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Journal ArticleDOI

Evaluation of the effect of border closure on COVID-19 incidence rates across nine African countries: an interrupted time series study.

TL;DR: In this article, the effect of border closure on the incidence rate of COVID-19 across nine African countries was evaluated using the itsa function with ordinary least squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure.
Abstract: Background: Border closure is one of the policy changes implemented to mitigate against coronavirus disease 2019 (COVID-19). We evaluated the effect of border closure on the incidence rate of COVID-19 across nine African countries. Methods: An interrupted time series analysis was used to assess COVID-19 incidence rates in Egypt, Tunisia, Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Ghana, Nigeria, Senegal and South Africa (SA). Data were collected between 14 February and 19 July 2020 from online data repositories. The linear trend and magnitude of change were evaluated using the itsa function with ordinary least-squares regression in Stata with a 7-d deferred interruption point, which allows a period of diffusion post-border closure. Results: Overall, the countries recorded an increase in the incidence rate of COVID-19 after border closure. However, when compared with matched control groups, SA, Nigeria, Ghana, Egypt and Kenya showed a higher incidence rate trend. In contrast, Ethiopia, DRC and Tunisia showed a lower trend compared with their controls. Conclusions: The implementation of border closures within African countries had minimal effect on the incidence of COVID-19. The inclusion of other control measures such as enhanced testing capacity and improved surveillance activities will reveal the effectiveness of border closure measures.
Citations
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Journal ArticleDOI
18 Nov 2021-BMJ
TL;DR: A systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19 as mentioned in this paper.
Abstract: Objective To review the evidence on the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. Design Systematic review and meta-analysis. Data sources Medline, Embase, CINAHL, Biosis, Joanna Briggs, Global Health, and World Health Organization COVID-19 database (preprints). Eligibility criteria for study selection Observational and interventional studies that assessed the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. Main outcome measures The main outcome measure was incidence of covid-19. Secondary outcomes included SARS-CoV-2 transmission and covid-19 mortality. Data synthesis DerSimonian Laird random effects meta-analysis was performed to investigate the effect of mask wearing, handwashing, and physical distancing measures on incidence of covid-19. Pooled effect estimates with corresponding 95% confidence intervals were computed, and heterogeneity among studies was assessed using Cochran’s Q test and the I2 metrics, with two tailed P values. Results 72 studies met the inclusion criteria, of which 35 evaluated individual public health measures and 37 assessed multiple public health measures as a “package of interventions.” Eight of 35 studies were included in the meta-analysis, which indicated a reduction in incidence of covid-19 associated with handwashing (relative risk 0.47, 95% confidence interval 0.19 to 1.12, I2=12%), mask wearing (0.47, 0.29 to 0.75, I2=84%), and physical distancing (0.75, 0.59 to 0.95, I2=87%). Owing to heterogeneity of the studies, meta-analysis was not possible for the outcomes of quarantine and isolation, universal lockdowns, and closures of borders, schools, and workplaces. The effects of these interventions were synthesised descriptively. Conclusions This systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19. Public health efforts to implement public health measures should consider community health and sociocultural needs, and future research is needed to better understand the effectiveness of public health measures in the context of covid-19 vaccination. Systematic review registration PROSPERO CRD42020178692.

270 citations

Journal ArticleDOI
25 Jun 2021
TL;DR: In this article, a structured questionnaire containing 16 items was used to assess the attitude of health professionals on COVID-19 vaccine acceptance, and Bivariable and multivariable logistic analysis was done to identify factors associated with the attitude.
Abstract: Control of coronavirus disease through vaccination is not merely dependent on vaccine efficacy and safety. Professional and general public acceptance is vital for the successful control of the virus. This study aimed (1) to assess health professionals' attitude towards COVID-19 vaccine acceptance; (2) to identify factors associated with health professional’s attitude towards COVID-19 vaccine acceptance. An Institutional based cross-sectional study was conducted on health professionals working at Debre Tabor Comprehensive Specialized Hospital. A structured questionnaire containing 16 items was used to assess the attitude of health professionals on vaccine acceptance. Bivariable and multivariable logistic analysis was done to identify factors associated with the attitude of health professionals. In this study, 42.3% [95% CI (36.7–47.6)] participants had positive attitude to COVID-19 vaccine acceptance. Age 30–39 years [AOR 2.23; (CI 1.23–4.04)] and ≥ 40 years [AOR 5.51; (CI 2.47–12.30)] of respondents have positive attitude than their counterparts. Also physicians [AOR 3.67; (CI 1.90–7.09)], pharmacists [AOR 4.27; (CI 1.39–13.09)] and laboratory professionals [AOR 4.56; (CI 1.34–15.39)] have higher attitude to COVID vaccine acceptance than nurses. In conclusion, the attitude level of health professionals on COVID-19 vaccine acceptance was poor. Age and profession were factors significantly associated with the attitude level of health professionals for COVID-19 vaccine acceptance.

