Estimating Exposure Risk to Guide Behaviour During the SARS-COV2 Pandemic

The fading impact of lockdowns: A data analysis of the effectiveness of Covid-19 travel restrictions during different pandemic phases

As countries struggled with SARS-COV2 outbreaks at the beginning of 2021, many citizens found themselves in yet another period of increasing travel restrictions, if not a strict lockdown. At the same time there was concern that further restrictions would prove to be less effective due to a range of reasons including increasing pandemic fatigue or the lack of appropriate supports. In this study we investigate whether restrictions remained effective as a way to limit non-essential travel in order to curb virus transmission. We do this by analysing adherence during periods of increasing and decreasing restrictions in 125 countries during three different 4-month phases, early (March-June 2020), middle (July-October 2020), and late (November 2020-February 2021) over the course of the first year of the pandemic, and prior to significant population-wide vaccination. We use the strength of the relationship between restriction levels and the level of personal mobility associated with non-essential travel in order to determine the degree of adherence to the restrictions imposed. We show that there is evidence of a significant decrease in adherence to restrictions during the middle and late phases of the pandemic, compared with the early phase. Our analysis further suggests that this decrease in adherence is due to changes in mobility rather than changes in restrictions. We conclude, therefore, that restrictions have become less effective at curbing non-essential travel, which may alter the cost-benefit analysis of restrictions and lockdowns, thus highlighting the need for governments to reconsider large-scale restrictions as a containment strategy in the future, in favour of more focused or flexible mitigation approaches.

Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis

Background

Mitigation of the spread of infection relies on targeted approaches aimed at preventing nonhousehold interactions. Contact tracing in the form of digital proximity tracing apps has been widely adopted in multiple countries due to its perceived added benefits of tracing speed and breadth in comparison to traditional manual contact tracing. Assessments of user responses to exposure notifications through a guided approach can provide insights into the effect of digital proximity tracing app use on managing the spread of SARS-CoV-2.

Objective

The aim of this study was to demonstrate the use of Venn diagrams to investigate the contributions of digital proximity tracing app exposure notifications and subsequent mitigative actions in curbing the spread of SARS-CoV-2 in Switzerland.

Methods

We assessed data from 4 survey waves (December 2020 to March 2021) from a nationwide panel study (COVID-19 Social Monitor) of Swiss residents who were (1) nonusers of the SwissCovid app, (2) users of the SwissCovid app, or (3) users of the SwissCovid app who received exposure notifications. A Venn diagram approach was applied to describe the overlap or nonoverlap of these subpopulations and to assess digital proximity tracing app use and its associated key performance indicators, including actions taken to prevent SARS-CoV-2 transmission.

Results

We included 12,525 assessments from 2403 participants, of whom 50.9% (1222/2403) reported not using the SwissCovid digital proximity tracing app, 49.1% (1181/2403) reported using the SwissCovid digital proximity tracing app and 2.5% (29/1181) of the digital proximity tracing app users reported having received an exposure notification. Most digital proximity tracing app users (75.9%, 22/29) revealed taking at least one recommended action after receiving an exposure notification, such as seeking SARS-CoV-2 testing (17/29, 58.6%) or calling a federal information hotline (7/29, 24.1%). An assessment of key indicators of mitigative actions through a Venn diagram approach reveals that 30% of digital proximity tracing app users (95% CI 11.9%-54.3%) also tested positive for SARS-CoV-2 after having received exposure notifications, which is more than 3 times that of digital proximity tracing app users who did not receive exposure notifications (8%, 95% CI 5%-11.9%).

Conclusions

Responses in the form of mitigative actions taken by 3 out of 4 individuals who received exposure notifications reveal a possible contribution of digital proximity tracing apps in mitigating the spread of SARS-CoV-2. The application of a Venn diagram approach demonstrates its value as a foundation for researchers and health authorities to assess population-level digital proximity tracing app effectiveness by providing an intuitive approach for calculating key performance indicators.