A tale of lockdown policies on the transmission of COVID-19 within and between Chinese cities: A study based on heterogeneous treatment effect.

During the early outbreak phase of COVID-19 in China, lockdowns prevailed as the only available policy tools to mitigate the spread of infection. To evaluate the impact of lockdown policies in the context of the first phase of COVID-19 pandemic, we leverage data on daily confirmed cases per million people and related characteristics of a large set of cities. The study analyzed 369 Chinese cities, among which 188 implemented lockdowns of varying severity levels from January 23 to March 31, 2020. We use nationwide Baidu Mobility data to estimate the impact of lockdown policies on mitigating COVID-19 cases through reducing human mobility. We adopt a heterogeneous treatment effect model to quantify the effect of lockdown policies on containing confirmed case counts. Our results suggest that lockdowns substantially reduced human mobility, and larger reduction in mobility occurred within-city compared to between-city. The COVID-19 daily confirmed cases per million people decreased by 9% - 9.2% for every ten-percentage point fall in within-city travel intensity in t+7 timeframe. We also find that one city's lockdowns can effectively reduce the spillover cases of the traveler's destination cities. We find no evidence that stricter lockdowns are more effective at mitigating COVID-19 risks. Our findings provide practical insights about the effectiveness of NPI during the early outbreak phase of the unprecedented pandemic.

The impacts of a global pandemic on the efficacy and stability of contemporary wildlife conservation: South Africa as a case study.

Conservationists speculated on potential benefits to wildlife of lockdown restrictions because of the COVID-19 pandemic but voiced concern that restrictions impeded nature conservation. We assessed the effects of lockdown restrictions on biodiversity conservation in South Africa, a biodiverse country with economic inequality and reliance on wildlife resources. We solicited expert opinion using the IUCN's Threats Classification Scheme to structure a questionnaire and illustrated responses with individual case studies from government parastatal and non-governmental conservation organisations. The most highly reported threats were biological resource use, residential/commercial developments, invasive species, and human intrusions. The trends reported by 90 survey respondents were supported by case studies using environmental compliance data from parastatal conservation organisations. Lack of tourism revenue and funding were cited as hindrances to conservation. Mechanisms to prevent environmental degradation in the face of global emergencies must be implemented and 'ring-fenced' to ensure conservation is not a casualty during future global crises.

Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff.

BACKGROUND: In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools. METHODS: We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared. RESULTS: Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities. CONCLUSIONS: Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

System dynamics analysis of COVID-19 prevention and control strategies.

The COVID-19 pandemic now affects the entire world and has many major effects on the global economy, environment, health, and society. Focusing on the harm COVID-19 poses for human health and society, this study used system dynamics to establish a prevention and control model that combines material supply, public opinion dissemination, public awareness, scientific and technological research, staggered work shifts, and the warning effect (of law/policy). Causal loop analysis was used to identify interactions between subsystems and explore the key factors affecting social benefit. Further, different scenarios were dynamically simulated to explore optimal combination modes. The main findings were as follows: (1) The low supervision mode will produce a lag effect and superimposed effect on material supply and impede social benefit. (2) The strong supervision mode has multiple performances; it can reduce online public opinion dissemination and the rate of concealment and false declaration and improve government credibility and social benefit. However, a fading effect will appear in the middle and late periods, and over time, the effect of strong supervision will gradually weaken (but occasionally rebound) and thus require adjustment. These findings can provide a theoretical basis for improving epidemic prevention and control measures.

Effects of mobility restrictions during COVID19 in Italy.

To reduce the spread and the effect of the COVID-19 global pandemic, non-pharmaceutical interventions have been adopted on multiple occasions by governments. In particular lockdown policies, i.e., generalized mobility restrictions, have been employed to fight the first wave of the pandemic. We analyze data reflecting mobility levels over time in Italy before, during and after the national lockdown, in order to assess some direct and indirect effects. By applying methodologies based on percolation and network science approaches, we find that the typical network characteristics, while very revealing, do not tell the whole story. In particular, the Italian mobility network during lockdown has been damaged much more than node- and edge-level metrics indicate. Additionally, many of the main Provinces of Italy are affected by the lockdown in a surprisingly similar fashion, despite their geographical and economic dissimilarity. Based on our findings we offer an approach to estimate unavailable high-resolution economic dimensions, such as real time Province-level GDP, based on easily measurable mobility information.

