Perceptions, risk and understandings of the COVID-19 pandemic in urban South Africa

Background: How people perceive the coronavirus disease 2019 (COVID-19) pandemic and understand their risk can influence their health, behaviours and overall livelihood. The disease's novelty and severity have elicited a range of attitudes and perspectives countrywide, which consequently influence the public's adherence to public health prevention and treatment guidelines. Aim: To investigate perceptions, experiences and knowledge on COVID-19 in a communitybased cohort study. Setting: Adults living in Soweto in South Africa's Gauteng province during the first six weeks of the national lockdown regulations (i.e. Alert Level 5 lockdown from end of March to beginning of May 2020). Methods: Participants completed a series of surveys and answered open-ended questions through telephonic interviews (n = 391). We queried their perceptions of the origins of COVID-19, understandings of the disease, personal and communal risks and its relations with the existing disease burden. Results: Findings from our sample of 391 adults show that perceptions and knowledge of COVID-19 vary across several demographic characteristics. We report moderate levels of understanding about COVID-19, prevention methods and risk, as well as exposure to major physical, psychosocial and financial stressors. Depressive symptoms, perceived infection risk and concern about COVID-19 significantly predicted COVID-19 prevention knowledge. Conclusion: Public health communication campaigns should focus on continuing to improve knowledge and reduce misinformation associated with the virus. Policymakers should consider the mental health- and non-health-related impact of the pandemic on their citizens in order to curb the pandemic in a manner that maximises well-being.

COVID-19 transmission in the U.S. before vs. after relaxation of social distancing measures

BackgroundWeeks after issuing social distancing orders, all U.S. states and the District of Columbia at least partially relaxed these measures. Critical unanswered questions remain about the timing of relaxation, and if and how unregulated social distancing measures can be sustained while effectively maintaining epidemic control. MethodsWe identified all statewide social distancing measures that were implemented and/or relaxed in the U.S. between March 10-July 15, 2020, triangulating data from state government and third-party sources. Using segmented linear regression, we evaluated the extent to which social distancing measure relaxation affected epidemic control, as indicated by the time-varying, state-specific effective reproduction number (Rt). ResultsIn the eight weeks prior to relaxation, mean Rt declined by 0.012 units per day (95% CI, -0.013 to -0.012), and 46/51 jurisdictions achieved Rt < 1.0 by the date of relaxation. After relaxation of social distancing, Rt reversed course and began increasing by 0.007 units per day (95% CI, 0.006-0.007), reaching a mean Rt of 1.16 eight weeks later, with only 9/51 jurisdictions maintaining Rt <1.0. Indicators often used to motivate relaxation at the time of relaxation (e.g. test positivity rate <5%) predicted greater post-relaxation epidemic growth. ConclusionsWe detected an immediate and significant reversal in epidemic growth gains after relaxation of social distancing measures across the U.S. These results illustrate the potential pitfalls of premature relaxation of social distancing measures in the U.S.

Social distancing to slow the U.S. COVID-19 epidemic: an interrupted time-series analysis

BackgroundSocial distancing measures to address the U.S. coronavirus disease 2019 (COVID-19) epidemic may have notable health and social impacts. Methods and FindingsWe conducted a longitudinal pretest-posttest comparison group study to estimate the change in COVID-19 case growth before versus after implementation of statewide social distancing measures in the U.S. The primary exposure was time before (14 days prior to, and up to 3 days after) versus after (beginning 4 days after, and up to 21 days after) implementation of the first statewide social distancing measures. Statewide restrictions on internal movement were examined as a secondary exposure. The primary outcome was the COVID-19 case growth rate. The secondary outcome was the COVID-19-attributed mortality growth rate. All states initiated social distancing measures between March 10-25, 2020. The mean daily COVID-19 case growth rate decreased beginning four days after implementation of the first statewide social distancing measures, by 0.9% per day (95% confidence interval [CI], -1.3% to -0.4%; P<0.001). We did not estimate a statistically significant difference in the mean daily case growth rate before versus after implementation of statewide restrictions on internal movement (0.1% per day; 95% CI, -0.04% to 0.3%, P=0.14), but there is significant difficulty in disentangling the unique associations with statewide restrictions on internal movement from the unique associations with the first social distancing measures. Beginning seven days after social distancing, the COVID-19-attributed mortality growth rate decreased by 1.7% per day (95% CI, -3.0% to -0.7%; P<0.001). Our analysis is susceptible to potential bias resulting from the aggregate nature of the ecological data, potential confounding by contemporaneous changes (e.g., increases in testing), and potential underestimation of social distancing due to spillovers across neighboring states. ConclusionsStatewide social distancing measures were associated with a decrease in the COVID-19 epidemic case growth rate that was statistically significant and a decrease in the COVID-19-attributed mortality growth rate that was not statistically significant. Author SummaryO_ST_ABSWhy was the study doneC_ST_ABSThere are few empirical data about the population health benefits of imposing statewide social distancing measures to reduce transmission of severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19). What did the researchers findWe compared data from each state before vs. after implementation of statewide social distancing measures to estimate changes in mean COVID-19 daily case growth rates. Growth rates declined by approximately 1% per day beginning four days (approximately one incubation period) after statewide social distancing measures were implemented. Stated differently, our model implies that social distancing reduced the total number of COVID-19 cases by approximately 1,600 reported cases at 7 days after implementation, by approximately reported 55,000 cases at 14 days after implementation, and by approximately reported 600,000 cases at 21 days after implementation. What do these findings meanStatewide social distancing measures were associated with a reduction in the growth rate of COVID-19 cases in the U.S. However, our analysis is susceptible to potential bias resulting from the aggregate nature of the data, potential confounding by other changes that occurred during the study period (e.g., increases in testing), and potential underestimation of social distancing due to spillovers across neighboring states.