The effects of non-pharmaceutical interventions on SARS-CoV-2 transmission in different socioeconomic populations in Kuwait: a modeling study

Fatima Khadadah # 1 2, Abdullah A Al-Shammari # 3 4, Ahmad Alhashemi 5, Dari Alhuwail 6 7, Bader Al-Saif 8 9, Saud N Alzaid 10, Barrak Alahmad 11, Isaac I Bogoch 12

Affiliations

01 May 2021

-

doi: 10.1186/s12889-021-10984-6

Abstract

Background: Aggressive non-pharmaceutical interventions (NPIs) may reduce transmission of SARS-CoV-2. The extent to which these interventions are successful in stopping the spread have not been characterized in countries with distinct socioeconomic groups. We compared the effects of a partial lockdown on disease transmission among Kuwaitis (P1) and non-Kuwaitis (P2) living in Kuwait.

Methods: We fit a modified metapopulation SEIR transmission model to reported cases stratified by two groups to estimate the impact of a partial lockdown on the effective reproduction number ([Formula: see text]). We estimated the basic reproduction number ([Formula: see text]) for the transmission in each group and simulated the potential trajectories of an outbreak from the first recorded case of community transmission until 12 days after the partial lockdown. We estimated [Formula: see text] values of both groups before and after the partial curfew, simulated the effect of these values on the epidemic curves and explored a range of cross-transmission scenarios.

Results: We estimate [Formula: see text] at 1·08 (95% CI: 1·00-1·26) for P1 and 2·36 (2·03-2·71) for P2. On March 22nd, [Formula: see text] for P1 and P2 are estimated at 1·19 (1·04-1·34) and 1·75 (1·26-2·11) respectively. After the partial curfew had taken effect, [Formula: see text] for P1 dropped modestly to 1·05 (0·82-1·26) but almost doubled for P2 to 2·89 (2·30-3·70). Our simulated epidemic trajectories show that the partial curfew measure greatly reduced and delayed the height of the peak in P1, yet significantly elevated and hastened the peak in P2. Modest cross-transmission between P1 and P2 greatly elevated the height of the peak in P1 and brought it forward in time closer to the peak of P2.

Conclusion: Our results indicate and quantify how the same lockdown intervention can accentuate disease transmission in some subpopulations while potentially controlling it in others. Any such control may further become compromised in the presence of cross-transmission between subpopulations. Future interventions and policies need to be sensitive to socioeconomic and health disparities.

Keywords: COVID-19; Mathematical modeling; Non-pharmaceutical interventions; Socioeconomic disparities.

Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1 Structure of the modified metapopulation SEIR model. The population is divided into two socioeconomic groups: Subpopulation 1 (P1) and Subpopulation 2 (P2). Individuals within each subpopulation are divided into the following infection classes or compartments: susceptible (S), exposed but not infectious (E), asymptomatic infectious (IA), pre-symptomatic infectious (IP), symptomatic infectious (IS), and removed (R). The progression through the different compartments is described by key epidemiological timescales that characterize the transmission dynamics of COVID-19 infection

Fig. 1 Structure of the modified metapopulation SEIR model. The population is divided into two socioeconomic groups: Subpopulation 1 (P1) and Subpopulation 2 (P2). Individuals within each subpopulation are divided into the following infection classes or compartments: susceptible (S), exposed but not infectious (E), asymptomatic infectious (IA), pre-symptomatic infectious (IP), symptomatic infectious (IS), and removed (R). The progression through the different compartments is described by key epidemiological timescales that characterize the transmission dynamics of COVID-19 infection

Fig. 2 Spatial structure of the population in Kuwait. a A geographical density distribution of the Kuwaiti and Non-Kuwaiti subpopulations. b A spatial density of the housing buildings by districts in Kuwait

Fig. 2 Spatial structure of the population in Kuwait. a A geographical density distribution of the Kuwaiti and Non-Kuwaiti subpopulations. b A spatial density of the housing buildings by districts in Kuwait

