Top

BMC Public Health

Published in:

01-12-2021 | Coronavirus | Research article

Onset of effects of non-pharmaceutical interventions on COVID-19 infection rates in 176 countries

Authors: Ingo W. Nader, Elisabeth L. Zeilinger, Dana Jomar, Clemens Zauchner

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

During the initial phase of the global COVID-19 outbreak, most countries responded with non-pharmaceutical interventions (NPIs). In this study we investigate the general effectiveness of these NPIs, how long different NPIs need to be in place to take effect, and how long they should be in place for their maximum effect to unfold.

Methods

We used global data and a non-parametric machine learning model to estimate the effects of NPIs in relation to how long they have been in place. We applied a random forest model and used accumulated local effect (ALE) plots to derive estimates of the effectiveness of single NPIs in relation to their implementation date. In addition, we used bootstrap samples to investigate the variability in these ALE plots.

Results

Our results show that closure and regulation of schools was the most important NPI, associated with a pronounced effect about 10 days after implementation. Restrictions of mass gatherings and restrictions and regulations of businesses were found to have a more gradual effect, and social distancing was associated with a delayed effect starting about 18 days after implementation.

Conclusions

Our results can inform political decisions regarding the choice of NPIs and how long they need to be in place to take effect.

Available only for authorised users

WHO. Coronavirus disease 2019 (COVID-19) situation report 97. 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200426-sitrep-97-covid-19.pdf?sfvrsn=d1c3e800_6. Accessed 26 Apr 2020.

Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, et al. COVID-19: towards controlling of a pandemic. Lancet. 2020;395(10229):1015–8. https://doi.org/10.1016/S0140-6736(20)30673-5.CrossRefPubMedPubMedCentral

Nussbaumer-Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, et al. Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst Rev. 2020. https://doi.org/10.1002/14651858.CD013574.

Viner RM, Russell SJ, Croker H, Packer J, Ward J, Stansfield C, et al. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. Lancet Child Adolesc Health. 2020;4(5):397–404. https://doi.org/10.1016/S2352-4642(20)30095-X.CrossRefPubMedPubMedCentral

Maier BF, Brockmann D. Effective containment explains subexponential growth in recent confirmed COVID-19 cases in China. Science. 2020;368(6492):742–6. https://doi.org/10.1126/science.abb4557.CrossRefPubMedPubMedCentral

Prem K, Liu Y, Russell TW, Kucharski AJ, Eggo RM, Davies N, et al. The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study. Lancet Public Health. 2020;5(5):e261–70. https://doi.org/10.1016/S2468-2667(20)30073-6.CrossRefPubMedPubMedCentral

Lai S, Ruktanonchai NW, Zhou L, Prosper O, Luo W, Floyd JR, et al. Effect of non-pharmaceutical interventions to contain COVID-19 in China. Nature. 2020:1–5.

Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. JAMA. 2020;323(19):1915–23. https://doi.org/10.1001/jama.2020.6130.CrossRefPubMed

Hsiang S, Allen D, Annan-Phan S, Bell K, Bolliger I, Chong T, et al. The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature. 2020:1–9.

10.

Flaxman S, Mishra S, Gandy A, Unwin HJT, Mellan TA, Coupland H, et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature. 2020:1–5.

11.

Brauner JM, Mindermann S, Sharma M, Stephenson AB, Gavenčiak T, Johnston D, et al. The effectiveness of eight nonpharmaceutical interventions against COVID-19 in 41 countries. medRxiv. 2020:2020.05.28.20116129.

12.

Jung S, Akhmetzhanov AR, Hayashi K, Linton NM, Yang Y, Yuan B, et al. Real-time estimation of the risk of death from novel coronavirus (COVID-19) infection: inference using exported cases. J Clin Med. 2020;9(2):523. https://doi.org/10.3390/jcm9020523.CrossRefPubMedCentral

13.

Ma J. Estimating epidemic exponential growth rate and basic reproduction number. Infect Dis Model. 2020;5:129–41. https://doi.org/10.1016/j.idm.2019.12.009.CrossRefPubMedPubMedCentral

14.

Muniz-Rodriguez K, Chowell G, Cheung C-H, Jia D, Lai P-Y, Lee Y, et al. Doubling Time of the COVID-19 Epidemic by Chinese Province. medRxiv. 2020. https://doi.org/10.1101/2020.02.05.20020750.

15.

Cheng C, Barceló J, Hartnett AS, Kubinec R, Messerschmidt L. COVID-19 Government Response Event Dataset (CoronaNet v.1.0). Nat Hum Behav. 2020;4(7):756–68. https://doi.org/10.1038/s41562-020-0909-7.CrossRefPubMed

16.

Apley DW, Zhu J. Visualizing the effects of predictor variables in black box supervised learning models. ArXiv161208468 Stat. 2019. http://arxiv.org/abs/1612.08468. Accessed 20 Apr 2020.

17.

Molnar C. Interpretable Machine Learning. https://christophm.github.io/interpretable-ml-book/. Accessed 7 June 2021.

18.

R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for statistical Computing; 2020. https://www.R-project.org/.

19.

Lang M, Binder M, Richter J, Schratz P, Pfisterer F, Coors S, et al. mlr3: A modern object-oriented machine learning framework in R. J Open Source Softw. 2019;4:1903.CrossRef

20.

