Dataset Information

Impact of age-selective vs non-selective physical-distancing measures against coronavirus disease 2019: a mathematical modelling study.

ABSTRACT:

Background

There is a real possibility of successive COVID-19-epidemic waves with devastating consequences. In this context, it has become mandatory to design age-selective measures aimed at achieving an optimal balance between protecting public health and maintaining a viable economic activity.

Methods

We programmed a Susceptible, Exposed, Infected, Removed (SEIR) model in order to introduce epidemiologically relevant age classes into the outbreak-dynamics analysis. The model was fitted to the official death toll and calculated age distribution of deaths in Wuhan using a constrained linear least-squares algorithm. Subsequently, we used synthetic location-specific and age-structured contact matrices to quantify the effect of age-selective interventions both on mortality and on economic activity in Wuhan. For this purpose, we simulated four different scenarios ranging from an absence of measures to age-selective interventions with stronger physical-distancing measures for older individuals.

Results

An age-selective strategy could reduce the death toll by >30% compared with the non-selective measures applied during Wuhan's lockdown for the same workforce. Moreover, an alternative age-selective strategy could allow a 5-fold increase in the population working on site without a detrimental impact on the death toll compared with the Wuhan scenario.

Conclusion

Our results suggest that age-selective-distancing measures focused on the older population could have achieved a better balance between COVID-19 mortality and economic activity during the first COVID-19 outbreak in Wuhan. However, the implications of this need to be interpreted along with considerations of the practical feasibility and potential wider benefits and drawbacks of such a strategy.

SUBMITTER: Ortega-Quijano D

PROVIDER: S-EPMC7989432 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally.DesignNatural experiment using interrupted time series analysis, with results synthesised using meta-analysis.Setting149 countries or regions, with data on daily reported cases of covid-19 from the European Centre for Disease Prevention and Control and data on the physical distancing policies from the Oxford covid-19 Government Response Tracker.ParticipantsIndividual countries or regions that implemented one of the five physical distancing interventions (closures of schools, workplaces, and public transport, restrictions on mass gatherings and public events, and restrictions on movement (lockdowns)) between 1 January and 30 May 2020.Main outcome measureIncidence rate ratios (IRRs) of covid-19 before and after implementation of physical distancing interventions, estimated using data to 30 May 2020 or 30 days post-intervention, whichever occurred first. IRRs were synthesised across countries using random effects meta-analysis.ResultsOn average, implementation of any physical distancing intervention was associated with an overall reduction in covid-19 incidence of 13% (IRR 0.87, 95% confidence interval 0.85 to 0.89; n=149 countries). Closure of public transport was not associated with any additional reduction in covid-19 incidence when the other four physical distancing interventions were in place (pooled IRR with and without public transport closure was 0.85, 0.82 to 0.88; n=72, and 0.87, 0.84 to 0.91; n=32, respectively). Data from 11 countries also suggested similar overall effectiveness (pooled IRR 0.85, 0.81 to 0.89) when school closures, workplace closures, and restrictions on mass gatherings were in place. In terms of sequence of interventions, earlier implementation of lockdown was associated with a larger reduction in covid-19 incidence (pooled IRR 0.86, 0.84 to 0.89; n=105) compared with a delayed implementation of lockdown after other physical distancing interventions were in place (pooled IRR 0.90, 0.87 to 0.94; n=41).ConclusionsPhysical distancing interventions were associated with reductions in the incidence of covid-19 globally. No evidence was found of an additional effect of public transport closure when the other four physical distancing measures were in place. Earlier implementation of lockdown was associated with a larger reduction in the incidence of covid-19. These findings might support policy decisions as countries prepare to impose or lift physical distancing measures in current or future epidemic waves.

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