Impact of tiered restrictions on human activities and the epidemiology of the second wave of COVID-19 in Italy
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Abstract
To counter the second COVID-19 wave in autumn 2020, the Italian government introduced a system of physical distancing measures organized in progressively restrictive tiers (coded as yellow, orange, and red) imposed on a regional basis according to real-time epidemiological risk assessments. We leverage the data from the Italian COVID-19 integrated surveillance system and publicly available mobility data to evaluate the impact of the three-tiered regional restriction system on human activities, SARS-CoV-2 transmissibility and hospitalization burden in Italy. The individuals’ attendance to locations outside the residential settings was progressively reduced with tiers, but less than during the national lockdown against the first COVID-19 wave in the spring. The reproduction number R(t) decreased below the epidemic threshold in 85 out of 107 provinces after the introduction of the tier system, reaching average values of about 0.95-1.02 in the yellow tier, 0.80-0.93 in the orange tier and 0.74-0.83 in the red tier. We estimate that the reduced transmissibility resulted in averting about 36% of the hospitalizations between November 6 and November 25, 2020. These results are instrumental to inform public health efforts aimed at preventing future resurgence of cases.
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SciScore for 10.1101/2021.01.10.21249532: (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 Sentences Resources Impact of tiered restrictions on human activities: In order to assess the impact of tiered restrictions on human activities, we applied the following linear mixed model to mobility data for each location category in the Google reports [8]: where Impact of tiered restrictions on transmissibility: We applied a linear mixed model on the estimated SARS- CoV-2 transmissibility (i.e., the mean value of Rt):
where Impact of tiered restrictions on hospital admissions: For each region, we projected the curve of daily hospitalizations using the renewal equation22 under alternative assumptions on …
SciScore for 10.1101/2021.01.10.21249532: (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 Sentences Resources Impact of tiered restrictions on human activities: In order to assess the impact of tiered restrictions on human activities, we applied the following linear mixed model to mobility data for each location category in the Google reports [8]: where Impact of tiered restrictions on transmissibility: We applied a linear mixed model on the estimated SARS- CoV-2 transmissibility (i.e., the mean value of Rt):
where Impact of tiered restrictions on hospital admissions: For each region, we projected the curve of daily hospitalizations using the renewal equation22 under alternative assumptions on the implemented interventions.
Googlesuggested: (Google, RRID:SCR_017097)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:This is not surprising, considering that the restrictions mainly acted on social gathering venues that had not been targeted by previous interventions, such as bars, restaurants and shopping malls, and that they introduced limitations to individual movements. Reductions of attendance in schools (data not available in the Google mobility data) and workplaces may have contributed to the reduction in public transport use. However, we found that the activity reduction in all locations outside of home was far from that observed during the nation-wide lockdown imposed to counter the first wave, even in the strictest tier where a stay-home mandate was in place. As a comparison, during the lockdown the time spent in retail/recreational locations and in transit stations had dropped by over 75% with respect to the pre-pandemic values (against 50% in the red tier), and the time spent at home had increased by 27% (against 17% in the red tier)8. On the epidemiological side, we found that the yellow tier reduced Rt to values close to 1, while orange and red tiers brought the reproduction number significantly below the epidemic threshold, even though starting from higher values. Overall, provinces in the yellow tier achieved a mean 18% reduction of Rt with respect to the transmission level determined by the preceding nationwide restrictions, while a reduction of 34% and 45% was observed in the orange and red tier respectively (Appendix). These results remained robust with respect to a numbe...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
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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