Reducing societal impacts of SARS-CoV-2 interventions through subnational implementation

  1. Mark M Dekker
  2. Luc E Coffeng
  3. Frank P Pijpers
  4. Debabrata Panja  Is a corresponding author
  5. Sake J de Vlas
  1. Utrecht University, Netherlands
  2. Erasmus MC, Netherlands
  3. University of Amsterdam, Netherlands

Abstract

To curb the initial spread of SARS-CoV-2, many countries relied on nation-wide implementation of non-pharmaceutical intervention measures, resulting in substantial socio-economic impacts. Potentially, subnational implementations might have had less of a societal impact, but comparable epidemiological impact. Here, using the first COVID-19 wave in the Netherlands as a case in point, we address this issue by developing a high-resolution analysis framework that uses a demographically-stratified population and a spatially-explicit, dynamic, individual contact-pattern based epidemiology, calibrated to hospital admissions data and mobility trends extracted from mobile phone signals and Google. We demonstrate how a subnational approach could achieve similar level of epidemiological control in terms of hospital admissions, while some parts of the country could stay open for a longer period. Our framework is exportable to other countries and settings, and may be used to develop policies on subnational approach as a better strategic choice for controlling future epidemics.

Data availability

Data associated with mobility and mixing reductions (Google mobility and PIENTER) [17, 34], age-stratified mixing matrices used in the analysis (POLYMOD) [9], and hospital admission data (NICE) publicly available as described in SI A.5, have been made available at the Data Repository https://osf.io/muj4q/. All analysis codes have been made available at https://github.com/MarkMDekker/covid_intervention_evaluation. Our analysis also uses mobility information as input. This dataset is owned by a commercial party (Mezuro) and can therefore not be made public. For the purpose of enabling readers to run our codes and obtaining comparable results, we have made synthetic mobility data available, also at the Data Repository https://osf.io/muj4q/. This synthetic data has been generated using a gravity model. For frequent travels, this is entirely standard, for infrequent visits square root of the distance is used in the numerator. The prefactor G in the standard gravity model is chosen as 0.5 to account for the double counting due to return journeys. For infrequent visits, mostly weekend trips, we have used G = 1/7. Request for the actual mobility data can be sent to info@mezuro.com as a proposal. Access to the data may require payment, and will certainly be subject to vetting related to privacy issues by GDPR (General Data Protection Regulation).

Article and author information

Author details

  1. Mark M Dekker

    Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
    Competing interests
    The authors declare that no competing interests exist.
  2. Luc E Coffeng

    Department of Public Health, Erasmus MC, Rotterdam, Netherlands
    Competing interests
    The authors declare that no competing interests exist.
  3. Frank P Pijpers

    Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, Netherlands
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-7572-9435
  4. Debabrata Panja

    Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
    For correspondence
    d.panja@uu.nl
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-2141-9735
  5. Sake J de Vlas

    Department of Public Health, Erasmus MC, Rotterdam, Netherlands
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-1830-5668

Funding

ZonMw (10430022010001)

  • Sake J de Vlas

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Reviewing Editor

  1. Ben S Cooper, University of Oxford, United Kingdom

Version history

  1. Preprint posted: March 31, 2022 (view preprint)
  2. Received: June 6, 2022
  3. Accepted: February 20, 2023
  4. Accepted Manuscript published: March 7, 2023 (version 1)
  5. Version of Record published: March 17, 2023 (version 2)

Copyright

© 2023, Dekker et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

Metrics

  • 1,096
    views
  • 158
    downloads
  • 4
    citations

Views, downloads and citations are aggregated across all versions of this paper published by eLife.

Download links

A two-part list of links to download the article, or parts of the article, in various formats.

Downloads (link to download the article as PDF)

Open citations (links to open the citations from this article in various online reference manager services)

Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)

  1. Mark M Dekker
  2. Luc E Coffeng
  3. Frank P Pijpers
  4. Debabrata Panja
  5. Sake J de Vlas
(2023)
Reducing societal impacts of SARS-CoV-2 interventions through subnational implementation
eLife 12:e80819.
https://doi.org/10.7554/eLife.80819

Share this article

https://doi.org/10.7554/eLife.80819

Further reading

    1. Epidemiology and Global Health
    Xiaoxin Yu, Roger S Zoh ... David B Allison
    Review Article

    We discuss 12 misperceptions, misstatements, or mistakes concerning the use of covariates in observational or nonrandomized research. Additionally, we offer advice to help investigators, editors, reviewers, and readers make more informed decisions about conducting and interpreting research where the influence of covariates may be at issue. We primarily address misperceptions in the context of statistical management of the covariates through various forms of modeling, although we also emphasize design and model or variable selection. Other approaches to addressing the effects of covariates, including matching, have logical extensions from what we discuss here but are not dwelled upon heavily. The misperceptions, misstatements, or mistakes we discuss include accurate representation of covariates, effects of measurement error, overreliance on covariate categorization, underestimation of power loss when controlling for covariates, misinterpretation of significance in statistical models, and misconceptions about confounding variables, selecting on a collider, and p value interpretations in covariate-inclusive analyses. This condensed overview serves to correct common errors and improve research quality in general and in nutrition research specifically.

    1. Ecology
    2. Epidemiology and Global Health
    Emilia Johnson, Reuben Sunil Kumar Sharma ... Kimberly Fornace
    Research Article

    Zoonotic disease dynamics in wildlife hosts are rarely quantified at macroecological scales due to the lack of systematic surveys. Non-human primates (NHPs) host Plasmodium knowlesi, a zoonotic malaria of public health concern and the main barrier to malaria elimination in Southeast Asia. Understanding of regional P. knowlesi infection dynamics in wildlife is limited. Here, we systematically assemble reports of NHP P. knowlesi and investigate geographic determinants of prevalence in reservoir species. Meta-analysis of 6322 NHPs from 148 sites reveals that prevalence is heterogeneous across Southeast Asia, with low overall prevalence and high estimates for Malaysian Borneo. We find that regions exhibiting higher prevalence in NHPs overlap with human infection hotspots. In wildlife and humans, parasite transmission is linked to land conversion and fragmentation. By assembling remote sensing data and fitting statistical models to prevalence at multiple spatial scales, we identify novel relationships between P. knowlesi in NHPs and forest fragmentation. This suggests that higher prevalence may be contingent on habitat complexity, which would begin to explain observed geographic variation in parasite burden. These findings address critical gaps in understanding regional P. knowlesi epidemiology and indicate that prevalence in simian reservoirs may be a key spatial driver of human spillover risk.