36 citations

Journal ArticleDOI
01 Jan 2021
TL;DR: In this paper, the Covid-19 pandemic provides a stark reminder of the political tensions associated with the field of immigration and health, highlighting the central role that nationalism, racism and xenophobia play in determining responses to communicable diseases.
Abstract: The Covid-19 pandemic provides a stark reminder of the political tensions associated with the field of immigration and health, highlighting the central role that nationalism, racism and xenophobia play in determining responses to communicable diseases. The blurring of global health, immigration governance, and the global health security agendas has long been recognised. However, an improved understanding of the politics influencing these entanglements, specifically within the context of the Covid-19 response in low- and middle-income country contexts, is urgently needed. This includes – but is not limited to – the immediate concerns surrounding inclusive social, political and medical responses to Covid-19; vaccine nationalism – at both global and national levels; and calls for ‘vaccine passports’. To this end, we draw on the Southern African Development Community (SADC) context – one associated with high levels of diverse population movements and a large burden of communicable diseases – to explore responses to Covid-19. We unpack tensions surrounding the management of migration and the ways in which sovereignty impacts attempts at building regional, coordinated responses to migration and health, and consider how this affects progress towards global health targets. With an initial focus on South Africa, we build on previous work exploring the blurring of global health, immigration governance, and the global health security agendas in SADC, and draw from ongoing research on the governance of migration and health within the region. This includes current and evolving research exploring migration and Covid-19, initiated in March 2020 when the first cases of Covid-19 were identified in Southern Africa. The aim is for these findings to catalyse a new and evolving researh agenda to inform the development and implementation of appropriate pandemic responses in a region associated with some of the highest levels of inequality globally. To this end, an evolving research agenda should be responsive to current needs. We suggest that, in SADC, priority research should focus on improving our understanding of (1) the political factors influencing the (dis)connections between migration and health governance structures in the context of Covid-19, and how to overcome these in the context of a pandemic; and (2) the motivations for and implications of a ‘vaccine passport’ system on movement within and beyond the SADC region. This requires a reactive, cross-disciplinary, regional research network. In a context where funding for research is increasingly inaccessible, this requires innovative, informal, collaborative engagement.

16 citations

Journal ArticleDOI
25 Jun 2021
TL;DR: In this paper, the authors compared the effectiveness of COVID-19 control policies on the virus's spread and on the change of the infection dynamics in China, Germany, Austria, and the USA relying on a regression discontinuity in time and epidemic models.
Abstract: This study compares the effectiveness of COVID-19 control policies on the virus’s spread and on the change of the infection dynamics in China, Germany, Austria, and the USA relying on a regression discontinuity in time and ‘earlyR’ epidemic models. The effectiveness of policies is measured by real-time reproduction number and cases counts. Comparison between the two lockdowns within each country showed the importance of people's risk perception for the effectiveness of the measures. Results suggest that restrictions applied for a long period or reintroduced later may cause at-tenuated effect on the circulation of the virus and the number of casualties.

9 citations

Journal ArticleDOI
06 Apr 2022-PLOS ONE
TL;DR: In this article, the authors investigated the effect of lockdown policy on Covid-19 third wave implemented by the province of Ontario, Canada, on April 3rd 2021, followed by a stay-at-home order on April 7th 2021 while free vaccination were in progress.
Abstract: The Covid-19 global pandemic that began in March 2020 was not fully mitigated through governmental Non-Pharmaceutical Interventions (NPIs) and continued to infect people and take lives through 2021. Since many countries were affected by the second, third, and fourth waves of Covid-19, governments extended and strengthened NPIs, but these actions led to citizen protests and fatigue. In this study, we investigate the effect of a lockdown policy on Covid-19 third wave implemented by the province of Ontario, Canada, on April 3rd 2021, followed by a stay-at-home order on April 7th 2021 while free Covid-19 testing and vaccination were in progress. Herein, the effect of both NPIs and vaccination are considered simultaneously. We used the prevalence of Covid-19 cases, tests, and administered vaccines data reported publicly by the Government of Ontario on their website. Because mobility changes can reflect the behaviors and adherence of residents with a stay-at-home order, Covid-19 community mobility data for Ontario provided by Google was also considered. A statistical method called interrupted time series was used to analyze the data. The results indicated that, although vaccinations helped to control the Covid-19 infection rate during this time, the stay-at-home order caused a rate reduction by decreasing the trend of the Covid-19 prevalence by 13 (±0.8962) persons per million daily and the level by 33 (±7.6854) persons per million. Furthermore, the stay-at-home order resulted in approximately a 37% reduction in Covid-19 prevalence one week after the intervention’s effective date. Therefore, Ontario’s strict lockdown policy, including several NPIs, mitigated the Covid-19 surge during the third wave. The results show that even when vaccination is in progress, strict NPIs such as lockdown is required to control Covid-19 waves, and early re-openings should be avoided. These results may also be useful for other countries that have implemented delayed vaccination schedules.

