Association between COVID-19 infection rates by region and implementation of non-pharmaceutical interventions: a cross-sectional study in Japan

  1. Tomomi Anan
  2. Tomohiro Ishimaru
  3. Ayako Hino
  4. Tomohisa Nagata
  5. Seiichiro Tateishi
  6. Mayumi Tsuji
  7. Akira Ogami
  8. Shinya Matsuda
  9. Yoshihisa Fujino
  10. for the CORoNaWork project

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Abstract

Background

During a pandemic, non-pharmaceutical interventions (NPIs) play an important role in protecting oneself and others from infection. There are large regional differences in COVID-19 infection rates in Japan. We hypothesized that the local infection incidence may affect adherence to individual NPIs.

Methods

This cross-sectional study was conducted online among full-time workers in Japan in December 2020. The questionnaire asked the respondents to identify their habits regarding seven common NPIs (wearing masks, washing hands after the bathroom, disinfecting hands when entering indoors, gargling when returning home, ventilating the room, disinfecting or washing hands after touching frequently touched surfaces, carrying alcohol sanitizers when outdoors).

Results

A total of 27 036 participants were analyzed. Compared with the region with the lowest infection rate, five of the seven NPIs showed statistically significant trends across regional infection levels, the two exceptions being wearing masks and washing hands after the bathroom. Multivariate adjustment did not change these trends.

Conclusions

This study found that NPIs were more prevalent in regions with higher incidence rates of COVID-19 in Japanese workers. The findings suggest that the implementation of NPIs was influenced not only by personal attributes but also by contextual effects of the local infection level.

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  1. Version published to 10.1093/pubmed/fdab385
  2. ScreenIT

    SciScore for 10.1101/2021.07.26.21261107: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study was approved by the ethics committee of the University of Occupational and Environmental Health, Japan (reference No. R2-079 and R3-006).
    Consent: Participants provided informed consent by completing a form on the survey website.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    : Release 16; StataCorp LLC, TX, USA).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations in this study. First, we conducted a survey of full-time workers only; we did not include part-time workers, housewives, the elderly, or people under 15 years of age. Accordingly, the results do not present a complete picture of NPI practices in the community; some reports show different rates of implementation of preventive measures in different age groups (6). Second, given the cross-sectional nature of the study, it is not possible to assign causation. In other words, it is not possible to compare rates of NPI implementation before and after the increase in COVID-19 infection rate in a given region. Therefore, we cannot conclude that the rate of implementation has increased because of the increase in infectious rate. Third, we used a simple question to measure NPI adherence; details about frequency and timing remain unknown. To prevent the spread of COVID-19, performing NPIs is essential, along with organizational efforts such as emergency declarations and lockdowns. In this study of Japanese workers, NPIs were more prevalent in regions with higher incidence rates, suggesting that implementation was affected not only by personal attributes but also by the contextual effects of local infection level. In particular, for areas where the implementation is not widespread and the level of infection is low, we propose that environmental interventions such as campaigns to promote awareness of NPIs may be beneficial.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.07.26.21261107v1 on medRxiv