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Abstract

Background

Non-pharmaceutical interventions (NPIs) were implemented worldwide to control the spread of SARS-CoV-2.

Aim

To evaluate the impact of tiered NPIs and a nationwide lockdown on reduction of COVID-19 incidence during the second and third epidemic waves in Portugal.

Methods

Surveillance data on laboratory-confirmed COVID-19 cases were used to conduct an interrupted time series analysis to estimate changes in daily incidence during a second wave tiered NPI period (9 November–18 December 2020), and a third wave lockdown period without (15–21 January 2021) and with school closure (22 January–10 February 2021).

Results

Significant changes in trends were observed for the overall incidence rate; declining trends were observed for tiered NPIs (−1.9% per day; incidence rate ratio (IRR): 0.981; 95% confidence interval (CI): 0.973–0.989) and a lockdown period without (−3.4% per day; IRR: 0.966; 95% CI: 0.935–0.998) and with school closure (−10.3% per day, IRR: 0.897; 95% CI: 0.846–0.951). Absolute effects associated with tiered NPIs and a lockdown on a subsequent 14-day period yielded 137 cases and 437 cases per 100,000 population potentially averted, respectively.

Conclusion

Our results indicate that tiered NPIs implemented during the second wave caused a decline in COVID-19 incidence, although modest. Moreover, a third wave lockdown without school closure was effective in reducing COVID-19 incidence, but the addition of school closure provided the strongest effect. These findings emphasise the importance of early and assertive decision-making to control the pandemic.

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2022-06-09
2024-12-24
/content/10.2807/1560-7917.ES.2022.27.23.2100497
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References