Wright MN, Ziegler A. ranger: A Fast Implementation of Random Forests for High Dimensional Data in C++ and R. J Stat Softw. 2017;77. https://doi.org/10.18637/jss.v077.i01.

21.

Molnar C. iml: An R package for Interpretable Machine Learning. J Open Source Softw. 2018;3:786.CrossRef

22.

Piburn J. Wbstats: programmatic access to the World Bank API. Oak Ridge, Tennessee: Oak Ridge National Laboratory; 2018. https://www.ornl.gov/division/csed/gist

23.

Wickham H. ggplot2: Elegant Graphics for Data Analysis. New York: Springer-Verlag; 2016. https://ggplot2.tidyverse.orgCrossRef

24.

Ferguson N, Laydon D, Nedjati Gilani G, Imai N, Ainslie K, Baguelin M, et al. Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand. Report. 2020. https://doi.org/10.25561/77482.

25.

Auger KA, Shah SS, Richardson T, Hartley D, Hall M, Warniment A, et al. Association between statewide school closure and COVID-19 incidence and mortality in the US. JAMA. 2020;324(9):859–70. https://doi.org/10.1001/jama.2020.14348.CrossRefPubMed

26.

Williams SN, Armitage CJ, Tampe T, Dienes K. Public perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic: a UK-based focus group study. BMJ Open. 2020;10(7):e039334. https://doi.org/10.1136/bmjopen-2020-039334.CrossRefPubMed

27.

Harper CA, Satchell LP, Fido D, Latzman RD. Functional Fear Predicts Public Health Compliance in the COVID-19 Pandemic. Int J Ment Heal Addict. 2020:1–14.

28.

Yuan J, Li M, Lv G, Lu ZK. Monitoring transmissibility and mortality of COVID-19 in Europe. Int J Infect Dis. 2020;95:311–5. https://doi.org/10.1016/j.ijid.2020.03.050.CrossRefPubMedPubMedCentral

29.

Rao ASRS, Vazquez JA. Identification of COVID-19 can be quicker through artificial intelligence framework using a mobile phone-based survey in the populations when cities/towns are under quarantine. Infect Control Hosp Epidemiol. 2020;41(7):826–30. https://doi.org/10.1017/ice.2020.61.CrossRef

30.

Fattorini D, Regoli F. Role of the chronic air pollution levels in the Covid-19 outbreak risk in Italy. Environ Pollut. 2020;264:114732. https://doi.org/10.1016/j.envpol.2020.114732.CrossRefPubMedPubMedCentral

31.

Wilder B, Charpignon M, Killian JA, Ou H-C, Mate A, Jabbari S, et al. Modeling between-population variation in COVID-19 dynamics in Hubei, Lombardy, and new York City. SSRN scholarly paper. Rochester: Social Science Research Network; 2020. https://doi.org/10.2139/ssrn.3564800.CrossRef

32.

Wright AL, Sonin K, Driscoll J, Wilson J. Poverty and economic dislocation reduce compliance with COVID-19 shelter-in-place protocols. In: SSRN scholarly paper. Rochester: Social Science Research Network; 2020. https://doi.org/10.2139/ssrn.3573637.CrossRef

33.

Dryhurst S, Schneider CR, Kerr J, Freeman ALJ, Recchia G, van der Bles AM, et al. Risk perceptions of COVID-19 around the world. J Risk Res. 2020:1–13.

34.

Tang JW. The effect of environmental parameters on the survival of airborne infectious agents. J R Soc Interface. 2009;6(suppl_6):S737–46.PubMedPubMedCentral

35.

WHO. Coronavirus disease 2019 (COVID-19) situation report 12 (Indonesia). 2020. https://www.who.int/docs/default-source/searo/indonesia/covid19/who-situation-report-12.pdf?sfvrsn=811c7f19_2. Accessed 28 July 2020.

36.

Tsang TK, Wu P, Lin Y, Lau EHY, Leung GM, Cowling BJ. Effect of changing case definitions for COVID-19 on the epidemic curve and transmission parameters in mainland China: a modelling study. Lancet Public Health. 2020;5(5):e289–96. https://doi.org/10.1016/S2468-2667(20)30089-X.CrossRefPubMedPubMedCentral

Title: Onset of effects of non-pharmaceutical interventions on COVID-19 infection rates in 176 countries
Authors: Ingo W. Nader
Elisabeth L. Zeilinger
Dana Jomar
Clemens Zauchner
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Coronavirus
COVID-19
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-11530-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Onset of effects of non-pharmaceutical interventions on COVID-19 infection rates in 176 countries

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Prevalence and associated factors of circadian rhythm sleep-wake disorders and insomnia among visually impaired Japanese individuals

An experience of mass administration of fractional dose inactivated polio vaccine through intradermal needle-free injectors in Karachi, Sindh, Pakistan

The role of managerial leadership in sickness absence in health and social care: antecedent or moderator in the association between psychosocial working conditions and register-based sickness absence? A longitudinal study based on a swedish cohort

The association between sleep duration and excess body weight of the American adult population: a cross-sectional study of the national health and nutrition examination survey 2015–2016

Mind the gap: what explains the rural-nonrural inequality in diarrhoea among under-five children in low and medium-income countries? A decomposition analysis

The little things are big: evaluation of a compassionate community approach for promoting the health of vulnerable persons