Effect of Long-Distance Domestic Travel Ban Policies in Japan on COVID-19 Outbreak Dynamics During Dominance of the Ancestral Strain: Ex Post Facto Retrospective Observation Study

Abstract

Background: In Japan, long-distance domestic travel was banned while the ancestral SARS-CoV-2 strain was dominant under the first declared state of emergency from March 2020 until the end of May 2020. Subsequently, the "Go To Travel" campaign travel subsidy policy was activated, allowing long-distance domestic travel, until the second state of emergency as of January 7, 2021. The effects of this long-distance domestic travel ban on SARS-CoV-2 infectivity have not been adequately evaluated.

Objective: We evaluated the effects of the long-distance domestic travel ban in Japan on SARS-CoV-2 infectivity, considering climate conditions, mobility, and countermeasures such as the "Go To Travel" campaign and emergency status.

Methods: We calculated the effective reproduction number R(t), representing infectivity, using the epidemic curve in Kagoshima prefecture based on the empirical distribution of the incubation period and procedurally delayed reporting from an earlier study. Kagoshima prefecture, in southern Japan, has several resorts, with an airport commonly used for transportation to Tokyo or Osaka. We regressed R(t) on the number of long-distance domestic travelers (based on the number of airport limousine bus users provided by the operating company), temperature, humidity, mobility, and countermeasures such as state of emergency declarations and the "Go To Travel" campaign in Kagoshima. The study period was June 20, 2020, through February 2021, before variant strains became dominant. A second state of emergency was not declared in Kagoshima prefecture but was declared in major cities such as Tokyo and Osaka.

Results: Estimation results indicated a pattern of declining infectivity with reduced long-distance domestic travel volumes as measured by the number of airport limousine bus users. Moreover, infectivity was lower during the "Go To Travel" campaign and the second state of emergency. Regarding mobility, going to restaurants, shopping malls, and amusement venues was associated with increased infectivity. However, going to grocery stores and pharmacies was associated with decreased infectivity. Climate conditions showed no significant association with infectivity patterns.

Conclusions: The results of this retrospective analysis suggest that the volume of long-distance domestic travel might reduce SARS-CoV-2 infectivity. Infectivity was lower during the "Go To Travel" campaign period, during which long-distance domestic travel was promoted, compared to that outside this campaign period. These findings suggest that policies banning long-distance domestic travel had little legitimacy or rationale. Long-distance domestic travel with appropriate infection control measures might not increase SARS-CoV-2 infectivity in tourist areas. Even though this analysis was performed much later than the study period, if we had performed this study focusing on the period of April or May 2021, it would likely yield the same results. These findings might be helpful for government decision-making in considering restarting a "Go To Travel" campaign in light of evidence-based policy.

Keywords: COVID-19; Go To Travel campaign; airport users; effective reproduction number; hotel visitors; infection control; lockdown; long-distance travel; mobility; pandemic; travel; travelling.

Figure 1

Numbers of newly confirmed COVID-19 cases in Kagoshima prefecture, Japan, from March 26, 2020, to the end of February 2021. Bars represent the epidemic curve showing the numbers of patients by onset date. The arrow indicates the period during which the "Go To Travel" campaign was in effect.

Figure 2

Map of Japan with Kagoshima prefecture indicated in the red circle and the airport routes to the main tourism cities for long-distance domestic travel marked.

Figure 3

Effective reproduction number (black line) with 95% CIs (gray lines) of COVID-19 in Kagoshima prefecture, Japan, from June 20, 2020, to the end of February, 2021.

Figure 4

Number of airport limousine bus users at Kagoshima airport from the beginning of 2020 to the end of 2021.