  1. Our World in Data. COVID-19: Government Stringency Index. [Accessed: 12 Feb 2021]. Available from: https://ourworldindata.org/grapher/covid-stringency-index
  2. Decreto do Presidente da República Portuguesa n.º 14-A/2020. [Decree of the President of the Portuguese Republic nº 14-A/2020. 18 March 2020]. Lisbon: Diário da República; 2020. Portuguese. Available from: https://dre.pt/dre/detalhe/decreto-presidente-republica/14-a-2020-130399862
  3. World Health Organization (WHO). Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19. Geneva: WHO. [Accessed: 31 Dec 2020]. Available from: https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19
  4. República Portuguesa XXII Governo. Relatório sobre a aplicação da declaração do estado de emergência de 9 a 23 de novembro de 2020. [Report on the application of the declaration of the state of emergency: 9-23 november, 2020]. Lisbon: 2020. Portuguese. Available from: https://www.portugal.gov.pt/pt/gc22/comunicacao/documento?i=relatorio-sobre-a-aplicacao-da-declaracao-do-estado-de-emergencia
  5. Statistics Portugal (INE). COVID-19: uma leitura do contexto demográfico e da expressão territorial da pandemia. [COVID-19: a reading on the demographic context and territorial expression of the pandemic]. Lisbon: INE; 2021. Portuguese. Available from: https://www.ine.pt/ngt_server/attachfileu.jsp?look_parentBoui=503581337&att_display=n&att_download=y
  6. Askitas N, Tatsiramos K, Verheyden B. Estimating worldwide effects of non-pharmaceutical interventions on COVID-19 incidence and population mobility patterns using a multiple-event study. Sci Rep. 2021;11(1):1972.  https://doi.org/10.1038/s41598-021-81442-x  PMID: 33479325 
  7. Della Rossa F, Salzano D, Di Meglio A, De Lellis F, Coraggio M, Calabrese C, et al. A network model of Italy shows that intermittent regional strategies can alleviate the COVID-19 epidemic. Nat Commun. 2020;11(1):5106.  https://doi.org/10.1038/s41467-020-18827-5  PMID: 33037190 
  8. Ricoca Peixoto V, Vieira A, Aguiar P, Carvalho C, Rhys Thomas D, Abrantes A. Initial Assessment of the impact of the emergency state lockdown measures on the 1st wave of the COVID-19 epidemic in Portugal. Acta Med Port. 2020;33(11):733-41.  https://doi.org/10.20344/amp.14129  PMID: 33160423 
  9. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348-55. PMID: 27283160 
  10. Directorate General of Health Portugal (DGS). COVID-19 status report. [Accessed: 9 Mar 2021]. Available from: https://covid19.min-saude.pt
  11. National Institute of Health Doutor Ricardo Jorge. Covid-19: epidemic curve and transmissibility parameters. [Accessed: 9 Mar 2021]. Available from: http://www.insa.min-saude.pt/category/areas-de-atuacao/epidemiologia/covid-19-curva-epidemica-e-parametros-de-transmissibilidade
  12. Statistics Portugal. Estimates of resident population. [Accessed: 7 Jan 2021]. Available from: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&contecto=pi&indOcorrCod=0008273&selTab=tab0&xlang=pt
  13. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299-309.  https://doi.org/10.1046/j.1365-2710.2002.00430.x  PMID: 12174032 
  14. Google. COVID-19 Community mobility reports. [Accessed: 9 Mar 2021]. Available from: https://www.google.com/covid19/mobility
  15. Imai C, Armstrong B, Chalabi Z, Mangtani P, Hashizume M. Time series regression model for infectious disease and weather. Environ Res. 2015;142:319-27.  https://doi.org/10.1016/j.envres.2015.06.040  PMID: 26188633 
  16. Brumback BA, Ryan LM, Schwartz JD, Neas LM, Stark PC, Burge HA. Transitional regression models, with application to environmental time series. J Am Stat Assoc. 2000;95(449):16-27.  https://doi.org/10.1080/01621459.2000.10473895 
  17. McAloon C, Collins Á, Hunt K, Barber A, Byrne AW, Butler F, et al. Incubation period of COVID-19: a rapid systematic review and meta-analysis of observational research. BMJ Open. 2020;10(8):e039652.  https://doi.org/10.1136/bmjopen-2020-039652  PMID: 32801208 
  18. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2017. Available from: https://www.R-project.org
  19. Portuguese Institute for Sea and Atmosphere (IPMA). Boletim Climatológico, Janeiro 2021. [Climatological Bulletin, January 2021]. IPMA: Lisbon. [Accessed: 9 Mar 2021]. Available from: https://www.ipma.pt/resources.www/docs/im.publicacoes/edicoes.online/20210211/aPfaiebjulFVnnmyDJPz/cli_20210101_20210131_pcl_mm_co_pt.pdf
  20. Davies NG, Barnard RC, Jarvis CI, Russell TW, Semple MG, Jit M, et al. , Centre for Mathematical Modelling of Infectious Diseases COVID-19 Working Group, ISARIC4C investigators. Association of tiered restrictions and a second lockdown with COVID-19 deaths and hospital admissions in England: a modelling study. Lancet Infect Dis. 2021;21(4):482-92.  https://doi.org/10.1016/S1473-3099(20)30984-1  PMID: 33357518 
  21. Ge J, He D, Lin Z, Zhu H, Zhuang Z. Four-tier response system and spatial propagation of COVID-19 in China by a network model. Math Biosci. 2020;330(October):108484.  https://doi.org/10.1016/j.mbs.2020.108484  PMID: 33039365 
  22. Borges V, Sousa C, Menezes L, Gonçalves AM, Picão M, Almeida JP, et al. Tracking SARS-CoV-2 lineage B.1.1.7 dissemination: insights from nationwide spike gene target failure (SGTF) and spike gene late detection (SGTL) data, Portugal, week 49 2020 to week 3 2021. Euro Surveill. 2021;26(10):1-6.  https://doi.org/10.2807/1560-7917.ES.2021.26.10.2100130  PMID: 33706862 
  23. Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA). Diversidade genética do novo coronavírus SARS-CoV-2 (COVID-19) em Portugal. [Genetic diversity of the novel coronavirus SARS-CoV-2 (COVID-19) in Portugal]. Lisbon: INSA. [Accessed: 9 Mar 2021]. Portuguese. Available from: https://insaflu.insa.pt/covid19
  24. 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  PMID: 32745200 
  25. Kislaya I, Gonçalves P, Barreto M, Sousa R, Garcia AC, Matos R, et al. Seroprevalence of SARS-CoV-2 infection in Portugal in May-July 2020: results of the first national serological survey (ISNCOVID-19). Acta Med Port. 2021;34(2):87-94.  https://doi.org/10.20344/amp.15122  PMID: 33641702 
  26. Di Domenico L, Pullano G, Coletti P, Hens N, Colizza V. Expected impact of school closure and telework to mitigate COVID-19 epidemic in France. Epic. Lab, vol. 15, 2020. Available from: https://www.epicx-lab.com/uploads/9/6/9/4/9694133/inserm_covid-19-school-closure-french-regions_20200313.pdf
  27. Zanettini C, Omar M, Dinalankara W, Imada EL, Colantuoni E, Parmigiani G, et al. Influenza vaccination and COVID19 mortality in the USA: An Ecological Study. Vaccines (Basel). 2021;9(5):427.  https://doi.org/10.3390/vaccines9050427  PMID: 33923159 
  28. Wu Y, Jing W, Liu J, Ma Q, Yuan J, Wang Y, et al. Effects of temperature and humidity on the daily new cases and new deaths of COVID-19 in 166 countries. Sci Total Environ. 2020;729:139051.  https://doi.org/10.1016/j.scitotenv.2020.139051  PMID: 32361460 
  29. Notari A. Temperature dependence of COVID-19 transmission. Sci Total Environ. 2021;763:144390.  https://doi.org/10.1016/j.scitotenv.2020.144390  PMID: 33373782 
  30. Günther F, Bender A, Katz K, Küchenhoff H, Höhle M. Nowcasting the COVID-19 pandemic in Bavaria. Biom J. 2021;63(3):490-502.  https://doi.org/10.1002/bimj.202000112  PMID: 33258177 
  31. Moran C, Campbell DJT, Campbell TS, Roach P, Bourassa L, Collins Z, et al. Predictors of attitudes and adherence to COVID-19 public health guidelines in Western countries: a rapid review of the emerging literature. J Public Health (Oxf). 2021;43(4):739-53.  https://doi.org/10.1093/pubmed/fdab070  PMID: 33704456 
Impact of stringent non-pharmaceutical interventions applied during the second and third COVID-19 epidemic waves in Portugal, 9 November 2020 to 10 February 2021: an ecological study
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Ana+Rita+Torres&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Torres Ana Rita</a>, <a href="/search?value1=Ana+Paula+Rodrigues&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rodrigues Ana Paula</a>, <a href="/search?value1=Mafalda+Sousa-Uva&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sousa-Uva Mafalda</a>, <a href="/search?value1=Irina+Kislaya&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kislaya Irina</a>, <a href="/search?value1=Susana+Silva&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Silva Susana</a>, <a href="/search?value1=Liliana+Antunes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Antunes Liliana</a>, <a href="/search?value1=Carlos+Dias&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dias Carlos</a>, <a href="/search?value1=Baltazar+Nunes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nunes Baltazar</a></span>. Impact of stringent non-pharmaceutical interventions applied during the second and third COVID-19 epidemic waves in Portugal, 9 November 2020 to 10 February 2021: an ecological study. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(23):pii=2100497. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.23.2100497" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.23.2100497</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 21 Mar 2021;&nbsp;&nbsp; <span class="generated">Accepted</span>: 21 Jan 2022 </span> </p>
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