The impact of local and national restrictions in response to COVID-19 on social contacts in England: a longitudinal natural experiment

CMMID COVID-19 working group

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14 Citations (Scopus)

Abstract

Background: England’s COVID-19 response transitioned from a national lockdown to localised interventions. In response to rising cases, these were supplemented by national restrictions on contacts (the Rule of Six), then 10 pm closing for bars and restaurants, and encouragement to work from home. These were quickly followed by a 3-tier system applying different restrictions in different localities. As cases continued to rise, a second national lockdown was declared. We used a national survey to quantify the impact of these restrictions on epidemiologically relevant contacts. Methods: We compared paired measures on setting-specific contacts before and after each restriction started and tested for differences using paired permutation tests on the mean change in contacts and the proportion of individuals decreasing their contacts. Results: Following the imposition of each measure, individuals tended to report fewer contacts than they had before. However, the magnitude of the changes was relatively small and variable. For instance, although early closure of bars and restaurants appeared to have no measurable effect on contacts, the work from home directive reduced mean daily work contacts by 0.99 (95% confidence interval CI] 0.03–1.94), and the Rule of Six reduced non-work and school contacts by a mean of 0.25 (0.01–0.5) per day. Whilst Tier 3 appeared to also reduce non-work and school contacts, the evidence for an effect of the lesser restrictions (Tiers 1 and 2) was much weaker. There may also have been some evidence of saturation of effects, with those who were in Tier 1 (least restrictive) reducing their contacts markedly when they entered lockdown, which was not reflected in similar changes in those who were already under tighter restrictions (Tiers 2 and 3). Conclusions: The imposition of various local and national measures in England during the summer and autumn of 2020 has gradually reduced contacts. However, these changes are smaller than the initial lockdown in March. This may partly be because many individuals were already starting from a lower number of contacts.

Original languageEnglish
Article number52
Number of pages12
JournalBMC Medicine
Volume19
Issue number1
DOIs
Publication statusPublished - 19 Feb 2021

Bibliographical note

Funding Information:
The following funding sources are acknowledged as providing funding for the working group authors. Alan Turing Institute (AE). BBSRC LIDP (BB/M009513/1: DS). This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: KP, MJ, YL; NTD Modelling Consortium OPP1184344: CABP, GFM; OPP1180644: SRP; OPP1183986: ESN; OPP1191821: KO’R, MA). BMGF (OPP1157270: KA). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP). DTRA (HDTRA1-18-1-0051: JWR). ERC Starting Grant (#757699: JCE, MQ, RMGJH). This project has received funding from the European Union’s Horizon 2020 research and innovation programme - project EpiPose (101003688: KP, MJ, PK, RCB, YL). This research was partly funded by the Global Challenges Research Fund (GCRF) project ‘RECAP’ managed through RCUK and ESRC (ES/P010873/1: TJ). HDR UK (MR/S003975/1: RME). MRC (MR/N013638/1: NRW). Nakajima Foundation (AE). This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (16/136/46: BJQ; 16/137/109: BJQ, CD, FYS, MJ, YL; Health Protection Research Unit for Immunisation NIHR200929: NGD; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; NIHR200908: RME; NIHR200929: FGS, MJ; PR-OD-1017-20002: AR). Royal Society (Dorothy Hodgkin Fellowship: RL; RP\EA\180004: PK). UK DHSC/UK Aid/NIHR (ITCRZ 03010: HPG). UK MRC (LID DTP MR/N013638/1: GRGL, QJL; MC_PC_19065: NGD, RME, SC, TJ, YL; MR/P014658/1: GMK). Authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). Wellcome Trust (206250/Z/17/Z: AJK, TWR; 206471/Z/17/Z: OJB; 208812/Z/17/Z: SC, SF; 210758/Z/18/Z: JDM, JH, KS, NIB, SA, SFunk, SRM). No funding (AKD, AMF, AS, CJVA, DCT, JW, KEA, SH, YJ, YWDC).

Funding Information:
This research was partly funded by the Bill & Melinda Gates Foundation (INV-001754: MQ; INV-003174: KP, MJ, YL; NTD Modelling Consortium OPP1184344: CABP, GFM; OPP1180644: SRP; OPP1183986: ESN; OPP1191821: KO?R, MA). BMGF (OPP1157270: KA). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP). DTRA (HDTRA1-18-1-0051: JWR). ERC Starting Grant (#757699: JCE, MQ, RMGJH). This project has received funding from the European Union?s Horizon 2020 research and innovation programme - project EpiPose (101003688: KP, MJ, PK, RCB, YL). This research was partly funded by the Global Challenges Research Fund (GCRF) project ?RECAP? managed through RCUK and ESRC (ES/P010873/1: TJ). HDR UK (MR/S003975/1: RME). MRC (MR/N013638/1: NRW). Nakajima Foundation (AE). This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (16/136/46: BJQ; 16/137/109: BJQ, CD, FYS, MJ, YL; Health Protection Research Unit for Immunisation NIHR200929: NGD; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: TJ; NIHR200908: RME; NIHR200929: FGS, MJ; PR-OD-1017-20002: AR). Royal Society (Dorothy Hodgkin Fellowship: RL; RP\EA\180004: PK). UK DHSC/UK Aid/NIHR (ITCRZ 03010: HPG). UK MRC (LID DTP MR/N013638/1: GRGL, QJL; MC_PC_19065: NGD, RME, SC, TJ, YL; MR/P014658/1: GMK). Authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). Wellcome Trust (206250/Z/17/Z: AJK, TWR; 206471/Z/17/Z: OJB; 208812/Z/17/Z: SC, SF; 210758/Z/18/Z: JDM, JH, KS, NIB, SA, SFunk, SRM). No funding (AKD, AMF, AS, CJVA, DCT, JW, KEA, SH, YJ, YWDC). We would also like to thank the team at Ipsos who have been excellent in running the survey, collecting the data, and allowing for this study to happen at a rapid speed. We would like to thank Tim P Morris for feedback on the manuscript. We thank TW and FC, for providing data and insight on local restrictions.

Funding Information:
CoMix is funded by the EU Horizon 2020 Research and Innovations Programme - project EpiPose (Epidemic Intelligence to Minimize COVID-19’s Public Health, Societal and Economical Impact, No 101003688) and by the Medical Research Council (Understanding the dynamics and drivers of the COVID-2019 epidemic using real-time outbreak analytics MC_PC 19065). CIJ and WJE receive funding from the Global Challenges Research Fund (GCRF) project ‘RECAP’ managed through RCUK and ESRC (ES/P010873/1). KvZ is supported by Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. The R2HC programme is funded by the UK Government (Foreign, Commonwealth and Development Office, previously DFID), the Wellcome Trust, and the UK National Institute for Health Research (NIHR). The following funding sources are acknowledged as providing funding for the named authors: Elrha R2HC/UK FCO/Wellcome Trust; and the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research, NIHR (PR-OD-1017-20002: WJE). UK MRC (MC_PC_19065: AG, WJE).

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • COVID-19
  • Contact survey
  • Disease outbreak
  • England
  • Lockdowns
  • Non-pharmaceutical interventions
  • Pandemic
  • United Kingdom

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