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The impact of time to impose lockdown on COVID-19 cases and deaths in European countries
El impacto del tiempo hasta el confinamiento en los casos y la mortalidad por COVID-19 en países europeos
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Modelos lineales univariantes desarrollados con los datos de los 16 países europeos incluidos en el estudio para a) número total de fallecidos por COVID-19, y b) número total de fallecidos por millón de habitantes a los 90 días de detectarse el primer caso en cada país, incluyendo el número de días transcurridos desde ese primer caso hasta la declaración de confinamiento en el mismo. c) Evolución del número de fallecidos por COVID-19 relativos a la población de cada país entre los días 15 y 90 tras detectarse el primer caso de la enfermedad. La escala de color separa aquellos países que declararon el confinamiento antes de 27 días desde el primer caso detectado, o en tiempos superiores a este. Se detectaron diferencias significativas entre estos grupos para el número de fallecidos por millón de habitantes registrados en el día 90 tras el primer caso (ANOVA, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0015), mientras que en el día 15 no existían esas diferencias entre países (ANOVA, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,712).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carmen Martínez-Valero, Juande D. Miranda, Francisco Javier Martín-Sánchez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Carmen" "apellidos" => "Martínez-Valero" ] 1 => array:2 [ "nombre" => "Juande D." 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Miranda, Francisco Javier Martín-Sánchez" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Carmen" "apellidos" => "Martínez-Valero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Juande D." "apellidos" => "Miranda" "email" => array:1 [ 0 => "juandedios.miranda@repsol.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Repsol (Risk Modelling Area), Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Clínico San Carlos (IdISSC), Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El impacto del tiempo hasta el confinamiento en los casos y la mortalidad por COVID-19 en países europeos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1650 "Ancho" => 3167 "Tamanyo" => 352267 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between the time until lockdown and the absolute and relative number of deaths from COVID-19. Univariate linear models developed with data from the 16 European countries included in the study for a) total number of deaths from COVID-19, and b) total number of deaths per million inhabitants 90 days after the first case was detected in each country, including the number of days that elapsed from that first case to the declaration of lockdown therein. c) Evolution of the number of deaths from COVID-19 relative to the population of each country between days 15 and 90 after detecting the first case of the disease. The colour scale separates those countries that declared lockdown within 27 days of the first case detected, or after 27 days. Significant differences were detected between these groups for the number of deaths per million inhabitants registered on day 90 after the first case (ANOVA, p = 0.0015), while on day 15 there were no such differences between countries (ANOVA, p = 0.712).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In December 2019, the infection by the SARS-CoV-2 coronavirus that causes the COVID-19 disease, characterised by its highly contagious nature, was described for the first time. Its global expansion has led to a public health crisis unprecedented in modern times.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The control measures employed in the SARS epidemic in 2003, appear to have been more successful than those currently used for COVID-19. Possible reasons for this could be that SARS-CoV-2 is far more transmissible, plus the existence of asymptomatic patients who transmit the disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Many European countries have implemented severe epidemiological measures to control the pandemic, such as early detection of cases and case isolation, comprehensive contact monitoring and quarantine, and social distancing and lockdown measures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In fact, implementing lockdown seems to have had an effect in the reduction of deaths reported daily just 2–3 weeks after its inception.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the number of cases and deaths related to COVID-19, differences have been documented between countries such as Norway, Finland or Portugal, and others, such as Italy, United Kingdom or Spain. One possible hypothesis is the existence of a direct relationship between the consequences of the pandemic (number of cases and deaths) and the time that elapsed between the first case and the introduction of social distancing measures.</p><p id="par0025" class="elsevierStylePara elsevierViewall">For this reason, our study objective is to investigate the effect of the time until social distancing measures were introduced, on the number of declared cases of COVID-19 and mortality in European countries. For this, data was collected from 16 European countries (Belgium, Denmark, Finland, France, Austria, Germany, Iceland, Ireland, Italy, Norway, Holland, Portugal, Spain, Sweden, Switzerland and the United Kingdom) until 30 June 2020.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The study variables were time until social distancing (date of entry into force of social distancing measures and the date of the first case detected) and time until lockdown (date of entry into force of lockdown measures and the date of the first case detected). The result variables were the total number of cases and deaths, both absolute and relative, adjusted to the total population of each country, related to COVID-19 registered 90 days after the first case of the disease declared in each country. Adjusted and univariate linear regression models (stepwise backwards) were used for the number of tests performed and the number of cases and deaths up to the date of the start of the most demanding social distancing measure, that is, lockdown.