Fig. 3 Temporal dynamics of COVID-19 in Kuwait from Feb-May 2020

Fig. 3 Temporal dynamics of COVID-19 in Kuwait from Feb-May 2020

Fig. 4 a Effect of partial curfew on the epidemic curves. Model simulations of the daily infection incidence for P1 and P2 (higher and lower socioeconomic groups respectively) before and after the partial curfew. (Overall) Simulations based on the basic reproduction numbers R 0 , 1 = 1 ⋅ 08 and R 0 , 2 = 2 ⋅ 36 . (Pre-curfew) Simulations based on pre-curfew reproduction numbers R e , 1 = 1 ⋅ 19 and R e , 2 = 1 ⋅ 75 . (Post-curfew) Simulations based on post-curfew reproduction numbers R e , 1 = 1 ⋅ 05 and R e , 2 = 2 ⋅ 89 . Cross-transmission is modeled by using β12 = β12 = 0, 0 · 01, 0 · 02 to simulate an increase in uncontrolled transmission (or leak) from individuals in P2 to P1 and vice versa. Solid lines refer to P1 and dashed lines refer to P2. Line colors refer to different infection states: Grey = asymptomatic infections, pink = pre-symptomatic & symptomatic infections, and blue = symptomatic infections. b-c Change in the peak and overall infections of COVID-19 in P1 and P2 under different cross-transmission scenarios. From left to right, with increasing symmetric cross-transmission between P2 and P1 (i.e. β12 = β12), less and less cases are averted in P1 and the effect of the NPI on peak incidence is gradually blunted. The maximum averted COVID-19 infections in P1 is found in the absence of cross-transmission. In this case, the peak incidence is reduced by 91.4% and the total infections are averted by 21.5%. Black color refers to P1 and grey color refers to P2. (Vertical axes have been amended to highlight the differences in the effect of the intervention)

Fig. 4 a Effect of partial curfew on the epidemic curves. Model simulations of the daily infection incidence for P1 and P2 (higher and lower socioeconomic groups respectively) before and after the partial curfew. (Overall) Simulations based on the basic reproduction numbers R 0 , 1 = 1 ⋅ 08 and R 0 , 2 = 2 ⋅ 36 . (Pre-curfew) Simulations based on pre-curfew reproduction numbers R e , 1 = 1 ⋅ 19 and R e , 2 = 1 ⋅ 75 . (Post-curfew) Simulations based on post-curfew reproduction numbers R e , 1 = 1 ⋅ 05 and R e , 2 = 2 ⋅ 89 . Cross-transmission is modeled by using β12 = β12 = 0, 0 · 01, 0 · 02 to simulate an increase in uncontrolled transmission (or leak) from individuals in P2 to P1 and vice versa. Solid lines refer to P1 and dashed lines refer to P2. Line colors refer to different infection states: Grey = asymptomatic infections, pink = pre-symptomatic & symptomatic infections, and blue = symptomatic infections. b-c Change in the peak and overall infections of COVID-19 in P1 and P2 under different cross-transmission scenarios. From left to right, with increasing symmetric cross-transmission between P2 and P1 (i.e. β12 = β12), less and less cases are averted in P1 and the effect of the NPI on peak incidence is gradually blunted. The maximum averted COVID-19 infections in P1 is found in the absence of cross-transmission. In this case, the peak incidence is reduced by 91.4% and the total infections are averted by 21.5%. Black color refers to P1 and grey color refers to P2. (Vertical axes have been amended to highlight the differences in the effect of the intervention)

