Lockdown Interventions Research Articles

Forecasting hospital demand in metropolitan areas during the current COVID-19 pandemic and estimates of lockdown-induced 2nd waves.

We present a forecasting model aim to predict hospital occupancy in metropolitan areas during the current COVID-19 pandemic. Our SEIRD type model features asymptomatic and symptomatic infections with detailed hospital dynamics. We model explicitly branching probabilities and non-exponential residence times in each latent and infected compartments. Using both hospital admittance confirmed cases and deaths, we infer the contact rate and the initial conditions of the dynamical system, considering breakpoints to model lockdown interventions and the increase in effective population size due to lockdown relaxation. The latter features let us model lockdown-induced 2nd waves. Our Bayesian approach allows us to produce timely probabilistic forecasts of hospital demand. We have applied the model to analyze more than 70 metropolitan areas and 32 states in Mexico.

Impacts of Lockdown Interventions on the Spread of COVID-19 in India.

Sir, COVID-19 outbreak caused by SARS-CoV2 has now become a global pandemic and a significant health concern throughout the world.[1] The first case of COVID-19 was reported in India on January 30, 2020.[2] Due to burgeoning incidence rate, India is on the second position globally in terms of confirmed cases after the USA. As of September 25, 2020, more than 5.81 million cases along with 92,317 deaths have been reported. The case fatality rate is 1.58% with 70% comorbidities. More than 81% of patients have been recovered (https://www.mohfw.gov.in). The Government of India has implemented the lockdown intervention to reduce the transmission of COVID-19 for 68 days in four different phases [Figure 1]. The major interventions include the social distancing, school closure, travel restrictions, border closures, wearing the face masks, quarantine of symptomatic patients, and their contacts. The main purpose of these interventions was to break the chain of transmission and to increase the awareness and to enhance the health infrastructure. Earlier, the lockdown processes have reduced the transmission of disease in China, Italy, Spain, and Australia,[345] however, the impact of lockdown in Indian scenario has not been evaluated yet.Figure 1: Timeline of COVID-19 spread and lockdown strategies in India. The distributions of COVID-19 cases and lockdown strategies done by the Government of India have been shownWe analyzed the COVID-19 data available on the Ministry of Health and Family Welfare, India. The data were taken before and during the entire lockdown period. The data suggest that 1 week before the lockdown, COVID-19 cases were increasing, with an average rate of 21.81% per day, which was decreased to 15.44% in the first phase [Figure 2a]. The doubling period was increased from 3.30 to 4.66 days. The average increment in mortality rate was reduced from 21.15% to 19.17% per day [Figure 2b]. The mean rate of recovery was 17.98% per day (ranging from 4.49% to 48.89% on different periods) [Figure 2c].Figure 2: Impacts of lockdown on COVID-19 spread. The distribution of COVID-19 at different time points has been shown. (a) The percentage increase in COVID-19 cases. The increment in mortality and recovered cases has been shown in (b and c), respectivelyIn the second phase, the average increment in infected cases was 7.17% everyday, with a doubling period of 10.0 days (cases increased from 11933 to 40263) [Figure 2a]. The average increment in mortality was 7.15% per day (ranging from 2.86% to 12.96%). Total 9543 infected cases were recovered, with an average increment of 12.44% per day [Figure 2c]. In the subsequent phase, the average increment in infected cases was approximately 6% per day, with a doubling period of 12 days. Total 1483 patients died, with an average increment rate of 5.82% per day (ranging from 3.9% to 14.0%). Total 22,347 infected cases were recovered, with an average rate of 8.51% per day. In the last phase, the average increment in infected cases was 5.09% per day, with a doubling period of 14.17 days. The increment in mortality cases was ranging from 3.63% to 5.63% (average increment: 4.28% per day). Total 50,160 infected patients were recovered, with an average rate of 6.95% per day [Figure 2]. Overall, the lockdown strategies seem successful in reducing the transmission of COVID-19 infection in India. The proportion of the young age population (65% below 35 years of age) along with the mitigation strategies had definitely made a negative impact on the transmission. Financial support and sponsorship The grant, No. 56/2/Hae/BMS to NB, received from Indian Council for Medical Research (ICMR), New Delhi, is highly acknowledged. Conflicts of interest There are no conflicts of interest.

