key: cord-0875768-lfus1f8b
authors: Nabi, K. N.; Robiul, I. M.
title: HAS COUNTRYWIDE LOCKDOWN WORKED AS A FEASIBLE MEASURE IN BENDING THE COVID-19 CURVE IN DEVELOPING COUNTRIES?
date: 2020-06-24
journal: nan
DOI: 10.1101/2020.06.23.20138685
sha: a7e30306ef3592b23588ca50044fc3708c824d34
doc_id: 875768
cord_uid: lfus1f8b

In the absence of any effective vaccine and clinically proven treatment, experts thought that strict lockdown measures could be an effective way to slow down the spread of novel coronavirus. Despite the strict lockdown measures in several developing countries, the number of newly infected cases is getting unbridled as time progresses. This anomaly ignites questions about the effectiveness of the prolonged strict confinement measures. In light of the above view, with an aim to find the answer to this question, trends of four epidemiological parameters: growth factor of daily reported COVID-19 cases, daily incidence proportion, daily cumulative index and effective reproduction number in five developing countries named Bangladesh, Brazil, Chile, Pakistan and South Africa have been analysed meticulously considering the different phases of their national lockdowns. Any compelling evidence has not been found in favor of country-wide lockdown effectiveness in the above-mentioned countries. Numerical results illustrate that stringent nationwide lockdown measures have failed bringing the epidemic threshold (Re) of COVID-19 under unity. In addition, citizens of the aforementioned countries have been struggling with catastrophic socio-economic consequences due to prolonged confinement measures. Our study suggests that a new policy should be proposed for developing countries to battle against future disease outbreaks ensuring a perfect balance between saving lives and confirming livelihoods.

scarcity of medical equipment and diagnostic kits to identify the potential spreaders, 20 these countries failed to halt the initial outbreak of the virus Nabi (2020) . 21 In the absence of any effective vaccine and clinically established treatment, any 22 affected country could think of only two possible strategies to bring a control over the 23 pandemic at an early stage of the outbreak Gollier (2020) . Firstly, the entire population 24 could be exposed to the virus with an aim to develop herd immunity in the community 25 in a progressive way. However, in this way a targeted population (often elderly people) 26 could die which would be highly unethical. Another strategy could be to enforce non- With an aim to ensure smooth supply chains for essential services, most of the gov- 2 . 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)

The copyright holder for this preprint this version posted June 24, 2020. deaths. This seemingly ignites a fact that something went wrong in these developing 68 countries which requires broad-ranging research.

In light of the above view, the main objective of this study is to quantify the 

In this study, trends of four significant epidemiological metrics: growth factor (GF), 3 . 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)

The copyright holder for this preprint this version posted June 24, 2020. .

Growth factor (GF) of the daily infected cases of COVID-19 has been used in this study as an insightful metric to understand the progression of a outbreak in any country Tang & Wang, (2020). A 5-day moving average of the daily infected cases of COVID-19 has been applied to calculate the growth factor of daily infected cases. This can be estimated by taking the average of the values of the observing day data, the previous two days data and the future two days data. It has been found that the number daily reported COVID-19 cases is somewhat noisy and volatile due to inconsistent daily testing numbers. To generate a better realistic scenario in any developing country, the 5-day moving average of the daily confirmed cases has been used Ganyani et al., (2020) . The daily growth factor of COVID-19 new infections has been calculated using the following expression with an aim to understand the progression of the novel coronavirus in any country.

Growth Factor (r) = Today's reported cases of COVID-19 Yesterday's reported cases of COVID-19

For any country, r > 1 depicts that the trend curve of new infections blows up expo-91 nentially, whereas r < 1 represents that the same curve decays to zero.

Daily incidence proportion (DIP) is the next epidemiological risk measure which has been used to estimate the probability of developing disease in any country Lai et al., (2020a) and Lai et al., (2020b) . In an outbreak setting, from this estimation we can get a deeper understanding of disease progression as well as frequency of daily occurrence of new COVID-19 cases within a population as time progresses. It can also be referred as an attack rate or risk of developing any disease. As discussed earlier, a 5-day moving average of daily new infected cases has been used to calculate the DIP (per 1, 000, 000 per day) using the following expression: 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 June 24, 2020. . To quantify the transmissibility of an epidemic, effective reproduction number (R e ) can be regraded as one of the most insightful epidemiological parameters. This significant metric represents the average number of secondary infections caused by an individual who has the capability to transmit any disease in an entirely susceptible population Nabi (2020). To date, sophisticated statistical methods have been employed to estimate the value of R e precisely from the confirmed number of daily infected cases. Nevertheless, it is often really challenging to determine reliable estimates of R e from available information. In our study, disease generation interval which refers to the duration between symptom onset of the primary case and the symptom onset of the secondary case has been used to estimate the effective reproduction number ( . 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 June 24, 2020. Muslim festival (Eid-Ul-Fitr). It has been found in our study that the growth factor of 127 new infections followed a downward trend and reached 0.3 before the lockdown could 128 have been responsible for such decline (Fig. 1b) . Disease incubation period (around 5 129 days Nabi (2020)) should be considered in this regard to determine the earliest effect 130 of the imposed lockdown. Nevertheless, after five days of the lockdown a noticeable 131 upswing of growth factor has been developed and hovered between 1.66 and 2 for one 132 week (Fig. 1b) . On the last day of this lockdown phase, the number of cumulative (Table 1 ). In the second lockdown phase, it has been observed that the growth fac- force down the epidemic threshold below 1 (Fig. 1f) . When a strict two-month long (Table 2) . Galloping growths in both DIP and DCI were evident in 161 different lockdown periods (Figs. 2d and 2e) . Importantly, the effective reproduction 162 number could not be brought under unity (Fig. 2f) in spite of having more than two 163 months of lockdown (Table 2 ). 164 7 . 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 June 24, 2020. . https://doi.org/10.1101/2020.06.23.20138685 doi: medRxiv preprint 8 . 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 June 24, 2020. (Fig. 3b) . In addition, a sharp daily increase of 180 about 22% in growth factor was noticeable in this curfew period (Fig. 3b) . As of May 

