key: cord-0841702-bi16aim8 authors: Oruc Aglar, B. E.; Baxter, A.; Keskinocak, P.; Asplund, J.; Serban, N. title: Homebound by COVID19: The Benefits and Consequences of Non-Pharmaceutical Intervention Strategies date: 2020-07-24 journal: nan DOI: 10.1101/2020.07.22.20160085 sha: 21fe3a30b5f24d9651ad48235b2e767bf31c1c46 doc_id: 841702 cord_uid: bi16aim8 Objectives. To evaluate the tradeoffs between potential benefits (e.g., reduction in infection spread and deaths) of non-pharmaceutical interventions for COVID19 and being homebound (i.e., refraining from community/workplace interactions). Methods. An agent-based simulation model to project the disease spread and estimate the number of homebound people and person-days under multiple scenarios, including combinations of shelter-in-place, voluntary quarantine, and school closure in Georgia from March 1 to September 1, 2020. Results. Compared to no intervention, under voluntary quarantine, voluntary quarantine with school closure, and shelter-in-place with school closure scenarios 3.43, 19.8, and 200+ homebound adult-days were required to prevent one infection, with the maximum number of adults homebound on a given day in the range of 121K-268K, 522K-567K, 5,377K-5,380K, respectively. Conclusions. Voluntary quarantine combined with school closure significantly reduced the number of infections and deaths with a considerably smaller number of homebound person-days compared to shelter-in-place. Three-question Summary Box 49 1.) What is the current understanding of this subject? 50 Recent research has been conducted by various countries and regions on the impact of non-51 pharmaceutical interventions (NPIs) on reducing the spread of COVID19. 52 2.) What does this report add to the literature? 53 Our report assessed which intervention strategies provided the best results in terms of both 54 reducing infection outcomes (cases, deaths, etc.) and minimizing their social and economic 55 effects (e.g., number of people homebound, providing childcare, etc.). 3.) What are the implications for public health practice? 57 Voluntary quarantine proved to be the most beneficial in terms of reducing infections and deaths 58 compared to the number of people who were homebound. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 24, 2020. . https: //doi.org/10.1101 //doi.org/10. /2020 Some NPIs, such as shelter-in-place, apply to large populations for an extended duration, whereas 76 others, such as voluntary quarantine, impact targeted populations for a limited time. It is important to 77 understand the tradeoffs between the public health benefits and other consequences of NPIs, 78 particularly, as measured by homebound person-days or the size of the homebound population over 79 time. There is sparse research on assessing which interventions have a higher overall impact in reducing 80 societal interactions versus the ability to reduce infection spread and adverse outcomes 8, 9, 24, 25 . This study evaluates the trade-offs between the public health impact measures (e.g., the number of cases, . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 24, 2020 . . https://doi.org/10.1101 Intervention Analysis The following NPIs, with varying combinations and compliance levels in different scenarios (Figure 1 Table B1 ). • Homebound: For adults and elderly, this status is defined as staying home due to voluntary 112 quarantine, symptoms, shelter-in-place, or at home childcare, i.e., providing supervision to a 113 child who is home due to their status (e.g., due to symptoms or school closure). For example, if a 114 child is at home in need of supervision, the status of an adult or elderly member in the household 115 is updated to indicate that they provide supervision, labeled as at home childcare. For children 116 and youth, homebound is defined as staying home due to voluntary quarantine, symptoms, or 117 school closure. • Inactive: For adults and elderly, a status of inactive refers to being inactive from society due to 119 being homebound, hospitalized, or providing hospital care, i.e., caring for a child or youth who 120 became hospitalized. A status of inactive for children and youth is defined as being inactive from 121 society due to being homebound or hospitalized. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 24, 2020. Table B2 . The infection spread measures are contrasted with the following intervention metrics, which are reported 134 for the study period: • Homebound or inactive subpopulation: Number of people in a subpopulation (adults/elderly or 136 children/youth) with homebound or inactive status, respectively, on a given day. • Percentage of days adults homebound or inactive: Average percentage of days an adult has 138 homebound or inactive status, respectively. • Homebound days: Average number of days a (sub)population has homebound status. • Homebound or inactive peak day: The day when the number of a (sub)population has 141 homebound or inactive status, respectively, is highest. • Homebound or inactive peak: The highest number (or percentage) of a (sub)population 143 homebound or inactive, respectively, on a given day. • Adults absent from work: The number of adults who are absent from work due to an inactive 145 status (further details are provided in Supplementary Material Section B). • Homebound days to prevent an infection: Additional adult homebound days needed to prevent an 147 infection (in Scenario X, relative to Scenario 1), calculated as follows: • Homebound days to prevent a death: Additional adult homebound days needed to prevent a death 152 (in Scenario X, relative to Scenario 1), calculated as follows: 153 154 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10. 