response level, response timing and the epidemic trajectory. The pandemic can be viewed as a series of distinct local epidemics in different spread phases. There are many reasons why the severity of the pandemic has varied in different countries or regions. In addition to the differences in capacity of countries to adapt their health system to the COVID-19 epidemic [7], differences in governmental policy responses may explain some of the differences. It’s hard to compare the measures implemented in different countries directly. We lack a comprehensive index to reflect the overall response level of a country with implementation of multiple sub-measures
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