Impact of COVID-19 Testing Strategies and Lockdowns on Disease Management Across Europe, South America, and the United States: Analysis Using Skew-Normal Distributions

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Abstract

As COVID-19 infections worldwide exceed 6 million confirmed cases, the data reveal that the first wave of the outbreak is coming to an end in many European countries. There is variation in the testing strategies (eg, massive testing vs testing only those displaying symptoms) and the strictness of lockdowns imposed by countries around the world. For example, Brazil’s mitigation measures lie between the strict lockdowns imposed by many European countries and the more liberal approach taken by Sweden. This can influence COVID-19 metrics (eg, total deaths, confirmed cases) in unexpected ways.

Objective

This study aimed to evaluate the effectiveness of local authorities’ strategies in managing the COVID-19 pandemic in Europe, South America, and the United States.

Methods

The early stage of the COVID-19 outbreak in Brazil was compared to Europe using the weekly transmission rate. Using the European data as a basis for our analysis, we examined the spread of COVID-19 and modeled curves pertaining to daily confirmed cases and deaths per million using skew-normal probability density functions. For Sweden, the United Kingdom, and the United States, we forecasted the end of the pandemic, and for Brazil, we predicted the peak value for daily deaths per million. We also discussed additional factors that could play an important role in the fight against COVID-19, such as the fast response of local authorities, testing strategies, number of beds in the intensive care unit, and isolation strategies adopted.

Results

The European data analysis demonstrated that the transmission rate of COVID-19 increased similarly for all countries in the initial stage of the pandemic but changed as the total confirmed cases per million in each country grew. This was caused by the variation in timely action by local authorities in adopting isolation measures and/or massive testing strategies. The behavior of daily confirmed cases for the United States and Brazil during the early stage of the outbreak was similar to that of Italy and Sweden, respectively. For daily deaths per million, transmission in the United States was similar to that of Switzerland, whereas for Brazil, it was greater than the counts for Portugal, Germany, and Austria (which had, in terms of total deaths per million, the best results in Europe) but lower than other European countries.

Conclusions

The fitting skew parameters used to model the curves for daily confirmed cases per million and daily deaths per million allow for a more realistic prediction of the end of the pandemic and permit us to compare the mitigation measures adopted by local authorities by analyzing their respective skew-normal parameters. The massive testing strategy adopted in the early stage of the pandemic by German authorities made a positive difference compared to other countries like Italy where an effective testing strategy was adopted too late. This explains why, despite a strictly indiscriminate lockdown, Italy’s mortality rate was one of the highest in the world.

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  1. SciScore for 10.1101/2020.06.01.20119461: (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: 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.

    About SciScore

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