The effect of a national lockdown in response to COVID-19 pandemic on the prevalence of clinical symptoms in the population

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Abstract

The vast and rapid spread of COVID-19 calls for immediate action from policy-makers, and indeed various lockdown measures were implemented in many countries. Here, we utilized nationwide surveys that assess COVID-19 associated symptoms to analyze the effect of the lockdown policy in Israel on the prevalence of clinical symptoms in the population. Daily symptom surveys were distributed online and included fever, respiratory symptoms, gastrointestinal symptoms, anosmia and Ageusia. A total of 1,456,461 survey responses were analyzed. We defined a single measure of symptoms, Symptoms Average (SA), as the mean number of symptoms reported by responders. Data were collected between March 15th to May 11th, 2020. Notably, following severe lockdown measures, we found that between March 15th and April 20th, SA sharply declined by 83.8%, as did every individual symptom, including the most common symptoms reported by our responders, cough and rhinorrhea and\or nasal congestion, which decreased by 74.1% and 69.6%, respectively. Individual symptoms exhibit differences in reduction dynamics, suggesting differences in the medical conditions that they represent or in the nature of the symptoms themselves. The reduction in symptoms was observed in all the cities in Israel, and in several stratifications of demographic characteristics. Between April 20th and May 11th, following several subsequent lockdown relief measures, the decrease in SA and individual symptoms halted and they remain relatively stable with no significant change. Overall, these results demonstrate a profound decrease in a variety of clinical symptoms following the implementation of a lockdown in Israel. As our survey symptoms are not specific to COVID-19 infection, this effect likely represents an overall nationwide reduction in the prevalence of infectious diseases, including COVID-19. This quantification may be of major interest for COVID-19 pandemic, as many countries consider implementation of lockdown strategies.

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  1. SciScore for 10.1101/2020.04.27.20076000: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.


    Results from OddPub: Thank you for sharing your code and data.


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, we ask participants to fill the survey anonymously since we are obligated to ensure the privacy of our participants. As such, we cannot link daily surveys of the same responder, which could have provided trends in symptoms at the individual level and insights on the progression of symptoms and the disease over time, and the influence of lockdown policies on the progression of symptoms at the individual level. At the time of writing, we are deploying newer versions of our survey that will be distributed nationally in Israel, allowing us not only to collect data which will be more representative but also to link responses of an individual over time, while protecting the anonymity and privacy of the responders. Second, our surveys were deployed as a voluntary tool, and thus the population of the study, which was defined by the responders to the survey, is prone to selection bias, and may not represent the entire Israeli population across all geographic locations. In an attempt to reduce this bias, the survey was distributed in six different languages to reflect the most common languages spoken in Israel and substantial efforts were made to reach disadvantaged populations by engaging leaders in local religious communities, and promoting the survey through both Hebrew and Arabic-speaking media channels. Furthermore, we perform several sensitivity analyses to evaluate the robustness of our estimates, which all show similar results (Figure S...

    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.

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