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study.

BACKGROUND: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. METHODS: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. FINDINGS: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. INTERPRETATION: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. FUNDING: National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.

Association of Jail Decarceration and Anticontagion Policies With COVID-19 Case Growth Rates in US Counties.

Importance: Mass incarceration is known to foster infectious disease outbreaks, amplification of infectious diseases in surrounding communities, and exacerbation of health disparities in disproportionately policed communities. To date, however, policy interventions intended to achieve epidemic mitigation in US communities have neglected to account for decarceration as a possible means of protecting public health and safety. Objective: To evaluate the association of jail decarceration and government anticontagion policies with reductions in the spread of SARS-CoV-2. Design, Setting, and Participants: This cohort study used county-level data from January to November 2020 to analyze COVID-19 cases, jail populations, and anticontagion policies in a panel regression model to estimate the association of jail decarceration and anticontagion policies with COVID-19 growth rates. A total of 1605 counties with data available on both jail population and COVID-19 cases were included in the analysis. This sample represents approximately 51% of US counties, 72% of the US population, and 60% of the US jail population. Exposures: Changes to jail populations and implementation of 10 anticontagion policies: nursing home visitation bans, school closures, mask mandates, prison visitation bans, stay-at-home orders, and closure of nonessential businesses, gyms, bars, movie theaters, and restaurants. Main Outcomes and Measures: Daily COVID-19 case growth rates. Results: In the 1605 counties included in this study, the mean (SD) prison population was 283.38 (657.78) individuals, and the mean (SD) population was 315.24 (2151.01) persons per square mile. An estimated 80% reduction in US jail populations, achievable through noncarceral management of nonviolent alleged offenses and in line with average international incarceration rates, would have been associated with a 2.0% (95% CI, 0.8%-3.1%) reduction in daily COVID-19 case growth rates. Jail decarceration was associated with 8 times larger reductions in COVID-19 growth rates in counties with above-median population density (4.6%; 95% CI, 2.2%- 7.1%) relative to those below this median (0.5%; 95% CI, 0.1%-0.9%). Nursing home visitation bans were associated with a 7.3% (95% CI, 5.8%-8.9%) reduction in COVID-19 case growth rates, followed by school closures (4.3%; 95% CI, 2.0%-6.6%), mask mandates (2.5%; 95% CI, 1.7%-3.3%), prison visitation bans (1.2%; 95% CI, 0.2%-2.2%), and stay-at-home orders (0.8%; 95% CI, 0.1%-1.6%). Conclusions and Relevance: Although many studies have documented that high incarceration rates are associated with communitywide health harms, this study is, to date, the first to show that decarceration is associated with population-level public health benefits. Its findings suggest that, among other anticontagion interventions, large-scale decarceration and changes to pretrial detention policies are likely to be important for improving US public health, biosecurity, and pandemic preparedness.

Domestic Violence Police Reporting and Resources During the 2020 COVID-19 Stay-at-Home Order in Chicago, Illinois.

