Association of tiered restrictions and a second lockdown with COVID-19 deaths and hospital admissions in England: a modelling study.
Association of tiered restrictions and a second lockdown with COVID-19 deaths and hospital admissions in England: a modelling study.
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DOI：
10.1016/s1473-3099(20)30984-1
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发表时间：
2021-04
期刊：
影响因子：
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通讯作者：
ISARIC4C investigators
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文献类型：
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作者：
Davies NG;Barnard RC;Jarvis CI;Russell TW;Semple MG;Jit M;Edmunds WJ;Centre for Mathematical Modelling of Infectious Diseases COVID-19 Working Group;ISARIC4C investigators
2020年秋季，英格兰出现第二波COVID-19病例，导致当地实施分级限制（所谓的警戒级别），随后实施第二次全国封锁。我们研究了这些分层限制以及封锁严格性、时间和持续时间的替代方案对严重急性呼吸系统综合征冠状病毒2型（SARS-CoV-2）传播以及COVID-19导致的住院和死亡的影响。我们将SARS-CoV-2传播的年龄结构数学模型与入院和医院床位占用率数据拟合（ISARIC 4C/COVID-19临床信息网络，英国国家卫生服务体系[NHS]），血清阳性率（国家统计局，英国生物库，REACT-2研究），病毒学（REACT-1研究），以及2020年3月1日至10月13日期间英格兰七个NHS地区的死亡人数（英格兰公共卫生）。我们分析了移动性（Google社区移动性）和社交联系（CoMix研究）数据，以估计2020年10月在英格兰实施的分层限制以及在北方爱尔兰和威尔士实施的封锁措施的影响，并预测了英格兰截至2021年3月31日的流行病学情景。我们估计第2级的有效繁殖数（Rt）减少2%（95%可信区间[CrI] 0-4），第3级减少10%（6-14），北方爱尔兰严格封锁学校关闭35%（30-41），威尔士严格封锁学校关闭44%（37-49）。从2020年10月1日至2021年3月31日，在没有分层限制或封锁的情况下，预计COVID-19疫情导致280 000人（95%预测区间274 000-287 000）住院和58 500人（55 800-61 100）死亡。 分级限制将使住院人数减少到23.8万（23.1万至24.5万），死亡人数减少到4.86万（4.64万至5.07万）。 从2020年11月5日起，为期4周的威尔士式封锁，学校保持开放-类似于2020年11月在英格兰宣布的封锁措施-预计将进一步减少住院人数至186 000人（179 000-193 000），死亡人数减少至36 800人（34 900-38 800）。 关闭学校预计将进一步减少住院人数至157 000人（152 000-163 000人），死亡人数减少至30 300人（29 000-31 900人）。 预计超过4周的封锁将减少死亡人数，但在减少医院服务高峰压力方面的回报将逐渐减少。提前封锁将在短期内减少死亡和住院人数，但将导致2021年1月后病例更快复苏。在事后分析中，我们估计英格兰的第二次封锁（11月5日至12月2日）将Rt降低了22%（95% CrI 15-29），而不是威尔士严格封锁学校开放时估计的32%（25-39）。封锁措施在减少累积死亡方面优于不太严格的限制。我们预计，11月5日宣布在英格兰开始的封锁政策，与威尔士采取的封锁措施类似，将减轻卫生服务的压力，并将适时控制冬季期间的死亡人数，同时允许学校继续开放。分析完成后，我们分析了2020年11月的新数据，发现尽管政策相似，但英格兰的第二次封锁对行为的影响比威尔士的第二次封锁要小，导致的死亡和住院人数比我们最初在关注威尔士严格的封锁情况时预测的要多。地平线2020，英国医学研究理事会和国家健康研究所。
A second wave of COVID-19 cases in autumn, 2020, in England led to localised, tiered restrictions (so-called alert levels) and, subsequently, a second national lockdown. We examined the impact of these tiered restrictions, and alternatives for lockdown stringency, timing, and duration, on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and hospital admissions and deaths from COVID-19. We fit an age-structured mathematical model of SARS-CoV-2 transmission to data on hospital admissions and hospital bed occupancy (ISARIC4C/COVID-19 Clinical Information Network, National Health Service [NHS] England), seroprevalence (Office for National Statistics, UK Biobank, REACT-2 study), virology (REACT-1 study), and deaths (Public Health England) across the seven NHS England regions from March 1, to Oct 13, 2020. We analysed mobility (Google Community Mobility) and social contact (CoMix study) data to estimate the effect of tiered restrictions implemented in England, and of lockdowns implemented in Northern Ireland and Wales, in October, 2020, and projected epidemiological scenarios for England up to March 31, 2021. We estimated a reduction in the effective reproduction number (Rt) of 2% (95% credible interval [CrI] 0–4) for tier 2, 10% (6–14) for tier 3, 35% (30–41) for a Northern Ireland-stringency lockdown with schools closed, and 44% (37–49) for a Wales-stringency lockdown with schools closed. From Oct 1, 2020, to March 31, 2021, a projected COVID-19 epidemic without tiered restrictions or lockdown results in 280 000 (95% projection interval 274 000–287 000) hospital admissions and 58 500 (55 800–61 100) deaths. Tiered restrictions would reduce hospital admissions to 238 000 (231 000–245 000) and deaths to 48 600 (46 400–50 700). From Nov 5, 2020, a 4-week Wales-type lockdown with schools remaining open—similar to the lockdown measures announced in England in November, 2020—was projected to further reduce hospital admissions to 186 000 (179 000–193 000) and deaths to 36 800 (34 900–38 800). Closing schools was projected to further reduce hospital admissions to 157 000 (152 000–163 000) and deaths to 30 300 (29 000–31 900). A projected lockdown of greater than 4 weeks would reduce deaths but would bring diminishing returns in reducing peak pressure on hospital services. An earlier lockdown would have reduced deaths and hospitalisations in the short term, but would lead to a faster resurgence in cases after January, 2021. In a post-hoc analysis, we estimated that the second lockdown in England (Nov 5–Dec 2) reduced Rt by 22% (95% CrI 15–29), rather than the 32% (25–39) reduction estimated for a Wales-stringency lockdown with schools open. Lockdown measures outperform less stringent restrictions in reducing cumulative deaths. We projected that the lockdown policy announced to commence in England on Nov 5, with a similar stringency to the lockdown adopted in Wales, would reduce pressure on the health service and would be well timed to suppress deaths over the winter period, while allowing schools to remain open. Following completion of the analysis, we analysed new data from November, 2020, and found that despite similarities in policy, the second lockdown in England had a smaller impact on behaviour than did the second lockdown in Wales, resulting in more deaths and hospitalisations than we originally projected when focusing on a Wales-stringency scenario for the lockdown. Horizon 2020, UK Medical Research Council, and the National Institute for Health Research.