COVID-19 Lockdown Policies: An Interdisciplinary Review

Lockdown interventions employed in response to the COVID-19 pandemic have been evaluated via research at biomedical, economic, psychological, and ethical levels of analysis. The aim of this article is to integrate these perspectives into an interdisciplinary biopsychosocial review. Biomedical evidence from the early months of the pandemic suggests that lockdowns were associated with a reduced viral reproductive rate, but that less restrictive measures also had a similar effect. Lockdowns are associated with reduced mortality in epidemiological modelling studies but not in studies based on empirical data from the Covid-19 pandemic. Psychological research supports the proposition that lengthy lockdowns may exacerbate stressors such as social isolation and unemployment that have been shown to be strong predictors of falling ill if exposed to a respiratory virus. Studies at the economic level of analysis points to the possibility that deaths associated with economic harms or underfunding of other health issues may outweigh the deaths that lockdowns save, and that the extremely high financial cost of lockdowns may have negative implications for overall population health in terms of diminished resources for treating other conditions. Research on ethics in relation to lockdowns points to the inevitability of value judgements in balancing different kinds of harms and benefits than lockdowns cause. Suggestions for future research are provided to promote an increasingly fine-grained and nuanced evaluation of these policies.

Indoor and Outdoor Exposure to PM2.5 during COVID-19 Lockdown in Suburban Malaysia

During the COVID-19 pandemic, key policies aimed at reducing exposure to the virus from social distancing, restrictions on travel through to strongly enforced lockdowns. However, COVID-19 restrictions required people to spend more time at home so the exposure to air pollutants shifted to being derived from that of domestic interiors, rather than outdoors or the workplace environment. This study aims to characterise the influence of lockdown intervention on the balance of indoor and outdoor PM2.5 exposure in a Malaysian suburb. We also calculate the potential health risk from exposure to both indoor and outdoor PM2.5 to give context to personal exposure assessment in different microenvironments during the COVID-19 lockdown, known locally as Movement Control Orders (MCO). The implementation of the MCOs slightly reduced daily average of outdoor PM2.5 concentrations (median of 12.63 µg m–3 before and 11.72 µg m–3). In the Malaysian apartment considered here, cooking led to a substantial increase in exposure from increasing concentrations in PM2.5 during a COVID-19 lockdown (maximum average concentration at 52.2 µg m–3). The estimated excess risk to health was about 25% for lung cancer from staying indoor. Thus, there seems a potential for greater exposure to fine particles indoors under lockdown, so it is likely premature to suggest that more lives were saved through a reduction of outdoor pollutants than lost in the pandemic. Unfortunately, little is known about the toxicity of indoor particles and the types of exposures that result where people increase the amount of time they spend working from home or staying indoors, especially during periods of lockdown.

Bidirectional association between COVID-19 and the environment: A systematic review

The global crisis caused by SARS-CoV-2 (COVID-19) affected economics, social affairs, and the environment, not to mention public health. It is estimated that near 82% of the SARS-CoV-2 genome is similar to the severe acute respiratory syndrome. The purpose of the review is to highlight how the virus is impacted by the environment and how the virus has impacted the environment. This review was based on an electronic search of the literature in the Scopus, Science Direct, and PubMed database published from December 2019 to July 2020 using combinations of the following keywords: SARS-CoV-2 transmission, COVID-19 transmission, coronavirus transmission, waterborne, wastewater, airborne, solid waste, fomites, and fecal-oral transmission. Studies suggest the thermal properties of ambient air, as well as relative humidity, may affect the transmissibility and viability of the virus. Samples taken from the wastewater collection network were detected contaminated with the novel coronavirus; consequently, there is a concern of its transmission via an urban sewer system. There are concerns about the efficacy of the wastewater treatment plant disinfection process as the last chance to inactivate the virus. Handling solid waste also requires an utmost caution as it may contain infectious masks, etc. Following the PRISMA approach, among all reviewed studies, more than 36% of them were directly or indirectly related to the indoor and outdoor environment, 16% to meteorological factors, 11% to wastewater, 14% to fomites, 8% to water, 9% to solid waste, and 6% to the secondary environment. The still growing body of literature on COVID-19 and air, suggests the importance of SARS-CoV-2 transmission via air and indoor air quality, especially during lockdown interventions. Environmental conditions are found to be a factor in transmitting the virus beyond geographical borders. Accordingly, countries need to pay extra attention to sustainable development themes and goals.

