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Heterogeneity in the Effectiveness of Non-pharmaceutical Interventions During the First SARS-CoV2 Wave in the United States.

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Date
2021-01
Authors
Pan, William K
Fernández, Daniel
Tyrovolas, Stefanos
Iago, Giné-Vázquez
Dasgupta, Rishav Raj
Zaitchik, Benjamin F
Lantos, Paul M
Woods, Christopher W
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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 article
Subject
SARS-CoV-2
United States
doubling time
mortality rate
non-pharmaceutical intervention (NPI)
Permalink
https://hdl.handle.net/10161/24163
Published Version (Please cite this version)
10.3389/fpubh.2021.754696
Publication 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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Scholars@Duke

Lantos

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
Pan

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
Woods

Christopher Wildrick Woods

Professor of Medicine
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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