Lockdown measures and relative changes in the age-specific incidence of SARS-CoV-2 in Spain

ABSTRACT

BACKGROUND: The first months of the SARS-CoV-2 epidemic in Spain resulted in high incidence and mortality. A national sero-epidemiological survey suggests higher cumulative incidence of infection in older individuals than in younger individuals. However, little is known about the epidemic dynamics in different age groups, including the relative effect of the lockdown measures introduced on March 15, and strengthened on March 30 to April 14, 2020 when only essential workers continued to work. METHODS: We used data from the National Epidemiological Surveillance Network (RENAVE in Spanish) on the daily number of reported COVID-19 cases (by date of symptom onset) in eleven 5-year age groups 15-19y through 65-69y. For each age group g, we computed the proportion E(g) of individuals in age group g among all reported cases aged 15-69y during the pre-lockdown period (March 1-10, 2020) and the corresponding proportion L(g) during two lockdown periods (March 25-April 3 and April 8-17, 2020). For each lockdown period, we computed the proportion ratios PR(g)= L(g)/E(g). For each pair of age groups g1,g2, PR(g1)>PR(g2) implies a relative increase in the incidence of detected SARS-CoV-2 infection in the age group g1 compared with g2 for the later vs. early period. RESULTS: For the first lockdown period, the highest PR values were in age groups 50-54y (PR=1.21;95% CI 1.12,1.30) and 55-59y (PR=1.19;1.11,1.27). For the second lockdown period, the highest PR values were in age groups 15-19y (PR=1.26;0.95,1.68) and 50-54y (PR=1.20;1.09,1.31). CONCLUSIONS: Our results suggest that different outbreak control measures led to different changes in the relative incidence by age group. During the first lockdown period, when non-essential work was allowed, individuals aged 40-64y, particularly those aged 50-59y presented with higher COVID-19 relative incidence compared to pre-lockdown period, while younger adults/older adolescents (together with persons aged 50-59y) had increased relative incidence during the later, strengthened lockdown. The role of different age groups during the epidemic should be considered when implementing future mitigation efforts.