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References

  1.  
    1. World Health Organisation. Coronavirus disease 2019 (COVID-19) Situation Report – 31. Geneva, Switzerland; 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/2.... Accessed 24 April 2020.
  2.  
    1. KUNA. كونا : (الصحة) الكويتية: لم يتم استثناء أحد ممن وصلوا فجر اليوم من (طهران) و (قم) من الحجر الصحي الاجباري - الصحة والبيئة - 24/02/2020. https://www.kuna.net.kw/ArticleDetails.aspx?id=2864468. Accessed 24 Apr 2020.
  3.  
    1. Tuite AR, Bogoch II, Sherbo R, Watts A, Fisman D, Khan K. Estimation of coronavirus disease 2019 (COVID-19) burden and potential for internationaldissemination of infection from Iran. Ann Intern Med. 2020;172(10):699–701. 10.7326/M20-0696. Epub 2020 Mar 16. - PMC - PubMed
  4.  
    1. KUNA : Kuwait gov’t imposes partial curfew, extends holiday for two weeks - MoI - Government - 22/03/2020. https://www.kuna.net.kw/ArticleDetails.aspx?id=2880575&language=en. Accessed 11 May 2020.
  5.  
    1. KUNA : Kuwait gov’t suspends commercial flights as of midnight March 13 - Government - 11/03/2020. https://www.kuna.net.kw/ArticleDetails.aspx?id=2876451&language=en. Accessed 11 May 2020.
  6.  
    1. KUNA : Kuwait extends school closure until March 26 - spokesman - Government - 09/03/2020. https://www.kuna.net.kw/ArticleDetails.aspx?id=2874997&language=en. Accessed 11 May 2020.
  7.  
    1. Hartley DM, Perencevich EN. Public health interventions for COVID-19: emerging evidence and implications for an evolving public health crisis. JAMA. 2020;323(19):1908–1909. doi: 10.1001/jama.2020.5910. - DOI - PubMed
  8.  
    1. Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A. 2007;104(18):7582–7587. doi: 10.1073/pnas.0610941104. - DOI - PMC - PubMed
  9.  
    1. Legido-Quigley H, Asgari N, Teo YY, Leung GM, Oshitani H, Fukuda K, Cook AR, Hsu LY, Shibuya K, Heymann D. Are high-performing health systems resilient against the COVID-19 epidemic? Lancet. 2020;395(10227):848–850. doi: 10.1016/S0140-6736(20)30551-1. - DOI - PMC - PubMed
  10.  
    1. White C, Nafilyan V. Coronavirus (COVID-19) related deaths by ethnic group, England and Wales - Office for National Statistics https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri.... Accessed 13 May 2020.
  11.  
    1. Chung H, Fung K, Ferreira-Legere L, Chen B, Ishiguro L, Kalappa G, et al. COVID-19 Laboratory Testing in Ontario: Patterns of Testing and Characteristics of Individuals Tested, as of April 30, 2020. . COVID-19 Laboratory Testing in Ontario: Patterns of Testing and Characteristics of Individuals Tested, as of April 30, 2020. Toronto, ON: ICES; 2020. https://www.ices.on.ca/Publications/Atlases-and-Reports/2020/COVID-19-La.... Accessed 13 May 2020.
  12.  
    1. Taylor K-Y. The black plague. The New Yorker https://www.newyorker.com/news/our-columnists/the-black-plague. Accessed 13 May 2020.
  13.  
    1. Twahirwa Rwema JO, Diouf D, Phaswana-Mafuya N, Rusatira JC, Manouan A, Uwizeye E, Drame FM, Tamoufe U, Baral SD. COVID-19 across Africa: epidemiologic heterogeneity and necessity of contextually relevant transmission models and intervention strategies. Ann Intern Med. 2020;173(9):752–753. doi: 10.7326/M20-2628. - DOI - PMC - PubMed
  14.  
    1. Public Authority for Civil Information. Statistics Services System. Stat Designer. 2019. https://www.paci.gov.kw/stat/Default.aspx. Accessed 15 May 2020.
  15.  
    1. Central Agency for Information Technology. COVID 19 Updates .::. Home. https://corona.e.gov.kw/En. Accessed 23 May 2020.
  16.  
    1. Al-Shall Report. Kuwaitis, expats wage difference 114.9% in public sector. ARAB TIMES - KUWAIT NEWS. 2019. http://www.arabtimesonline.com/news/kuwaitis-expats-wage-difference-114-.... Accessed 11 May 2020.
  17.  
    1. Ministry of Health, Kuwait. وزارة الصحة - الكويت (@KUWAIT_MOH) / Twitter. Twitter. https://twitter.com/kuwait_moh. Accessed 23 May 2020.
  18.  
    1. OpenStreetMap. OpenStreetMap. https://www.openstreetmap.org/. Accessed 23 May 2020.
  19.  
    1. Al-Shammari AAA, Ali H, Al-Ahmad B, Al-Refaei FH, Al-Sabah S, Jamal MH, et al. Real-time tracking and forecasting of the COVID-19 outbreak in Kuwait: a mathematical modeling study. medRxiv. 2020;:2020.05.03.20089771.
  20.  
    1. Core Team R. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2014.
  21.  
    1. Hamadah H, Alahmad B, Behbehani M, Al-Youha S, Almazeedi S, Al-Haddad M, et al. COVID-19 clinical outcomes and nationality: results from a Nationwide registry in Kuwait. BMC Public Health. 2020;20(1):1384. doi: 10.1186/s12889-020-09490-y. - DOI - PMC - PubMed