Is Social Distancing, and Quarantine Effective in Restricting COVID-19 Outbreak? Statistical Evidences from Wuhan, China

The flow of novel coronavirus (COVID-19) has affected almost every aspect of human life around the globe. Being the emerging ground and early sufferer of the virus, Wuhan city-data remains a case of multifold significance. Further, it is of notable importance to explore the impact of unique and unprecedented public health response of Chinese authorities—the extreme lockdown of the city. In this research, we investigate the statistical nature of the viral transmission concerning social distancing, extreme quarantine, and robust lockdown interventions. We observed highly convincing and statistically significant evidences in favor of quarantine and social distancing approaches. These findings might help countries, now facing, or likely to face the wave of the virus. We analyzed Wuhan-based data of “number of deaths” and “confirmed cases,” extracted from China CDC weekly database, dated from February 13, 2020, to March 24, 2020. To estimate the underlying group structure, the assembled data is further sub-divided into three blocks, each consists of two weeks. Thus, the complete data set is studied in three phases, such as, phase 1 (Ph 1) = February 13, 2020, to February 26, 2020; phase 2 (Ph 2) = February 27, 2020 to March 11, 2020; and phase 3 (Ph 3) = March 12, 2020 to March 24, 2020. We observed the overall median proportion of deaths in those six weeks remained 0.0127. This estimate is highly influenced by Ph1, when the early flaws of weak health response were still prevalent. Over the time, we witnessed a median decline of 92.12% in the death proportions. Moreover, a non-parametric version of the variability analysis of death data, estimated that the average rank of reported proportions in Ph 3 remained 7, which was 20.5 in Ph 2, and stayed 34.5 in the first phase. Similar patterns were observed, when studying the confirmed cases data. We estimated the overall median of the proportion of confirmed cases in Wuhan as 0.0041, which again, is highly inclined towards Ph 1 and Ph 2. We also witnessed minimum average rank proportions for Ph 3, such as 7, which was noticeably lower than Ph 2, 21.71, and Ph 1, 32.29. Moreover, the varying degree of clustering indicates that the effectiveness of quarantine based policies is time-dependent. In general, the decline in coronavirus transmission in Wuhan significantly coincides with the lockdown.

Estimating transmission dynamics and serial interval of the first wave of COVID-19 infections under different control measures: a statistical analysis in Tunisia from February 29 to May 5, 2020

BackgroundDescribing transmission dynamics of the outbreak and impact of intervention measures are critical to planning responses to future outbreaks and providing timely information to guide policy makers decision. We estimate serial interval (SI) and temporal reproduction number (Rt) of SARS-CoV-2 in Tunisia.MethodsWe collected data of investigations and contact tracing between March 1, 2020 and May 5, 2020 as well as illness onset data during the period February 29–May 5, 2020 from National Observatory of New and Emerging Diseases of Tunisia. Maximum likelihood (ML) approach is used to estimate dynamics of Rt.ResultsFour hundred ninety-one of infector-infectee pairs were involved, with 14.46% reported pre-symptomatic transmission. SI follows Gamma distribution with mean 5.30 days [95% Confidence Interval (CI) 4.66–5.95] and standard deviation 0.26 [95% CI 0.23–0.30]. Also, we estimated large changes in Rt in response to the combined lockdown interventions. The Rt moves from 3.18 [95% Credible Interval (CrI) 2.73–3.69] to 1.77 [95% CrI 1.49–2.08] with curfew prevention measure, and under the epidemic threshold (0.89 [95% CrI 0.84–0.94]) by national lockdown measure.ConclusionsOverall, our findings highlight contribution of interventions to interrupt transmission of SARS-CoV-2 in Tunisia.

COVID -19 AND THE PARALYSATION OF WOMEN LIVELIHOODS IN MICRO-ENTERPRISES IN MASVINGO URBAN, ZIMBABWE

Covid-19 has fast become a global catastrophic pandemic affecting all facets of life, including people’s livelihoods. Despite the devastating impact COVID-19 has caused across the globe, little has been researched on how lockdown intervention measures have affected livelihoods of entrepreneurial women. This study assesses how the conditions characterising the COVID-19 induced lockdown affected the livelihoods of Small and Medium Enterprises (SMEs) entrepreneurial women in the Masvingo Province of Zimbabwe. The study reveals that COVID-19 lockdown in Zimbabwe was (and continues to be) marred with enforced restrictions on women in the informal sector. Women in the urban areas were the most affected. The vulnerability context among urban women was characterised by shock, stress and restlessness. Based on findings of this study, we advance that COVID-19 induced lockdown paralysed entrepreneurial women’s capital assets thereby militating against their self-sustenance, self-reliance and advancement. The closure of markets, mobility permits, corruption on COVID-19 relief cash transfer and subsidised mealie-meal worsened the entrepreneurial women’s shocks, stresses and restlessness. We therefore conclude that the impact of COVID-19 has not only compromised nations’ food security and health systems, but most importantly paralysed entrepreneurial women’s livelihoods, yet women in the African context, musha mukadzi – without a mother there is no home.