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The results showed that there is a close correlation between the number of deaths from COVID-19, total and per million inhabitants, in relation to the days elapsed until lockdown (R<span class="elsevierStyleSup">2</span> adjusted 0.722 and 0.590, respectively) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The results on social distancing had a lower correlation (R<span class="elsevierStyleSup">2</span> 0.588 and 0.477, respectively) with the outcome variables (data not shown).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the total number of cases, a high correlation coefficient (R<span class="elsevierStyleSup">2</span> adjusted 0.726) was documented in relation to the time that elapsed until lockdown together with the number of tests performed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, panel c) of <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows how different the evolution of the pandemic has been (in terms of the number of deaths per million inhabitants) between the data at the beginning of the pandemic (15 days after detection of the first case) and the data collected 90 days after that first case in each country based on the time that elapsed until lockdown.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, the results of this paper show that there is a strong direct relationship between the number of deaths from COVID-19 in Europe (to a lesser extent with the number of cases declared) and the time that elapsed between the declaration of the first case and introducing the lockdown decision during the COVID-19 pandemic. It is true that these findings should be considered with caution as it is an observational study where cause-effect relationships cannot be established as there are many other biological, environmental, social and individual factors that could mediate as indirect factors of transmission. Additionally, observational learning by countries where the epidemic started later may be a partial reason for the data collected.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors CMV and JDM have contributed equally to this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authorship" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-Valero C, Miranda JD, Martín-Sánchez FJ. El impacto del tiempo hasta el confinamiento en los casos y la mortalidad por COVID-19 en países europeos. Med Clin (Barc). 2020;155:459–460.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1650 "Ancho" => 3167 "Tamanyo" => 352267 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between the time until lockdown and the absolute and relative number of deaths from COVID-19. Univariate linear models developed with data from the 16 European countries included in the study for a) total number of deaths from COVID-19, and b) total number of deaths per million inhabitants 90 days after the first case was detected in each country, including the number of days that elapsed from that first case to the declaration of lockdown therein. c) Evolution of the number of deaths from COVID-19 relative to the population of each country between days 15 and 90 after detecting the first case of the disease. The colour scale separates those countries that declared lockdown within 27 days of the first case detected, or after 27 days. Significant differences were detected between these groups for the number of deaths per million inhabitants registered on day 90 after the first case (ANOVA, p = 0.0015), while on day 15 there were no such differences between countries (ANOVA, p = 0.712).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can we contain the COVID-19 outbreak with the same measures as for SARS?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Wilder-Smith" 1 => "C.J. Chiew" 2 => "V.J. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1473-3099(20)30129-8" "Revista" => array:6 [ "tituloSerie" => "The Lancet Infectious Diseases" "fecha" => "2020" "volumen" => "20" "paginaInicial" => "102" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31676244" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Flaxman S., Mishra S., Gandy A., Unwin J.T., Coupland H., Mellan T.A., et al. Report 13: Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in 11 European countries [Internet]. Available from: https://doi.org/10.25561/77731." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronavirus Pandemic (COVID-19). Our World in Data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Roser" 1 => "H. Ritchie" 2 => "E. Ortiz-Ospina" 3 => "J. Hasell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://ourworldindata.org/coronavirus" "fecha" => "2020" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000010/v1_202011260800/S238702062030499X/v1_202011260800/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000010/v1_202011260800/S238702062030499X/v1_202011260800/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062030499X?idApp=UINPBA00004N" ]
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| 2022 April | 299 | 3 | 302 |
| 2022 March | 51 | 7 | 58 |
| 2022 February | 87 | 8 | 95 |
| 2022 January | 70 | 3 | 73 |
| 2021 December | 54 | 5 | 59 |
| 2021 November | 57 | 14 | 71 |
| 2021 October | 68 | 5 | 73 |
| 2021 September | 55 | 12 | 67 |
| 2021 August | 55 | 10 | 65 |
| 2021 July | 76 | 14 | 90 |
| 2021 June | 116 | 12 | 128 |
| 2021 May | 85 | 17 | 102 |
| 2021 April | 277 | 58 | 335 |
| 2021 March | 243 | 15 | 258 |
| 2021 February | 142 | 18 | 160 |
| 2021 January | 202 | 21 | 223 |
| 2020 December | 60 | 26 | 86 |
| 2020 November | 12 | 11 | 23 |
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