. 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 June 24, 2020. . https://doi.org/10.1101/2020.06.23.20138685 doi: medRxiv preprint 

In Pakistan, a battle against the novel coronavirus has been started on February 26, 195 with the identification of two COVID-19 positive cases who returned from Iran which 196 was the worst-hit country at that time in Asian region Shahid (2020, February 27).

With an aim to stanch the pandemic outbreak, a strict nationwide lockdown was forced . 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 June 24, 2020. . https://doi.org/10.1101/2020.06.23.20138685 doi: medRxiv preprint in search of work as a significant number of people are dependent on daily wages.

As the pandemic began to cripple Pakistan's economy drastically, the government was 208 compelled to take the decision of unlockdown with effect from May 9 Gulf Today (2020, 209 May 9). Notably of all, in this unlockdown phase, it has been found in our analysis 210 that the growth factor maintain an incessant trend with the mean value of around 1.04 211 (95% CI: 1.02-1.06, SD: 0.06) which is much lower than the average values of both 212 the lockdown periods (Table 4 ). This enlightens that the highly debated unlockdown 213 policy has not brought any significant change in the growth factor of new infections 214 (Fig. 4c) . Moreover, Fig. 4f illustrates that the effective reproduction number also 215 plateaued during this unlockdown period (Mean: 1.19; 95% CI: 1.12-1.27) ( Table 4) . 

In South Africa, the National institute for communicable diseases (NICD) first con- growth rate began to soar and raised above 1 during this lockdown period (Table 5) . (Table 5 ). In a nutshell, a two-month long 238 11 . 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 June 24, 2020. . https://doi.org/10.1101/2020.06.23.20138685 doi: medRxiv preprint 12 . 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 June 24, 2020. . https://doi.org/10.1101/2020.06.23.20138685 doi: medRxiv preprint 

. 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)

The copyright holder for this preprint this version posted June 24, 2020. 

Coronavirus: Economy down, poverty up in Bangladesh

Pakistan lockdown idles factories-where orders had shriv-271 eled up

Serial Inter-275 val of COVID-19 among Publicly Reported Confirmed Cases. Emerging Infectious 276 Diseases

Estimating the generation interval for coronavirus disease (COVID-19) based 279 on symptom onset data

If the objective is herd immunity, on whom should it be 281 built? EconPol Europe Policy Brief

The impact 284 of COVID-19 partial lockdown on the air quality of the city of Rio de Janeiro, Brazil, 285 Science of The Total Environment

List of developing countries, International Congress of Qualitative Inquiry 287

Bangladesh to partly ease lockdown amid virus concerns

Demystifying the Math of the Coronavirus. 293 emphHarvard Business School Working Paper

Global epidemi-295 ology of coronavirus disease 2019 (COVID-19): disease incidence, daily cumulative 296 index, mortality, and their association with country healthcare resources and eco-297 nomic status

Global coronavirus disease 2019: 299 What has daily cumulative index taught us?

The positive impact of lockdown in Wuhan on containing 303 the COVID-19 outbreak in China

COVID-19 and the developing world, The Financial Express

Brazil lockdowns, attacked by Bolsonaro, begin to slip

Full lockdown policies in Western Europe countries have 312 no evident impacts on the COVID-19 epidemic

Informe Epidemiológico COVID-19

Bangladesh prepares for lockdown

Forecasting COVID-19 pandemic: A data-driven analysis

Serial interval of novel 323 coronavirus (COVID-19) infections

Coronavirus Source Data

Pakistan lifts lockdown amid jump in coronavirus cases, Gulf Today

Bangladesh confirms its first three cases of coronavirus

Ramaphosa announces 21 day coronavirus lockdown for South Africa

Mexico and parts of Brazil reopen after lockdown-341 despite surging coronavirus cases

Pakistan stays under lockdown amid coronavirus 345 outbreak

Two coronavirus cases confirmed in Pakistan

Chile announces nationwide nightly curfew, coronavirus 353 cases hit 632, National post

South African Ministry of Health

South Africa set to move toward easing lockdown restrictions, Voice of America News