A qualitative exploration of the impact of COVID-19 on individuals with eating disorders in the UK

COVID-19 may have substantial impact on the mental health at a population level, but also has the potential to significantly affect those with pre-existing mental health difficulties such as eating disorders. This qualitative study explores the impact of COVID-19 and associated public health measures on adults with eating disorders within the UK. We conducted 10 in depth interviews with adults (24–38 years) with a self-reported eating disorder during lockdown. Data were analysed using an inductive thematic analysis approach. We identified core themes related to social restrictions (social isolation, changes in accountability to others, and increased responsibility for self and others), functional restrictions (lack of routine and structure, a need to intentionally plan activity, a desire for secrecy particularly around food shopping) and restrictions in access to mental health services. Overall, the impact of the lockdown was experienced as a catalyst for either increased disordered eating behaviours or for a drive for recovery, depending on individual circumstances going into these restrictions. This study is the first in depth interview approach with adults with mixed eating disorder presentations in the UK during COVID-19. Findings have important implications for post lockdown intervention care and practice.

Short-term and long-term health impacts of air pollution reductions from COVID-19 lockdowns in China and Europe: a modelling study

BackgroundExposure to poor air quality leads to increased premature mortality from cardiovascular and respiratory diseases. Among the far-reaching implications of the ongoing COVID-19 pandemic, a substantial improvement in air quality was observed worldwide after the lockdowns imposed by many countries. We aimed to assess the implications of different lockdown measures on air pollution levels in Europe and China, as well as the short-term and long-term health impact.MethodsFor this modelling study, observations of fine particulate matter (PM2·5) concentrations from more than 2500 stations in Europe and China during 2016–20 were integrated with chemical transport model simulations to reconstruct PM2·5 fields at high spatiotemporal resolution. The health benefits, expressed as short-term and long-term avoided mortality from PM2·5 exposure associated with the interventions imposed to control the COVID-19 pandemic, were quantified on the basis of the latest epidemiological studies. To explore the long-term variability in air quality and associated premature mortality, we built different scenarios of economic recovery (immediate or gradual resumption of activities, a second outbreak in autumn, and permanent lockdown for the whole of 2020).FindingsThe lockdown interventions led to a reduction in population-weighted PM2·5 of 14·5 μg m−3 across China (−29·7%) and 2·2 μg m−3 across Europe (−17·1%), with unprecedented reductions of 40 μg m−3 in bimonthly mean PM2·5 in the areas most affected by COVID-19 in China. In the short term, an estimated 24 200 (95% CI 22 380–26 010) premature deaths were averted throughout China between Feb 1 and March 31, and an estimated 2190 (1960–2420) deaths were averted in Europe between Feb 21 and May 17. We also estimated a positive number of long-term avoided premature fatalities due to reduced PM2·5 concentrations, ranging from 76 400 (95% CI 62 600–86 900) to 287 000 (233 700–328 300) for China, and from 13 600 (11 900–15 300) to 29 500 (25 800–33 300) for Europe, depending on the future scenarios of economic recovery adopted.InterpretationThese results indicate that lockdown interventions led to substantial reductions in PM2·5 concentrations in China and Europe. We estimated that tens of thousands of premature deaths from air pollution were avoided, although with significant differences observed in Europe and China. Our findings suggest that considerable improvements in air quality are achievable in both China and Europe when stringent emission control policies are adopted.FundingNone.

Anticipating the Novel Coronavirus Disease (COVID-19) Pandemic.

The COVID-19 outbreak was first declared an international public health, and it was later deemed a pandemic. In most countries, the COVID-19 incidence curve rises sharply over a short period of time, suggesting a transition from a disease-free (or low-burden disease) equilibrium state to a sustained infected (or high-burden disease) state. Such a transition is often known to exhibit characteristics of “critical slowing down.” Critical slowing down can be, in general, successfully detected using many statistical measures, such as variance, lag-1 autocorrelation, density ratio, and skewness. Here, we report an empirical test of this phenomena on the COVID-19 datasets of nine countries, including India, China, and the United States. For most of the datasets, increases in variance and autocorrelation predict the onset of a critical transition. Our analysis suggests two key features in predicting the COVID-19 incidence curve for a specific country: (a) the timing of strict social distancing and/or lockdown interventions implemented and (b) the fraction of a nation's population being affected by COVID-19 at that time. Furthermore, using satellite data of nitrogen dioxide as an indicator of lockdown efficacy, we found that countries where lockdown was implemented early and firmly have been successful in reducing COVID-19 spread. These results are essential for designing effective strategies to control the spread/resurgence of infectious pandemics.