Importance: Domestic violence (DV) has become a growing public health concern during the COVID-19 pandemic because individuals may be sheltering in place with abusers and facing mounting economic and health-related stresses. Objective: To analyze associations of the 2020 COVID-19 stay-at-home (SH) order with DV police reporting and resource availability, including differences by community area racial/ethnic composition. Design, Setting, and Participants: This longitudinal cohort study assessed DV police reports (January-June 2020) obtained from the Chicago, Illinois, Police Department and DV resource availability (March and August 2020) obtained from the NowPow community resource database, both for 77 community areas in Chicago. Data were analyzed July through December 2020. Exposures: The COVID-19 SH order effective March 21, 2020. Main Outcomes and Measures: Monthly rates of DV police reports and DV resource availability per 100 000 persons. Results: Of 77 community areas in Chicago, 28 (36.4%) were majority Black, 19 (24.7%) majority Hispanic/Latinx, 18 (23.4%) majority White, and 12 (15.6%) a different or no majority race/ethnicity, representing an estimated population of 2 718 555 individuals. For each community area, the SH order was associated with a decrease in the rate of DV police reports by 21.8 (95% CI, -30.48 to -13.07) crimes per 100 000 persons per month relative to the same months in 2019. Compared with White majority community areas, Black majority areas had a decrease in the rate of DV police reports by 40.8 (95% CI, -62.93 to -18.75) crimes per 100 000 persons per month relative to the same months in 2019. The SH order was also associated with a decrease in DV resource availability at a rate of 5.1 (95% CI, -7.55 to -2.67) resources per 100 000 persons, with the largest decreases for mental health (-4.3 [95% CI, -5.97 to -2.66] resources per 100 000 persons) and personal safety (-2.4 [95% CI, -4.40 to -0.41] resources per 100 000 persons). The Black majority south side of Chicago had a larger decrease in resource availability (-6.7 [95% CI, -12.92 to -0.46] resources per 100 000 persons) than the White majority north side. Conclusions and Relevance: In this longitudinal cohort study, the rate of DV police reports decreased after the SH order was implemented in Chicago. This decrease was largely observed in Black majority communities, whereas there was no significant change in White majority communities. These findings may reflect decreased DV incidence but may also reflect an exacerbation of underreporting. In addition, DV resource availability decreased disproportionately on the predominantly Black south side of Chicago.

COVID Border Accountability Project, a hand-coded global database of border closures introduced during 2020.

Quantifying the timing and content of policy changes affecting international travel and immigration is key to ongoing research on the spread of SARS-CoV-2 and the socioeconomic impacts of border closures. The COVID Border Accountability Project (COBAP) provides a hand-coded dataset of >1000 policies systematized to reflect a complete timeline of country-level restrictions on movement across international borders during 2020. Trained research assistants used pre-set definitions to source, categorize and verify for each new border policy: start and end dates, whether the closure is "complete" or "partial", which exceptions are made, which countries are banned, and which air/land/sea borders were closed. COBAP verified the database through internal and external audits from public health experts. For purposes of further verification and future data mining efforts of pandemic research, the full text of each policy was archived. The structure of the COBAP dataset is designed for use by social and biomedical scientists. For broad accessibility to policymakers and the public, our website depicts the data in an interactive, user-friendly, time-based map.

Analysis of the Effects of COVID-19 Mask Mandates on Hospital Resource Consumption and Mortality at the County Level.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas. METHODS: We used publicly reported county-level data to perform a mixed-methods before-and-after analysis along with other sources of public data for analyses of covariance. We used a least-squares regression analysis to adjust for confounders. A Texas state-level mask order was issued on July 3, 2020, followed by a Bexar County-level order on July 15, 2020. We defined the control period as June 2 to July 2 and the postmask order period as July 8, 2020-August 12, 2020, with a 5-day gap to account for the median incubation period for cases; longer periods of 7 and 10 days were used for hospitalization and ICU admission/death, respectively. Data are reported on a per-100,000 population basis using respective US Census Bureau-reported populations. RESULTS: From June 2, 2020 through August 12, 2020, there were 40,771 reported cases of COVID-19 within Bexar County, with 470 total deaths. The average number of new cases per day within the county was 565.4 (95% confidence interval [CI] 394.6-736.2). The average number of positive hospitalized patients was 754.1 (95% CI 657.2-851.0), in the ICU was 273.1 (95% CI 238.2-308.0), and on a ventilator was 170.5 (95% CI 146.4-194.6). The average deaths per day was 6.5 (95% CI 4.4-8.6). All of the measured outcomes were higher on average in the postmask period as were covariables included in the adjusted model. When adjusting for traffic activity, total statewide caseload, public health complaints, and mean temperature, the daily caseload, hospital bed occupancy, ICU bed occupancy, ventilator occupancy, and daily mortality remained higher in the postmask period. CONCLUSIONS: There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate.

Community engagement in the prevention and control of COVID-19: Insights from Vietnam.