6 citations

References
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Journal ArticleDOI
TL;DR: The results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases.
Abstract: Using news reports and press releases from provinces, regions, and countries outside Wuhan, Hubei province, China, this analysis estimates the length of the incubation period of COVID-19 and its pu...

5,215 citations

Journal ArticleDOI
06 Mar 2020-Science
TL;DR: The results suggest that early detection, hand washing, self-isolation, and household quarantine will likely be more effective than travel restrictions at mitigating this pandemic, and sustained 90% travel restrictions to and from mainland China only modestly affect the epidemic trajectory unless combined with a 50% or higher reduction of transmission in the community.
Abstract: Motivated by the rapid spread of coronavirus disease 2019 (COVID-19) in mainland China, we use a global metapopulation disease transmission model to project the impact of travel limitations on the national and international spread of the epidemic. The model is calibrated on the basis of internationally reported cases and shows that, at the start of the travel ban from Wuhan on 23 January 2020, most Chinese cities had already received many infected travelers. The travel quarantine of Wuhan delayed the overall epidemic progression by only 3 to 5 days in mainland China but had a more marked effect on the international scale, where case importations were reduced by nearly 80% until mid-February. Modeling results also indicate that sustained 90% travel restrictions to and from mainland China only modestly affect the epidemic trajectory unless combined with a 50% or higher reduction of transmission in the community.

2,949 citations

01 Jan 2020
TL;DR: Globally, as of 10,47am CEST, 28 May 2020, there have been 5,556,679 confirmed cases of COVID-19, including 351,866 deaths, reported to WHO.
Abstract: Globally, as of 10:47am CEST, 28 May 2020, there have been 5,556,679 confirmed cases of COVID-19, including 351,866 deaths, reported to WHO

2,785 citations

Journal ArticleDOI
TL;DR: This tutorial uses a worked example to demonstrate a robust approach to ITS analysis using segmented regression and describes the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders.
Abstract: Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design.

1,778 citations

Journal ArticleDOI
TL;DR: A significantly decreased growth rate and increased doubling time of cases was observed, which is most likely due to Chinese lockdown measures, which seem to have a potential to slow down the spread of COVID-19.
Abstract: BACKGROUND With its epicenter in Wuhan, China, the COVID-19 outbreak was declared a Public Health Emergency of International Concern by the World Health Organization (WHO). Consequently, many countries have implemented flight restrictions to China. China itself has imposed a lockdown of the population of Wuhan as well as the entire Hubei province. However, whether these two enormous measures have led to significant changes in the spread of COVID-19 cases remains unclear. METHODS We analyzed the available data on the development of confirmed domestic and international COVID-19 cases before and after lockdown measures. We evaluated the correlation of domestic air traffic to the number of confirmed COVID-19 cases and determined the growth curves of COVID-19 cases within China before and after lockdown as well as after changes in COVID-19 diagnostic criteria. RESULTS Our findings indicate a significant increase in doubling time from 2 days (95% CI: 1.9-2.6) to 4 days (95% CI: 3.5-4.3), after imposing lockdown. A further increase is detected after changing diagnostic and testing methodology to 19.3 (95% CI: 15.1-26.3), respectively. Moreover, the correlation between domestic air traffic and COVID-19 spread became weaker following lockdown (before lockdown: r = 0.98, P < 0.05 vs after lockdown: r = 0.91, P = NS). CONCLUSIONS A significantly decreased growth rate and increased doubling time of cases was observed, which is most likely due to Chinese lockdown measures. A more stringent confinement of people in high risk areas seems to have a potential to slow down the spread of COVID-19.

982 citations