The Effects of Easing and Tightening the Lock-Down Intervention on the Spread of COVID-19

A novel coronavirus (COVID-19) has affected more than 200 countries across the globe. It emerged in Wuhan, China in December 2019 and has been declared as a global pandemic by WHO. There are more than 20.2 million confirmed cases and 739 thousand deaths of the COVID-19 all around the world as of Aug 11, 2020. Each country has taken unprecedented measures in response to this outbreak. In this research we aim to estimate the effects of physical lockdown measure on the spread of the COVID-19 epidemic and how relaxation of this intervention affects the number of cases over time. We simulate the ongoing trajectory of an outbreak in four countries namely China, Italy, US, and Russia, using the susceptible - exposed - infected - critical - recovered - dead (SEICRD) model. We perform an extensive numerical study to assess the implication of different strategies and spread scenarios. Our projections show that the date lock-down starts, its duration, and proper implementation significantly impact the trajectory of the outbreak. We observe that 10 days delay in the lock-down may cause dramatic increase in the number of both infected and deceased cases. We also note that easing of the lockdown intervention before the number of cases decrease sufficiently may cause the second wave earlier than expected. Our findings indicate that the second wave has already started in US and the number of deaths are projected to be substantially higher than the first wave and will peak in late December, assuming that virus spread and fatality characteristics do not change.

Opening and closing the doors of the lockdown in Italy without forgetting lung cancer patients.

Coronavirus disease-19 (COVID-19) has rapidly spread to more than 200 countries all around the world, which are facing challenges in controlling its spread. The Italian Government initiated an unprecedented public health intervention to contain the epidemic by shutting down all people movements. Two weeks after the start of the lockdown period, the daily rate of patient admissions to hospitals significantly decreased. After 2 months, the quarantine progressively came to an end. A practical issue at this time is when and how the lockdown interventions should be relaxed since, without an effective vaccine, the general public still remains vulnerable. However, patient should not be placed at an increased risk of dying of lung cancer just to avoid COVID-19. Attention must be paid to all types of cancers and people should not hesitate to go to the hospital to be treated in time. All necessary actions should be taken by hospitals to minimize the risks of potential contagion, by designating differentiated routes and areas for patients potentially affected by COVID-19, while maintaining the highest standard of oncological care. If this ‘cancer amnesia’ situation persists, the mortality from lung neoplasms would far exceed that directly associated with the COVID-19 pandemic.

Influence of population mobility on the novel coronavirus disease (COVID-19) epidemic: based on panel data from Hubei, China

BackgroundThe novel coronavirus disease (COVID-19) was first reported in Wuhan, China. The mass population mobility in China during the Spring Festival has been considered a driver to the transmission of COVID-19, but it still needs more empirical discussion.MethodsBased on the panel data from Hubei, China between January 6th and February 6th, 2020, a random effects model was used to estimate the impact of population mobility on the transmission of COVID-19. Stata version 12.0 was used, and p < 0.05 was considered statistically significant.ResultsThe COVID-19 was more likely to be confirmed within 11–12 days after people moved from Wuhan to 16 other prefecture-level cities in Hubei Province, which suggests a period of 11–12 days from contact to being confirmed. The daily confirmed cases and daily increment in incidence in 16 prefecture-level cities show obvious declines 9–12 days post adaptation of city lockdown at the local level.ConclusionPopulation mobility is found to be a driver to the rapid transmission of COVID-19, and the lockdown intervention in local prefecture-level cities of Hubei Province has been an effective strategy to block the COVID-19 epidemic.

COVID-19 pandemic control: balancing detection policy and lockdown intervention under ICU sustainability

An extended SIR model, including several features of the recent COVID-19 outbreak, is considered: the infected and recovered individuals can either be detected or undetected and we also integrate an intensive care unit (ICU) capacity. We identify the optimal policy for controlling the epidemic dynamics using both lockdown and detection intervention levers, and taking into account the trade-off between the sanitary and the socio-economic cost of the pandemic, together with the limited capacity level of ICU. With parametric specification based on the COVID-19 literature, we investigate the sensitivities of various quantities on the optimal strategies. The optimal lockdown policy is structured into 4 phases: First a quick and strong lockdown intervention to stop the exponential growth of the contagion; second a short transition to reduce the prevalence of the virus; third a long period with full ICU capacity and stable virus prevalence; finally a return to normal social interactions with disappearance of the virus. The optimal scenario avoids the second wave of infection, provided the lockdown is released sufficiently slowly. Whenever massive resources are introduced to detect infected individuals, the pressure on social distancing can be released, whereas the impact of detection of immune individuals reveals to be more moderate.