  22.  
    1. Grantz KH, Rane MS, Salje H, Glass GE, Schachterle SE, Cummings DAT. Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918. Proc Natl Acad Sci U S A. 2016;113(48):13839–13844. doi: 10.1073/pnas.1612838113. - DOI - PMC - PubMed
  23.  
    1. Quinn SC, Kumar S. Health inequalities and infectious disease epidemics: a challenge for global health security. Biosecur Bioterror. 2014;12(5):263–273. doi: 10.1089/bsp.2014.0032. - DOI - PMC - PubMed
  24.  
    1. Chen J, Chu S, Chungbaek Y, Khan M, Kuhlman C, Marathe A, Mortveit H, Vullikanti A, Xie D. Effect of modelling slum populations on influenza spread in Delhi. BMJ Open. 2016;6(9):e011699. doi: 10.1136/bmjopen-2016-011699. - DOI - PMC - PubMed
  25.  
    1. Adiga A, Chu S, Eubank S, Kuhlman CJ, Lewis B, Marathe A, Marathe M, Nordberg EK, Swarup S, Vullikanti A, Wilson ML. Disparities in spread and control of influenza in slums of Delhi: findings from an agent-based modelling study. BMJ Open. 2018;8(1):e017353. doi: 10.1136/bmjopen-2017-017353. - DOI - PMC - PubMed
  26.  
    1. Zargar A. India’s poor hit hardest as coronavirus spreads and lockdown is extended. https://www.cbsnews.com/news/india-coronavirus-covid19-poor-hit-hardest-.... Accessed 13 May 2020.
  27.  
    1. Alahmad B, Kurdi H, Colonna K, Gasana J, Agnew J, Fox MA. COVID-19 stressors on migrant workers in Kuwait: cumulative risk considerations. BMJ Glob Health. 2020;5(7):e002995. doi: 10.1136/bmjgh-2020-002995. - DOI - PMC - PubMed
  28.  
    1. Koo JR, Cook AR, Park M, Sun Y, Sun H, Lim JT, Tam C, Dickens BL. Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study. Lancet Infect Dis. 2020;20(6):678–688. doi: 10.1016/S1473-3099(20)30162-6. - DOI - PMC - PubMed
  29.  
    1. Cai W, Lai KKR. Packed With Migrant Workers, Dormitories Fuel Coronavirus in Singapore. The New York Times. 2020. https://www.nytimes.com/interactive/2020/04/28/world/asia/coronavirus-si.... .
  30.  
    1. Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, et al. Association of Public Health Interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. JAMA. 2020. - PMC - PubMed
  31.  
    1. Fong MW, Gao H, Wong JY, Xiao J, Shiu EYC, Ryu S, et al. Nonpharmaceutical measures for pandemic influenza in nonhealthcare settings-social distancing measures. Emerging Infect Dis. 2020;26(5):976–84. 10.3201/eid2605.190995. - PMC - PubMed
  32.  
    1. Miyaki K, Sakurazawa H, Mikurube H, Nishizaka M, Ando H, Song Y, Shimbo T. An effective quarantine measure reduced the total incidence of influenza a H1N1 in the workplace: another way to control the H1N1 flu pandemic. J Occup Health. 2011;53(4):287–292. doi: 10.1539/joh.10-0024-FS. - DOI - PubMed
  33.  
    1. van Gemert C, Hellard M, McBryde ES, Fielding J, Spelman T, Higgins N, Lester R, Vally H, Bergeri I. Intrahousehold transmission of pandemic (H1N1) 2009 virus, Victoria, Australia. Emerg Infect Dis. 2011;17(9):1599–1607. doi: 10.3201/eid1709.101948. - DOI - PMC - PubMed
  34.  
    1. Wei WE. Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69. doi:10.15585/mmwr.mm6914e1. - PMC - PubMed
  35.  
    1. Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, Liu X, Wei L, Truelove SA, Zhang T, Gao W, Cheng C, Tang X, Wu X, Wu Y, Sun B, Huang S, Sun Y, Zhang J, Ma T, Lessler J, Feng T. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect Dis. 2020;20(8):911–919. doi: 10.1016/S1473-3099(20)30287-5. - DOI - PMC - PubMed
  36.  
    1. Li W, Zhang B, Lu J, Liu S, Chang Z, Cao P, et al. The characteristics of household transmission of COVID-19. Clin Infect Dis. 2020. - PMC - PubMed
  37.  
    1. 2020. الحطاب خ. 356 ألفاً یقطنون في مساكن مكدسة. جریدة القبس الإلكتروني. https://alqabas.com/article/5764616. Accessed 11 May 2020.
  38.  
    1. Alkhamis MA, Youha SA, Khajah MM, Haider NB, Alhardan S, Nabeel A, et al. Spatiotemporal dynamics of COVID-19 epidemic in the State of Kuwait. Int J Infect Dis. 2020;98:153–160. doi: 10.1016/j.ijid.2020.06.078. - DOI - PMC - PubMed
  39.  
    1. KUNA. كونا : سمو أمير البلاد يوجه كلمة إلى إخوانه وأبنائه المواطنين والمقيمين - عام - 22/03/2020. https://www.kuna.net.kw/ArticleDetails.aspx?id=2880748&language=ar#. Accessed 21 May 2020.
  40.  
    1. Nagraj. Kuwait to allow repatriation flights, offers amnesty for expats without valid residencies. Gulf Business. 2020. https://gulfbusiness.com/kuwait-to-allow-repatriation-flights-offers-amn.... Accessed 12 May 2020.

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