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Is a tiered restrictions system an effective intervention for COVID-19 control? Results from Portugal, November-December 2020

2024-04-04Journal article Open access
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dc.contributor.authorMoniz, Marta
dc.contributor.authorSoares, Patricia
dc.contributor.authorNunes, Baltazar
dc.contributor.authorLeite, Andreia
dc.date.accessioned2025-02-21T15:11:19Z
dc.date.available2025-02-21T15:11:19Z
dc.date.issued2024-04-04
dc.description.abstractBackground: In November 2020, similar to other European countries, Portugal implemented a tiered restrictions system to control the COVID-19 pandemic. We aimed to compare the COVID-19 growth rate across tiers to assess the effect of a tiered restrictions system in Portugal, using models with different times between tiers assessment. Our hypothesis was that being in a higher tier brings a faster deceleration in the growth rate than being in a lower tier. Methods: The national database of notified COVID-19 cases and publicly available data were used to analyse the effect of the tiered restrictions system on the COVID-19 incidence growth rate. The tiers were based on the European Centre for Disease Control risk classification: moderate, high, very and extremely high. We used a generalised mixed effects regression model to estimate the growth rate ratio (GRR) for each tier, comparing the growth rates of higher tiers using moderate tier as reference. Three models were fitted using different times between tiers assessment, separated by 14 days. Results: We included 156 034 cases. Very high tier was the most frequent combination in all the three moments assessed (21.2%), and almost 50% of the municipalities never changed tier during the study period. Immediately after the tiers implementation, a reduction was identified in the municipalities in high tier (GRR high tier: 0.90 [95%CI: 0.79; 1.02]) and very high tier (GRR very high tier: 0.68 [95%CI: 0.61; 0.77]), however with some imprecision in the 95% confidence interval for the high tier. A reduction in very high tier growth rate was identified two weeks (GRR: 0.79 [95%CI: 0.71; 0.88]) and four weeks (GRR: 0.77 [95%CI: 0.74; 0.82]) after the implementation, compared to moderate tier. In high tier, a reduction was also identified in both times, although smaller. Conclusions: We observed a reduction in the growth rate in very high tier after the tiered restriction system was implemented, but we also observed a lag between tiered restriction system implementation and the onset of consequent effects. This could suggest the importance of early implementation of stricter measures for pandemic control. Thus, studies analysing a broader period of time are needed.pt_PT
dc.description.sponsorshipThis work was funded by the Foundation for Science and Technology through a PhD research scholarship [2020.09525.BD] granted under the Call DOCTORATES 4 COVID-19; and Comprehensive Health Research Center [UIDP/04923/2020].
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationBMC Public Health. 2024 Apr 4;24(1):956. doi: 10.1186/s12889-024-18369-1
dc.identifier.doi10.1186/s12889-024-18369-1pt_PT
dc.identifier.issn1471-2458
dc.identifier.pmid38575989
dc.identifier.urihttp://hdl.handle.net/10400.18/10378
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBioMed Central
dc.relationComprehensive Health Research Center - Research, Education, Training and Innovation in Clinical research and Public Health
dc.relation.hasversionhttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-18369-1
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectCOVID-19pt_PT
dc.subjectTiered Restrictionspt_PT
dc.subjectIncidence Ratept_PT
dc.subjectInfectious Diseasespt_PT
dc.subjectEpidemiologypt_PT
dc.subjectInfecções Respiratóriaspt_PT
dc.subjectEstados de Saúde e de Doençapt_PT
dc.titleIs a tiered restrictions system an effective intervention for COVID-19 control? Results from Portugal, November-December 2020pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardTitleComprehensive Health Research Center - Research, Education, Training and Innovation in Clinical research and Public Health
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDP%2F04923%2F2020/PT
oaire.citation.issue1pt_PT
oaire.citation.startPage956
oaire.citation.titleBMC Public Healthpt_PT
oaire.citation.volume24pt_PT
oaire.fundingStream6817 - DCRRNI ID
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameMoniz
person.familyNameSoares
person.familyNameNunes
person.familyNameLeite
person.givenNameAna Marta
person.givenNamePatricia
person.givenNameBaltazar
person.givenNameAndreia
person.identifier1050496
person.identifier1052436
person.identifier.ciencia-id9B1A-CF74-9545
person.identifier.ciencia-id0415-632D-8609
person.identifier.ciencia-idAB11-AD48-A8DF
person.identifier.ciencia-id2F10-F9A9-E8A7
person.identifier.orcid0000-0001-5902-9113
person.identifier.orcid0000-0001-5033-9115
person.identifier.orcid0000-0001-6230-7209
person.identifier.orcid0000-0003-0843-0630
person.identifier.scopus-author-id52063758300
person.identifier.scopus-author-id9133723200
person.identifier.scopus-author-id57109931300
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
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