Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries
Open accessAbstract
Objective: To evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally. Design: Natural experiment using interrupted time series analysis, with results synthesised using meta-analysis. Setting: 149 countries or regions, with data on daily reported cases of covid-19 from the European Centre for Disease Prevention and Control and data on the physical distancing policies from the Oxford covid-19 Government Response Tracker. Participants: Individual countries or regions that implemented one of the five physical distancing interventions (closures of schools, workplaces, and public transport, restrictions on mass gatherings and public events, and restrictions on movement (lockdowns)) between 1 January and 30 May 2020. Main outcome measure: Incidence rate ratios (IRRs) of covid-19 before and after implementation of physical distancing interventions, estimated using data to 30 May 2020 or 30 days post-intervention, whichever occurred first. IRRs were synthesised across countries using random effects meta-analysis. Results: On average, implementation of any physical distancing intervention was associated with an overall reduction in covid-19 incidence of 13% (IRR 0.87, 95% confidence interval 0.85 to 0.89; n=149 countries). Closure of public transport was not associated with any additional reduction in covid-19 incidence when the other four physical distancing interventions were in place (pooled IRR with and without public transport closure was 0.85, 0.82 to 0.88; n=72, and 0.87, 0.84 to 0.91; n=32, respectively). Data from 11 countries also suggested similar overall effectiveness (pooled IRR 0.85, 0.81 to 0.89) when school closures, workplace closures, and restrictions on mass gatherings were in place. In terms of sequence of interventions, earlier implementation of lockdown was associated with a larger reduction in covid-19 incidence (pooled IRR 0.86, 0.84 to 0.89; n=105) compared with a delayed implementation of lockdown after other physical distancing interventions were in place (pooled IRR 0.90, 0.87 to 0.94; n=41). Conclusions: Physical distancing interventions were associated with reductions in the incidence of covid-19 globally. No evidence was found of an additional effect of public transport closure when the other four physical distancing measures were in place. Earlier implementation of lockdown was associated with a larger reduction in the incidence of covid-19. These findings might support policy decisions as countries prepare to impose or lift physical distancing measures in current or future epidemic waves.
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Measures taken to handle the covid-19 pandemic varied substantially across countries.
“Measures taken to handle the covid-19 pandemic have also varied substantially across countries.”
From Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries (2021) · cites this paper as [3]
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- Authors
- Islam, N., Sharp, S. J., Chowell, G., Shabnam, S., Kawachi, I., Lacey, B., Massaro, J. M., D’Agostino, R. B., & White, M.
- Affiliations
- University of Cambridge (GB)
- Georgia State University (US)
- Pennsylvania State University (US)
- Harvard University (US)
- University of Oxford (GB)
- Boston University (US)
- Corresponding author
- Islam, Nazrul
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2020-07-15
- Volume
- 370
- Pages
- m2743
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC7360923
- OpenAlex
- W3043661845
- Cited by
- 601
- References
- 42
- Citations by year
- 2026: 7 · 2025: 23 · 2024: 65 · 2023: 79 · 2022: 139 · 2021: 208 · 2020: 80
- FWCI
- 19.99
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by-nc)
- ePrints Soton (University of Southampton) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Apollo
- Funders
- Medical Research Council (MR/K023187/1)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Physical Sciences › Environmental Science › Global and Planetary Change › COVID-19 impact on air quality
- Keywords
- COVID-19 incidence, lockdown, school closures, workplace closures, mobility restrictions, non-pharmaceutical interventions, natural experiment, Oxford COVID-19 Government Response Tracker, interrupted time series
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Communicable Disease Control, Humans, Pneumonia, Viral, Social Isolation, Incidence, Coronavirus Infections, Internationality, Pandemics, Interrupted Time Series Analysis
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