1101 Supplementary Material Table B2 presents the infection spread outcome measures, including the 159 population infected or dead and the peak infection. Table B2 ). respectively. Compared to Scenario 2 (school closure only), Scenarios 5a, 5b, 5c (shelter-in-place with 184 school closure) reduced the percentage of the total population infected from 51.69% to 48.11-50.55% 185 but more than doubled the percentage of days adults homebound to a range of 18.92-30.66%. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10. 1101 Supplementary Material Table B3 provides the percentage of days children, youth, adults, and elderly CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 24, 2020. School closure alone had limited impact on reducing the spread of COVID19. Compared to no 239 intervention, school closure only reduced the percentage of the population infected by less than 10% 240 while more than doubling the peak number of adults homebound and causing nearly 450,000 work 241 absences, the majority of which due to the need to provide at home childcare. Shelter-in-place combined with school closure (Scenarios 5a-5c) temporarily slowed down the infection 244 spread and delayed the peak, but had little impact on the magnitude of the peak and the cumulative 245 number of infections and deaths, which were similar to that observed in the school closure only scenario. However, under Scenarios 5a-5c, the peak number of homebound adults was 9-44 times larger than all 247 other intervention scenarios. Hence, the limited positive public health impact of shelter-in-place came at 248 a very high societal cost. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10. 1101 Under voluntary quarantine (Scenarios 3a, 3b, 3c) the percentage of the population infected was CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 24, 2020. If facemask usage was also considered in the NPI scenarios, the relative reduction in the number of 288 cases and deaths could be higher compared to baseline scenarios. The simulation was populated with 289 data from the state of Georgia and the results presented may not apply to other states or regions which 290 have significantly different population characteristics or density. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10.1101/2020.07.22.20160085 doi: medRxiv preprint CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10.1101/2020.07.22.20160085 doi: medRxiv preprint school . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10.1101/2020.07.22.20160085 doi: medRxiv preprint CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10.1101/2020.07.22.20160085 doi: medRxiv preprint CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 24, 2020. . https://doi.org/10. 1101 Public Health Interventions for COVID-19: Emerging Evidence 304 and Implications for an Evolving Public Health Crisis Impact assessment of non-pharmaceutical interventions 306 against coronavirus disease 2019 and influenza in Hong Kong: an observational study. The 307 Lancet Public Health Mathematical assessment of the impact of non-309 pharmaceutical interventions on curtailing the 2019 novel Coronavirus Community mitigation guidelines to prevent pandemic 312 influenza-United States Early evaluation of Wuhan City travel restrictions in response to the 314 2019 novel coronavirus outbreak Timing of community mitigation and changes in reported 316 COVID-19 and community mobility-four US metropolitan areas Comparing nonpharmaceutical interventions for 319 containing emerging epidemics When do shelter-in-place orders fight covid-19 322 best? policy heterogeneity across states and adoption time Did california's shelter-in-place order work? early 325 coronavirus-related public health effects Poverty and economic dislocation reduce compliance 328 with covid-19 shelter-in-place protocols How does household spending 331 respond to an epidemic? Consumption during the 2020 COVID-19 pandemic Tracking the Economic Impact of COVID-19 and 334 The Impacts of COVID-19 on Minority Unemployment: First 336 Evidence from April 2020 CPS Microdata. Available at SSRN 3604814. 2020. 337 14 COVID-19 and the consequences of isolating the elderly. The Lancet 341 Public Health Mitigate the effects of home confinement on 343 children during the COVID-19 outbreak. The Lancet Psychological interventions for people affected by the COVID-19 epidemic. The 345 Lancet Psychiatry Mental health and the Covid-19 pandemic An increasing risk of family violence during the Covid-19 pandemic: 349 Strengthening community collaborations to save lives Health care practitioners' 352 responsibility to address intimate partner violence related to the COVID-19 pandemic School Closure During the Coronavirus Disease 2019 (COVID-19) 355 Pandemic: An Effective Intervention at the Global Level? JAMA Pediatrics The Urgency and Challenge of Opening K-12 Schools in the Fall 357 of 2020 School closure and management practices during 359 coronavirus outbreaks including COVID-19: a rapid systematic review. The Lancet Child & 360 Adolescent Health Estimating the effects of non-pharmaceutical interventions 362 on COVID-19 in Europe The effect of large-scale anti-contagion policies on the 364 COVID-19 pandemic The Impact of Social Distancing 366 on COVID19 Spread: State of Georgia Case Study. medRxiv See Which States and Cities Have Told Residents to Stay at 371