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Meta-Analysis
. 2022 May;15(5):499-507.
doi: 10.1016/j.jiph.2022.03.011. Epub 2022 Mar 24.

The association of intensity and duration of non-pharmacological interventions and implementation of vaccination with COVID-19 infection, death, and excess mortality: Natural experiment in 22 European countries

Feng Zhou  1 , Tao-Jun Hu  1 , Xiao-Yu Zhang  2 , Keng Lai  3 , Jun-Hu Chen  4 , Xiao-Hua Zhou  5
Affiliations
Meta-Analysis

The association of intensity and duration of non-pharmacological interventions and implementation of vaccination with COVID-19 infection, death, and excess mortality: Natural experiment in 22 European countries

Feng Zhou et al. J Infect Public Health. 2022 May.

Abstract

Background: Critical questions remain regarding the need for intensity to continue NPIs as the public was vaccinated. We evaluated the association of intensity and duration of non-pharmaceutical interventions (NPIs) and vaccines with COVID-19 infection, death, and excess mortality in Europe.

Methods: Data comes from Our Word in Data. We included 22 European countries from January 20, 2020, to May 30, 2021. The time-varying constrained distribution lag model was used in each country to estimate the impact of different intensities and duration of NPIs on COVID-19 control, considering vaccination coverage. Country-specific effects were pooled through meta-analysis.

Results: This study found that high-intensity and long-duration of NPIs showed a positive main effect on reducing infection in the absence of vaccines, especially in the intensity above the 80th percentile and lasted for 7 days (RR = 0.93, 95% CI: 0.89-0.98). However, the adverse effect on excess mortality also increased with the duration and intensity. Specifically, it was associated with an increase of 44.16% (RR = 1.44, 95% CI: 1.27-1.64) in the excess mortality under the strict intervention (the intensity above the 80th percentile and lasted for 21 days). As the vaccine rollouts, the inhibition of the strict intervention on cases growth rate was increased (RR dropped from 0.95 to 0.87). Simultaneously, vaccination also alleviated the negative impact of the strict intervention on excess mortality (RR decreased from 1.44 to 1.25). Besides, maintaining the strict intervention appeared to more reduce the cases, as well as avoids more overall burden of death compared with weak intervention.

Conclusions: Our study highlights the importance of continued high-intensity NPIs in low vaccine coverage. Lifting of NPIs in insufficient vaccination coverage may cause increased infections and death burden. Policymakers should coordinate the intensity and duration of NPIs and allocate medical resources reasonably with widespread vaccination.

Keywords: COVID-19; Dynamic intervention; Excess mortality; Non-pharmacological interventions; Time series analysis; Vaccine.

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Conflict of interest statement

Competing interests The authors declare no competing financial interests.

Figures

Fig. 1
Fig. 1
Flowchart of country and region selection.
Fig. 2
Fig. 2
Pooled main and added effects (RR) for three outcomes with random effects model across countries under different strong interventions definitions before vaccine policies impalement. (a) case growth rate, (b) death growth rate, (c) excess mortality.
Fig. 3
Fig. 3
Pooled main, added, and vaccine effects (RR) under the weak (solid) and strict (hollow) intervention and vaccine coverage above 0%, 10%, and 20%. (a) case growth rate, (b) death growth rate, (c) excess mortality.
See this image and copyright information in PMC

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