Execution of intervention matters more than strategy: A lesson from the spatiotemporal assessment of COVID-19 clusters in Nepal

  1. Bipin Kumar Acharya
  2. Laxman Khanal
  3. Alnwisi Sameh Mansoor Mahyoub
  4. Zengliang Ruan
  5. Yin Yang
  6. Samir Kumar Adhikari
  7. Shreejana Pandit
  8. Basanta Kumar Neupane
  9. Binod Kumar Paudel
  10. Hualiang Lin

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Abstract

The novel coronavirus disease 2019 (COVID-19) has been the biggest public health problem of the present world. As the number of people suffering from the pandemic is rising, it is likely to claim more life and worsen the global health and economy. Nepal, one of the developing countries in the south Asia has been strongly influenced by the pandemic and struggling to contain it with multiple interventions, however, spatiotemporal dynamics of the epidemic and its linkage with various intervention strategies has not been studied yet. Here, we employed the prospective spatial-temporal analysis with SaTScan assessing dynamics of the COVID-19 cases from 23 January to 31 August 2020 at district level in Nepal. The results revealed that COVID-19 dynamics in the early stage of transmission was slower and confined in certain districts. However, from the third week of April, transmission spread rapidly across districts of Province No. 2 and Sudoorpaschim Province, primarily introduced by Nepalese citizens returning from India. Despite nationwide lockdown, nine statistically significant active and emerging clusters were detected between 23 January and 21 July 2020, whereas ten emerging clusters were observed for extended period to 31 August. The population density and population inflow from India crossing the sealed border had significant effects on the elevated risk of the epidemic. The capital city Kathmandu has become the highest-risk active cluster since August when travel restriction has been suspended. Movement restriction appears to be the most effective non-pharmaceutical intervention against the COVID-19 for resource-scarce countries with limited health care facilities. Our findings could be valuable to the health authorities within Nepal and beyond to better allocate resources and improve interventions on the pandemic for containing it efficiently.

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    SciScore for 10.1101/2020.11.07.20227520: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The null hypothesis states that there is no difference in risk between inside and outside of the circle or cylinder while alternative hypothesis states the number of observed cases exceeds the number of expected cases derived from null models with elevated risk within the circle/cylinder.
    circle/cylinder
    suggested: None

    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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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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  2. Version published to 10.1101/2020.11.07.20227520v1 on medRxiv