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Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States.
Abstract
Background: Attempts to quantify effect sizes of non-pharmaceutical interventions (NPI) to control
COVID-19 in the US have not accounted for heterogeneity in social or environmental
factors that may influence NPI effectiveness. This study quantifies national and sub-national
effect sizes of NPIs during the early months of the pandemic in the US. Methods: Daily county-level COVID-19 cases and deaths during the first wave (January 2020
through phased removal of interventions) were obtained. County-level cases, doubling
times, and death rates were compared to four increasingly restrictive NPI levels.
Socio-demographic, climate and mobility factors were analyzed to explain and evaluate
NPI heterogeneity, with mobility used to approximate NPI compliance. Analyses were
conducted separately for the US and for each Census regions (Pacific, Mountain, east/West
North Central, East/West South Central, South Atlantic, Middle Atlantic and New England).
A stepped-wedge cluster-randomized trial analysis was used, leveraging the phased
implementation of policies. Results: Aggressive (level 4) NPIs were associated with slower COVID-19 propagation, particularly
in high compliance counties. Longer duration of level 4 NPIs was associated with lower
case rates (log beta -0.028, 95% CI -0.04 to -0.02) and longer doubling times (log
beta 0.02, 95% CI 0.01-0.03). Effects varied by Census region, for example, level
4 effects on doubling time in Pacific states were opposite to those in Middle Atlantic
and New England states. NPI heterogeneity can be explained by differential timing
of policy initiation and by variable socio-demographic county characteristics that
predict compliance, particularly poverty and racial/ethnic population. Climate exhibits
relatively consistent relationships across Census regions, for example, higher minimum
temperature and specific humidity were associated with lower doubling times and higher
death rates for this period of analysis in South Central, South Atlantic, Middle Atlantic,
and New England states. Conclusion and Relevance: Heterogeneity exists in both the effectiveness of NPIs across US Census regions and
policy compliance. This county-level variability indicates that control strategies
are best designed at community-levels where policies can be tuned based on knowledge
of local disparities and compliance with public health ordinances.
Type
Journal articlePermalink
https://hdl.handle.net/10161/24163Published Version (Please cite this version)
10.3389/fpubh.2021.754696Publication Info
Pan, William K; Fernández, Daniel; Tyrovolas, Stefanos; Iago, Giné-Vázquez; Dasgupta,
Rishav Raj; Zaitchik, Benjamin F; ... Woods, Christopher W (2021). Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the
First SARS-CoV2 Wave in the United States. Frontiers in public health, 9. pp. 754696. 10.3389/fpubh.2021.754696. Retrieved from https://hdl.handle.net/10161/24163.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Paul Michael Lantos
Professor of Medicine
I am interested in the spatial epidemiology of infectious diseases. My research utilizes
geographic information systems (GIS) and geostatistical analyses to understand the
spatial and spatiotemporal distribution of diseases, and their relationship with environmental
and demographic factors. I currently have active studies evaluating the spatial distribution
of numerous domestic and international infectious diseases, including SARS-CoV-2 (COVID-19),
cytomegalovirus, influenza, and Lyme disease. A
William Kuang-Yao Pan
Elizabeth Brooks Reid and Whitelaw Reid Associate Professor
William Pan, PhD, Assistant Professor of Global Environmental Health, joined the faculty
at Duke in 2011. He holds a joint appointment at DGHI and the Nicholas School of Environment,
and is Adjunct Assistant Professor in the Department of International Health at Johns
Hopkins Bloomberg School of Public Health. Pan’s research interests focuses on Population,
Health, and Environmental interactions in developing countries, with particular interest
in translational research directed toward sus
Christopher Wildrick Woods
Wolfgang Joklik Distinguished Professor of Global Health
1. Emerging Infections 2. Global Health 3. Epidemiology of infectious diseases
4. Clinical microbiology and diagnostics 5. Bioterrorism Preparedness 6. Surveillance
for communicable diseases 7. Antimicrobial resistance
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