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Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries.
BMJ. 2020 07 15; 370:m2743.BMJ

Abstract

OBJECTIVE

To evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally.

DESIGN

Natural experiment using interrupted time series analysis, with results synthesised using meta-analysis.

SETTING

149 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.

PARTICIPANTS

Individual 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 MEASURE

Incidence 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.

RESULTS

On 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).

CONCLUSIONS

Physical 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.

Authors+Show Affiliations

Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford OX3 7LF, UK nazrul.islam@ndph.ox.ac.uk. MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, USA.Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA.Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford OX3 7LF, UK.Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.Department of Mathematics and Statistics, Boston University, Boston, MA, USA.MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32669358

Citation

Islam, Nazrul, et al. "Physical Distancing Interventions and Incidence of Coronavirus Disease 2019: Natural Experiment in 149 Countries." BMJ (Clinical Research Ed.), vol. 370, 2020, pp. m2743.
Islam N, Sharp SJ, Chowell G, et al. Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries. BMJ. 2020;370:m2743.
Islam, N., Sharp, S. J., Chowell, G., Shabnam, S., Kawachi, I., Lacey, B., Massaro, J. M., D'Agostino, R. B., & White, M. (2020). Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries. BMJ (Clinical Research Ed.), 370, m2743. https://doi.org/10.1136/bmj.m2743
Islam N, et al. Physical Distancing Interventions and Incidence of Coronavirus Disease 2019: Natural Experiment in 149 Countries. BMJ. 2020 07 15;370:m2743. PubMed PMID: 32669358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries. AU - Islam,Nazrul, AU - Sharp,Stephen J, AU - Chowell,Gerardo, AU - Shabnam,Sharmin, AU - Kawachi,Ichiro, AU - Lacey,Ben, AU - Massaro,Joseph M, AU - D'Agostino,Ralph B,Sr AU - White,Martin, Y1 - 2020/07/15/ PY - 2020/7/17/entrez PY - 2020/7/17/pubmed PY - 2020/7/25/medline SP - m2743 EP - m2743 JF - BMJ (Clinical research ed.) JO - BMJ VL - 370 N2 - OBJECTIVE: To evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally. DESIGN: Natural experiment using interrupted time series analysis, with results synthesised using meta-analysis. SETTING: 149 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. PARTICIPANTS: Individual 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 MEASURE: Incidence 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. RESULTS: On 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). CONCLUSIONS: Physical 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. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/32669358/Physical_distancing_interventions_and_incidence_of_coronavirus_disease_2019:_natural_experiment_in_149_countries_ L2 - http://www.bmj.com/lookup/pmidlookup?view=long&pmid=32669358 DB - PRIME DP - Unbound Medicine ER -