key: cord-0947337-a31oe7kc
authors: Wong, Martin; Huang, Junjie; Teoh, Jeremy; Wong, Sunny
title: Evaluation on different non-pharmaceutical interventions during COVID-19 pandemic: an analysis of 139 countries
date: 2020-06-21
journal: J Infect
DOI: 10.1016/j.jinf.2020.06.044
sha: 1a18a38944a57b809c6fe317a02bc42edc6e07ef
doc_id: 947337
cord_uid: a31oe7kc

nan

effectiveness to mitigate the COVID-19 pandemic is yet to be testified in real-life settings and in different countries.

We noticed an opportunity to examine the impact of these NPIs by a recently released index. The University of Oxford has developed an Oxford COVID-19 Government Response Tracker (OxCGRT) to offer a systematic way to follow the stringency of government responses to the pandemic across countries and time [2] . The Stringency Index consists of school closure (C1); workplace closure (C2); public event cancellation (C3); restrictions on gathering size (C4); public transport closure (C5); staying at home requirements (C6); restrictions on internal movement (C7); restrictions on international travel (C8); and public information campaigns (H1). We examined if the stringency of these containment measures could potentially reduce the number of confirmed infections.

We extracted the rate of increase in cumulative incidence for each country between 15 April to 30 April, 2020 from the COVID-19 data repository of the Johns Hopkins Centre for Systems Science and Engineering [3] . We computed the average of all stringency indices for each nation on or before 31 March 2020. A 14-day window period was applied between the closing date of the stringency index and the starting date of incidence change by making reference to recent literature [4] , and was determined by a panel of epidemiologists, physicians and public health practitioners. A linear regression model was constructed to examine the association between average stringency index and increase in incidence of COVID-19 cases as the outcome variable.

We controlled for the Gross Domestic Product (GDP) [5] and the population density of each country as potential confounders [6] .

The distribution of the Government response stringency index in various countries shows its increase over time (01 March, 2020 to 31, March 2020) [7] , probably due to the increase in incidence in this period. In multivariaable regression analysis of data in 139 countries (Table 1) , a higher stringency index was significantly associated with lower incidence increase between 15

April to 30 April, 2020 (β coefficient -0.03, 95% C.I. -0.05 to -0.01, p=0.014). Three indicators also showed an inverse association with incidence increase, namely "School closing" (β coefficient -0.53, 95% C.I. -1.00 to -0.06, p=0.027), "Workplace Closing" (β coefficient -0.56, 95% C.I. -1.06 to -0.06, p=0.028) and "Public Information campaign with public officials urging caution about COVID-19" (β coefficient -0.71, 95% C.I. -1.31 to -0.12, p=0.028). There are no interactions or multicollinearity detected among the predictors.

The findings of this study showed that more stringent containment and control measures could potentially lead to better COVID-19 pandemic control. In particular, closure of schools and workplace was found to be influential in mitigation of the disease. Stopping schools and workplace attendance involves a substantial number of students and employees, and this could represent a significant containment measure that exerted material effects on the disease incidence. In addition, public information campaign urging caution against COVID-19 was reported to be effective. This highlights the importance of communication among various stakeholders in the community during a pandemic [8] .

One limitation of the study included the absence of control for some cofounders like personal hygienic measures, testing capability [9] and the government's public health resources [10] .

Also, our results represent preliminary findings that should be further examined by large-scale confirmatory studies. We recommend future evaluations to explore the effectiveness of these containment strategies in relation to different global health capacities in different countries.

We declared no conflict of interests.

None.

The study was approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (SBRE-19-592). 

Modelling SARS-COV2 Spread in London: Approaches to Lift the Lockdown

Variation in Government responses to COVID-19

The 2019 Novel Coronavirus COVID-19 (2019-nCoV) data repository by Johns Hopkins Centre for Systems Science and Engineering (CSSE). Available at

The Incubation Period of Coronavirus Disease

COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

Countries by density by population 2020

Coronavirus government response tracker

Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic

Strengthening early testing and surveillance of COVID-19 to enhance identification of asymptomatic patients

The potential impact of vulnerability and coping capacity on the pandemic control of COVID-19