The effectiveness of Non-pharmaceutical interventions in COVID-19 pandemic in Uzbekistan

Abstract

ABSTRACT The effectiveness of Non-pharmaceutical interventions in COVID-19 pandemic in Uzbekistan Background The 2019 novel coronavirus (COVID-19) outbreak in Wuhan, China has attracted world-wide attention. As of November 12, 2022, the resulting COVID-19 pandemic had caused more than 635 million confirmed cases and more than 6.6 million (approximately 0.08% of world population) deaths. After detection first case of COVID-19 in Uzbekistan top government officials decided to implement large-scale non-pharmaceutical intervention (NPIs), namely travel restriction, school closure, quarantine and isolation, social distancing, mask wearing and lockdown to control and contain infection outbreak. NPIs were essential components of the public health response to COVID-19 outbreaks before vaccine invention. The implementation durations of each type of NPI ranged from 18 to 219 days. The longest duration of implementation was observed for mask wearing 708 days (96.9% of study period). In general, the goal of the implementation of any type of NPI was to reduce the reproduction number (R) below the threshold value of 1 and as close to 0 as possible. Several NPIs, including border, closure, school closure, social distancing, and lockdown, could reduce R substantially to near or below 1. Purpose The purpose of this study is to evaluate effectiveness of NPIs to reduce SARS-CoV-2 transmission in Uzbekistan and their association with basic reproduction number (R0). Method A retrospective study was conducted to estimate the effectiveness of each and subgroups of the NPIs. This study included 237,341 confirmed COVID-19 cases between 15 March, 2020-2022 in Uzbekistan. Findings on dependent variables or NPIs namely, border closure, school closure, mass gathering bans, venue closure, traffic bans, mask wearing and lockdown were obtained from official webpages of high-circulation newspapers published in Uzbekistan. And, on independent variable such as basic reproduction number was calculated based on simple mathematical formula using a software. Ordinal logistic regression analysis was used to estimate the effectiveness of NPIs associated with basic reproduction number of COVID-19. Result Governmental interventions were implemented overall 731 days in the country. The response implementation of NPIs continued for different periods of time, the least lasted was lockdown measure 131 days (17.9%), the longest one was mask wearing and it lasted 708 days (96.9%), respectively. The result of the study showed that an increase in basic reproduction number by 1.38 times was more likely led to implement traffic bans measure (OR: 1.38, 95% CI: 0.99 – 1.91, p=0.05), venue closure (OR: 1.41, 95% CI: 1.04 – 1.94, p=0.028), lockdown (OR: 1.43, 95% CI: 0.92 – 2.08, p=0.066), mass gathering bans (OR: 1.5, 95% CI: 1.08 – 2.09, p=0.015), border closure (OR: 2.21, 95% CI: 1.59 – 3.12, p=< .001), mask wearing (OR: 2.75, 95% CI: 1.87 – 4.25, p=< .001) and school closure (OR: 4.45, 95% CI: 2.93 – 6.97, p=< .001). The findings also revealed that Governmental response policy against coronavirus was changed several times according to level of R0 of COVID-19. Border closure measure policy was changed 6 times in the study period. In “no measure” period average R0 was 1.35 conditionally, overall days between policy change 64 days, “2nd decision” R0 was 1.18 (54 days), “3rd decision” R0 was 1.07 (143 days), “4th decision” R0 was 1.05 (155 days), “5th decision” R0 was 1.06 (120 days), and in the final cancellation period R0 was 0.9 (195 days). Median days for impose NPIs was 131.5 /IQR: 78.0 - 152.0/. Conclusion In conclusion, we found that any type Governmental interventions, namely mandatory face mask in public, border and school closure, social distancing and traffic restriction, may reduce the spread of COVID-19. Border and school closure and mask wearing seem more effective than the other types of NPIs. The re-decision by policymakers based on an increase in reproduction number lead to a decrease in the reproduction rate of the COVID-19 and it may be more essential for controlling the spread of coronavirus infection.