Reducing societal impacts of SARS-CoV-2 interventions through subnational implementation
- Utrecht University, Netherlands
- Erasmus MC, Netherlands
- 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
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
- Ben S Cooper, University of Oxford, United Kingdom
Version history
- Preprint posted: March 31, 2022 (view preprint)
- Received: June 6, 2022
- Accepted: February 20, 2023
- Accepted Manuscript published: March 7, 2023 (version 1)
- 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.
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Reducing societal impacts of SARS-CoV-2 interventions through subnational implementation
eLife 12:e80819.
https://doi.org/10.7554/eLife.80819
Further reading
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- Epidemiology and Global Health
- Medicine
Background:
Although there are several efficacious vaccines against COVID-19, vaccination rates in many regions around the world remain insufficient to prevent continued high disease burden and emergence of viral variants. Repurposing of existing therapeutics that prevent or mitigate severe COVID-19 could help to address these challenges. The objective of this study was to determine whether prior use of bisphosphonates is associated with reduced incidence and/or severity of COVID-19.
Methods:
A retrospective cohort study utilizing payer-complete health insurance claims data from 8,239,790 patients with continuous medical and prescription insurance January 1, 2019 to June 30, 2020 was performed. The primary exposure of interest was use of any bisphosphonate from January 1, 2019 to February 29, 2020. Bisphosphonate users were identified as patients having at least one bisphosphonate claim during this period, who were then 1:1 propensity score-matched to bisphosphonate non-users by age, gender, insurance type, primary-care-provider visit in 2019, and comorbidity burden. Main outcomes of interest included: (a) any testing for SARS-CoV-2 infection; (b) COVID-19 diagnosis; and (c) hospitalization with a COVID-19 diagnosis between March 1, 2020 and June 30, 2020. Multiple sensitivity analyses were also performed to assess core study outcomes amongst more restrictive matches between BP users/non-users, as well as assessing the relationship between BP-use and other respiratory infections (pneumonia, acute bronchitis) both during the same study period as well as before the COVID outbreak.
Results:
A total of 7,906,603 patients for whom continuous medical and prescription insurance information was available were selected. A total of 450,366 bisphosphonate users were identified and 1:1 propensity score-matched to bisphosphonate non-users. Bisphosphonate users had lower odds ratios (OR) of testing for SARS-CoV-2 infection (OR = 0.22; 95%CI:0.21–0.23; p<0.001), COVID-19 diagnosis (OR = 0.23; 95%CI:0.22–0.24; p<0.001), and COVID-19-related hospitalization (OR = 0.26; 95%CI:0.24–0.29; p<0.001). Sensitivity analyses yielded results consistent with the primary analysis. Bisphosphonate-use was also associated with decreased odds of acute bronchitis (OR = 0.23; 95%CI:0.22–0.23; p<0.001) or pneumonia (OR = 0.32; 95%CI:0.31–0.34; p<0.001) in 2019, suggesting that bisphosphonates may protect against respiratory infections by a variety of pathogens, including but not limited to SARS-CoV-2.
Conclusions:
Prior bisphosphonate-use was associated with dramatically reduced odds of SARS-CoV-2 testing, COVID-19 diagnosis, and COVID-19-related hospitalizations. Prospective clinical trials will be required to establish a causal role for bisphosphonate-use in COVID-19-related outcomes.
Funding:
This study was supported by NIH grants, AR068383 and AI155865, a grant from MassCPR (to UHvA) and a CRI Irvington postdoctoral fellowship, CRI2453 (to PH).
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- Epidemiology and Global Health
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