Impact of lockdown on COVID-19 epidemic in Île-de-France and possible exit strategies
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Abstract
Background
More than half of the global population is under strict forms of social distancing. Estimating the expected impact of lockdown and exit strategies is critical to inform decision makers on the management of the COVID-19 health crisis.
Methods
We use a stochastic age-structured transmission model integrating data on age profile and social contacts in Île-de-France to (i) assess the epidemic in the region, (ii) evaluate the impact of lockdown, and (iii) propose possible exit strategies and estimate their effectiveness. The model is calibrated to hospital admission data before lockdown. Interventions are modeled by reconstructing the associated changes in the contact matrices and informed by mobility reductions during lockdown evaluated from mobile phone data. Different types and durations of social distancing are simulated, including progressive and targeted strategies, with large-scale testing.
Results
We estimate the reproductive number at 3.18 [3.09, 3.24] (95% confidence interval) prior to lockdown and at 0.68 [0.66, 0.69] during lockdown, thanks to an 81% reduction of the average number of contacts. Model predictions capture the disease dynamics during lockdown, showing the epidemic curve reaching ICU system capacity, largely strengthened during the emergency, and slowly decreasing. Results suggest that physical contacts outside households were largely avoided during lockdown. Lifting the lockdown with no exit strategy would lead to a second wave overwhelming the healthcare system, if conditions return to normal. Extensive case finding and isolation are required for social distancing strategies to gradually relax lockdown constraints.
Conclusions
As France experiences the first wave of COVID-19 pandemic in lockdown, intensive forms of social distancing are required in the upcoming months due to the currently low population immunity. Extensive case finding and isolation would allow the partial release of the socio-economic pressure caused by extreme measures, while avoiding healthcare demand exceeding capacity. Response planning needs to urgently prioritize the logistics and capacity for these interventions.
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SciScore for 10.1101/2020.04.13.20063933: (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
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The set of mild or moderate interventions considered here still impose limitations. We tested strategies allowing a larger proportion of the population to go back to work, also to partially release the huge economic pressure that lockdown generated. Global economic uncertainty is at a record high52, due to the fear of COVID-19 pandemic spread, income losses, and globally stalled economies because of exceptional interventions freezing …
SciScore for 10.1101/2020.04.13.20063933: (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
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The set of mild or moderate interventions considered here still impose limitations. We tested strategies allowing a larger proportion of the population to go back to work, also to partially release the huge economic pressure that lockdown generated. Global economic uncertainty is at a record high52, due to the fear of COVID-19 pandemic spread, income losses, and globally stalled economies because of exceptional interventions freezing production. As a side effect, lockdown has likely created a forced opportunity to re-organize certain professional activities to make telework possible and efficient at larger scale than previously foreseen. Prior to lockdown, a small fraction of Europeans practiced telework37. If this change of paradigm is maintained beyond emergency response, it would be extremely valuable in the medium- to long-term to aid the control of the epidemic below healthcare system saturation. Rotation of individuals working from home (e.g. every week, or every 2 weeks) can be envisioned to maintain the required social distancing levels in the community while ensuring real-life connections. Here we consider unchanged intervention measures regarding children and seniors across all scenarios. Schools are assumed to remain closed, though reopening of certain school levels is possible under different protocols of attendance44. Seniors are considered to maintain a reduction of contacts through hygienic measures and physical distance, as they are especially vulnerable again...
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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