key: cord-0705668-z00jfvm2 authors: Cuellar, L.; Torres, I.; Romero-Severson, E. O.; Mahesh, R.; Ortega, N.; Pungitore, S.; Ke, R.; Hengartner, N. title: Assessing the Impact of Human Mobility to Predict Regional Excess Death in Ecuador date: 2021-05-22 journal: nan DOI: 10.1101/2021.05.19.21257056 sha: fd35777ad3d9dc909083e7a435661927e4579db0 doc_id: 705668 cord_uid: z00jfvm2 COVID-19 outbreaks have had high mortality in low- and medium-income countries such as Ecuador. Human mobility is an important factor influencing the spread of diseases possibly leading to a high burden of disease at the country level. Drastic control measures, such as complete lockdown are effective epidemic controls, yet in practice, one hopes that a partial shutdown would suffice. It is an open problem to determine how much mobility can be allowed while controlling an outbreak. In this paper, we use statistical models to relate human mobility to the excess death in Ecuador while controlling for demographic factors. The mobility index provided by GRANDATA, based on mobile phone users, represents the change of number of out-of-home events with respect to a benchmark date (March 2nd, the first date the data is available). The study confirms the global trend that more men are dying than expected compared to women, and that people under 30 show less deaths than expected. Specifically, individuals in the age groups younger than 20, we found have their death rate reduced during the pandemic between 22% and 27% of the expected deaths in the absence of COVID-19. The weekly median mobility time series shows a sharp decrease in human mobility immediately after a national lockdown was declared on March 17, 2020 and a progressive increase towards the pre-lockdown level within two months. Relating median mobility to excess death shows a lag in its effect: first, a decrease in mobility in the previous two to three weeks decreases the excess death and more novel, we found that an increase of mobility variability four weeks prior, increases the number of excess deaths. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 22, 2021 E c u a d o r w e r e c l o s e d o n M a r c h 1 3 t h , a n d o n M a r c h 1 7 t h , E c u a d o r i m p l e m e n t e d a n a t i o n a l l o c k d o w n . B o t h o f t h e s e m e a s u r e s d e c r e a s e t h e s p r e a d o f t h e d i s e a s e b y r e d u c i n g c o n t a c t s b e t w e e n i n f e c t e d a n d s u s c e p t i b l e i n d i v i d u a l s . I t i s p o s s i b l e t o m e a s u r e t h e c o m p l i a n c e t o t h e s e o r d e r s b y t r a c k i n g h u m a n m o b i l i t y d e r i v e d f r o m c e l l p h o n e d a t a . I n t h i s p a p e r , w e e m p i r i c a l l y a d d r e s s t h e h y p o t h e s i s t h a t a r e d u c t i o n i n m o b i l i t y p r e d i c t s a d e c r e a s e i n t h e f u t u r e n u m b e r o f C O V I D -1 9 c a s e s a n d d e a t h s . Q u a n t i f y i n g t h e s e v e r i t y o f t h e o u t b r e a k i n E c u a d o r i s c h a l l e n g i n g . D u e t o l i m i t e d t e s t i n g , t h e r e p o r t e d d a i l y c o u n t s o f C O V I D -1 9 i n c i d e n c e a n d d e a t h u n d e r e s t i m a t e t h e t r u e m a g n i t u d e o f t h e o u t b r e a k . E x c e s s d e a t h , w h i c h c o m p a r e s t o t a l n u m b e r o f o b s e r v e d d e a t h s t o t h e e x p e c t e d n u m b e r o f d e a t w o r s t a f f e c t e d b y t h e p a n d e m i c , h a v e m o r e t h a n 2 0 0 % m o r e d e a t h s t h a n e x p e c t e d , w i t h t h e h i g h e s t p e a k s i n l a t e M a r c h a n d e a r l y A p r i l r e a c h i n g b e t w e e n a 1 2 t o 1 5 -f o l d m o r e d e a t h s t h a n e x p e c t e d . A s f o r d e m o g r a p h i c s , w e f o u n d s i m i l a r p a t t e r n s t o t h o s e o b s e r v e d i n o t h e r c o u n t r i e s , f o r e x a m p l e w e f o u n d t h a t t h a t m e n h a d a d e a t h r a t e 1 8 3 % o f t h e e x p e c t e d v a l u e , w h i l e t h e r a t e i n w o m e n w a s 1 5 3 % o f e x p e c t e d d e a t h s ; a n d e v e n t h o u g h w e f i n d t h a t e x c e s s d e a t h i n c r e a s e d w i t h a g e , t h e g r o u p m o s t l y a f f e c t e d i s t h e [ 6 0 , 7 0 ) a g e g r o u p w i t h a d e a t h r a t e 2 3 3 % o f t h e e x p e c t e d v a l u e , w h i l e t h e a g e g r o u p w i t h p e o p l e o l d e r t h a n 8 0 , t h a t h a d a d e a t h r a t e 1 6 0 % o f t h e e x p e c t e d l e v e l . F i n a l l y , w e f o u n d t h a t t h e i n d i g e n o u s e t h n i c g r o u p w a s d i s p r o p o r t i o n a l l y a f f e c t e d w i t h a d e a t h r a t e 2 2 0 % m o r e t h a n e x p e c t e d c o m p a r e d t o 1 3 6 % f o r t h e m e s t i z o ' s g r o u p , t h e m o s t p r e v a l e n t e t h n i c g r o u p i n E c u a d o r . I n t h i s p a p e r , w e i n v e s t i g a t e t h e t e m p o r a l d y n a m i c o f e x c e s s d e a t h s w i t h i n e a c h p r o v i n c e i n E c u a d o r , a n d i n v e s t i g a t e h o w t h a t d y n a m i c i s l i n k e d t o h u m a n m o b i l i t y c h a r a c t e r i s t i c s d e r i . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 22, 2021 e , t y -. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 22, 2021. H i s t o r i c a l d e a t h r e c o r d s f r o m 2 0 1 5 -2 0 1 9 f o r a l l -c a u s e m o r t a l i t y w e r e o b t a i n e d f r o m t h e E c u a d o r i a n N a t i o n a l I n s t i t u t e o f S t a t i s t i c s a n d C e n s u s . F o r e a c h i n d i v i d u a l , t h e r e c o r d s i n c l u d e d a t e o f d e a t h , a g e , s e x , a n d e t h n i c i t y o f t h e d i s e a s e d , p l a c e o f d e a t h r e g i s t r a t i o n , r e s i d e n c e , a n d t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n o f D i s e a s e ( I C D ) c o d e f o r t h e c a u s e o f d e a t h . T G i v e n t h e s h i f t i n g d e l a y o f t h e o u t b r e a k i n e a c h p r o v i n c e , w e c h o s e t o m o d e l e a c h p r o v i n c e s e p a r a t e l y . O n a v e r a g e , a d e a t h f r o m C O V I D -1 9 i s e s t i m a t e d t o o c c u r t w o t o e i g h t w e e k s a f t e r i n f e c t i o n [ 4 5 ] . T o e x p l o r e t h e e f f e c t o f t h i s d e l a y , w e c o m p u t e d t h e c r o s s -c o r r e l a t i o n b e t w e e n t h e t i m e s e r i e s o f t h e E D F a n d t h e m o b i l i t y s t a t i s t i c s . T h a t i s , w e c a l c u l a t e d t h e c o r r e l a t i o n b e t w e e n t h e E D F i n a g i v e n w e . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 22, 2021 n s o m e o f t h e p r o v i n c e s , s u c h a s G u a y a s , P i c h i n c h a , a n d M a n a b í , m a i n t a i n e d a l o w e r m o b i l i t y t h a n b e f o r e t h e l o c k d o w n , w h i l e t h e p o p u l a t i o n i n o t h e r p r o v i n c e s , s u c h a s B o l i v a r a n d N a p o , t h e m o b i l i t y r e t u r n e d t o , o r e v e n e x c e e d e d , t h e l e v e l p r i o r t o t h e l o c k d o w n . f . t h e e . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 22, 2021 T h e s e f o u r s t a t e s w e r e c h o s e n b e c a u s e t h e y a r e a r c h e t y p e s o f w h e n t h e y r e a c h e d t h e i r p e a k o f E D F w i t h r e s p e c t t o l o c k d o w n p e r i o d . F o r G u a y a s , t h e l o c k d o w n s t a r t e d t o o l a t e t o i m p a c t t h e E D F p e a k , f o r M a n a b í , t h e l o c k d o w n h a d l i k e l y a p a r t i a l e f f e c t o n t h e t i m i n g a n d m a g n i t u d e o f t h e p e a k , a n d b o t h P i c h i n c h a a n d S a n t o D o m i n g o a r e e x a m p l e s o f p e a k s o c c u r r i n g w e l l a f t e r t h e l o c k d o w n e n d e d . T h e d i f f e r e n c e b e t w e e n t h e s e t w o p r o v i n c e s i s t h e p a t t e r n o f p o p u l a t i o n m o b i l i t y . I n P i c h i n c . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 22, 2021 T h e x -a x i s r e p r e s e n t s t h e l a g , t h e d i f f e r e n c e i n w e e k s , b e t w e e n t h e m o b i l i t y s t a t i s t i c a n d t h e E D F . A l a g o f z e r o ( r i g h t m o s t p o i n t ) m e a n s t h e c o r r e l a t i o n i s t a k e n b e t w e e n E D F a n d t h e m o b i l i t y s t a t i s t i c i n t h e s a m e w e e k , w h e r e a s a l a g o f -2 c o r r e s p o n d s t o a c o r r e l a t i o n b e t w e e n E D F a n d t h e m o b i l i t y s t a t i s t i c f o r t w o w e e k s p r i o r . T h e c o l o r s i n d i c a t e p o s i t i v e ( g r e is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 22, 2021. ; L o o k i n g a t t h e p l o t o f t h e c r o s s -c o r r e l a t i o n f o r t h e m e d i a n i n t h e A p p e n d i x , w e s e e t h e d e s c r i b e d p a t t e r n r e p e a t f o r a l l p r o v i n c e s , d i v i d i n g t h e m i n t o p r o v i n c e s w h o s e o u t b r e a k w a s a l r e a d y i n p r o g r e s s a t t h e t i m e o f t h e l o c k d o w n , a n d t h o s e w h o s e o u t b r e a k e m e r g e d a f t e r t h e l o c k d o w n . T h e i n t e r p r e t a t i o n f o r t h e v a r i a b i l i t y s t a t i s t i c s i s h a r d e r . L o o k i n g a t c r o s s c o r r e l a t i o n p l o t f o r t e g r e s s i o n a n a l y s i s T h e r e g r e s s i o n a n a l y s i s i m p r o v e s u p o n t h e c r o s s -c o r r e l a t i o n i n t h a t i t a l l o w s t o c o n t r o l f o r a g e g r o u p a n d s e x , c o n s i d e r s t h e j o i n t b e h a v i o r o f a s e t o f e x p l a n a t o r y v a r i a b l e s , a n d a l l o w s m o d e l s e l e c t i o n . T h e l a t t e r h e l p s i d e n t i f y w h i c h e x p l a n a t o r y v a r i a b l e s a r e s t a t i s t i c a l l y s i g n i f i c a n . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 22, 2021 . T a b l e 1 M u l t i p l i e r f o r t h e e x p e c t e d e x c e s s d e a t h f a c t o r f r o m a 1 0 % d e c r e a s e o f m o b i l i t y s t a t i s t i c s L a g s J u r i s d i c t i o n M e d i a n I Q R % V a r . E x p l a i n e d L a g 2 L a g 3 L a g 4 L a g 2 L a g 3 L a g . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) [32] Pepe, E., Bajardi, P., Gauvin, L., Privitera, F., Lake, B., Cattuto, C., and Tizzoni, M. (2020). Covid-19 outbreak response: a first assessment of mobility changes in italy following national lockdown. medRxiv. [ https://www.defensa.gob.ec/wpcontent/uploads/downloads/2020/03/Decreto_presidencial_No_1017_17-Marzo-2020.pdf Estimating the burden of COVID-19 on mortality, life expectancy and lifespan inequality in England and Wales: A population-level study Measuring excess mortality during the COVID-19 pandemic in low-and lower-middle income countries: the need for mobile phone surveys Linking excess mortality to Google mobility data during the COVID-19 pandemic in England and Wales Sex differential in COVID-19 mortality varies markedly by age COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries Economic and Social Consequences of Human Mobility Restrictions Under COVID-19 Aggregated mobility data could help fight COVID-19 Ecuador confirma el primer caso de coronavirus en el país Coordination Platform for refugees and migrants from Venezuela Coronavirus tracked: the latest figures as countries start to reopen Régression avec Rm 2e édition In-depth spatial, temporal and demographic analyses of excess deaths reveal true impact of COVID-19 on mortality in Ecuador Travelling waves in the occurrence of dengue haemorrhagic fever in Thailand Subsistema de Vigilancia SIVE-Alerta enfermedades transmitidas por vectores Ecuador. Subsecretaria Nacional de Vigilancia de la Salud Pública Direcciún Nacional de Vigilancia Epidemiol$cute{ ext{o}}$gica. Weeks 1 to 26 Suspensión de las actividades académicas para los estudiantes para precautelar la salud de la comunidad educativa Senescyt suspende actividades universitarias a nivel nacional; Espol dará clases virtuales; PUCE suspende clases Bodies lie in the streets of Guayaquil, Ecuador, emerging epicenter of the coronavirus in Latin America The use of mobile phone data to inform analysis of COVID-19 pandemic epidemiology John Hopking COVID-19 tracking project The effect of human mobility and control measures on the COVID-19 epidemic in China Impact of COVID-19 Temporal dynamics in total excess mortality and COVID-19 deaths in Italian cities Evaluating Data Types: A Guide for Decision Makers using Data to Understand the Extent and Spread of COVID-19 Demographic, jurisdictional, and spatial effects on social distancing in the United States during the COVID-19 pandemic Health at a Glance: Latin America and the Caribbean 2020 Health at a Glance: Latin America and the Caribbean 2020 Mobile phone data for informing public health actions across the COVID-19 pandemic life cycle Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study Excess Deaths Associated with COVID-19, by Age and Race and Ethnicity -United States Identifying malaria transmission foci for elimination using human mobility data High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis Excess mortality during the COVID-19 outbreak in Italy: a two-stage interrupted time-series analysis Estimation of excess deaths associated with the COVID-19 pandemic in the United States Quantifying the impact of human mobility on malaria Commentary: containing the Ebola outbreak -the potential and challenge of mobile network data Impact of human mobility on the emergence of dengue epidemics in Pakistan Connecting mobility to infectious diseases: the promise and limits of mobile phone data Measles outbreak risk in Pakistan: exploring the potential of combining vaccination coverage and incidence data with novel data-streams to strengthen control WHO. Report of the WHO-China Joint Mission on Coronavirus Disease Travel and the emergence of infectious diseases Excess deaths from COVID-19 and other causes Mortality and Morbidity: The Measure of a Pandemic