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Modelling the impact of the tier system on SARS-CoV-2 transmission in the UK between the first and second national lockdowns.

Published version
Peer-reviewed

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Type

Article

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Authors

Hinsley, Wes R 
Samartsidis, Pantelis 
Flaxman, Seth 

Abstract

OBJECTIVE: To measure the effects of the tier system on the COVID-19 pandemic in the UK between the first and second national lockdowns, before the emergence of the B.1.1.7 variant of concern. DESIGN: This is a modelling study combining estimates of real-time reproduction number Rt (derived from UK case, death and serological survey data) with publicly available data on regional non-pharmaceutical interventions. We fit a Bayesian hierarchical model with latent factors using these quantities to account for broader national trends in addition to subnational effects from tiers. SETTING: The UK at lower tier local authority (LTLA) level. 310 LTLAs were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Reduction in real-time reproduction number Rt . RESULTS: Nationally, transmission increased between July and late September, regional differences notwithstanding. Immediately prior to the introduction of the tier system, Rt averaged 1.3 (0.9-1.6) across LTLAs, but declined to an average of 1.1 (0.86-1.42) 2 weeks later. Decline in transmission was not solely attributable to tiers. Tier 1 had negligible effects. Tiers 2 and 3, respectively, reduced transmission by 6% (5%-7%) and 23% (21%-25%). 288 LTLAs (93%) would have begun to suppress their epidemics if every LTLA had gone into tier 3 by the second national lockdown, whereas only 90 (29%) did so in reality. CONCLUSIONS: The relatively small effect sizes found in this analysis demonstrate that interventions at least as stringent as tier 3 are required to suppress transmission, especially considering more transmissible variants, at least until effective vaccination is widespread or much greater population immunity has amassed.

Description

Funder: Community Jameel

Keywords

COVID-19, epidemiology, infectious diseases, Bayes Theorem, COVID-19, Communicable Disease Control, Humans, Pandemics, SARS-CoV-2, United Kingdom

Journal Title

BMJ Open

Conference Name

Journal ISSN

2044-6055
2044-6055

Volume Title

11

Publisher

BMJ
Sponsorship
Medical Research Council (MR/R015600/1)
National Institute for Health Research (MR/R015600/1, PR-OD-1017-20002)
Academy of Medical Sciences (SBF004\1080)
UK Department for International Development (MR/R015600/1)