INTRODUCTION: Community engagement (CE) is an effective public health strategy for improving health outcomes. There is limited published knowledge about effective approaches to CE in ensuring effective responses to COVID-19 throughout lockdowns, travel restrictions and social distancing. In this paper, we contribute to bridging this gap by highlighting experience of CE in Vietnam, specifically focusing on migrant workers in Vietnam. METHODS: A cross-sectional qualitative study design was used with qualitative data collection was carried out during August-October 2020. Two districts were purposefully selected from two large industrial zones. Data was collected using in-depth interviews (n = 36) with individuals and households, migrants and owners of dormitories, industrial zone factory representatives, community representatives and health authorities. Data was analyzed using thematic analysis approach. The study received ethics approval from the Hanoi University Institutional Review Board. RESULTS: The government's response to COVID-19 was spearheaded by the multi-sectoral National Steering Committee for the Prevention and Control of COVID-19, chaired by the Vice Prime Minister and comprised different members from 23 ministries. This structure was replicated throughout the province and local levels and all public and private organizations. Different activities were carried out by local communities, following four key principles of infection control: early detection, isolation, quarantine and hospitalization. We found three key determinants of engagement of migrant workers with COVID-19 prevention and control: availability of resources, appropriate capacity strengthening, transparent and continuous communication and a sense of trust in government legitimacy. DISCUSSION AND CONCLUSION: Our results support the current literature on CE in infection control which highlights the importance of context and suggests that future CE should consider five key components: multi-sectoral collaboration with a whole-of-community approach to strengthen governance structures with context-specific partnerships; mobilization of resources and decentralization of decision making to encourage self-reliance and building of local capacity; capacity building through training and supervision to local institutions; transparent and clear communication of health risks and sensitization of local communities to improve compliance and foster trust in the government measures; and understanding the urgent needs ensuring of social security and engaging all parts of the community, specifically the vulnerable groups.

Feats, Flops, and Free Lessons From NZ's Response to the COVID-19 Pandemic.

Beginning from the first reports of COVID-19 out of China, this article provides a commentary on the actions taken by the Government of New Zealand in terms of nine themes-a national response with an elimination goal, speed, and comprehensiveness of the initial response; an evidence-based, science-led approach, prioritised on protecting lives; effective communication; leadership style which appealed to collective responsibility and attempted to de-politicise the Government's response to the virus; flexibility of response characterised by 'learning as you go'; oversight of coercive state powers, including a pragmatic response which attempted to defuse conflict and reserved use of 'hard power' to a last resort; deployment of public health interventions, and health system adaptations; the impact on Maori and marginalised communities; and economic protection and stimulus-to identify factors that might help explain why New Zealand's pandemic response was successful and those which could have been managed better. The partially successful legal challenge brought to the four-and-a half week lockdown, the most stringent in the world, in Borrowdale v Director-General of Health, is also considered.

Mitigation strategies and compliance in the COVID-19 fight; how much compliance is enough?

The U.S. with only 4% of the world's population, bears a disproportionate share of infections in the COVID-19 pandemic. To understand this puzzle, we investigate how mitigation strategies and compliance can work together (or in opposition) to reduce (or increase) the spread of COVID-19 infection. Building on the Oxford index, we create state-specific stringency indices tailored to U.S. conditions, to measure the degree of strictness of public mitigation measures. A modified time-varying SEIRD model, incorporating this Stringency Index as well as a Compliance Indicator is then estimated with daily data for a sample of 6 U.S. states: New York, New Hampshire, New Mexico, Colorado, Texas, and Arizona. We provide a simple visual policy tool to evaluate the various combinations of mitigation policies and compliance that can reduce the basic reproduction number to less than one, the acknowledged threshold in the epidemiological literature to control the pandemic. Understanding of this relationship by both the public and policy makers is key to controlling the pandemic. This tool has the potential to be used in a real-time, dynamic fashion for flexible policy options. Our methodology can be applied to other countries and has the potential to be extended to other epidemiological models as well. With this first step in attempting to quantify the factors that go into the "black box" of the transmission factor ß, we hope that our work will stimulate further research in the dual role of mitigation policies and compliance.