An interrupted time series analysis of the lockdown policies in India: a national-level analysis of COVID-19 incidence

Abstract

India implemented a national mandatory lockdown policy (Lockdown 1.0) on 24 March 2020 in response to Coronavirus Disease 2019 (COVID-19). The policy was revised in three subsequent stages (Lockdown 2.0–4.0 between 15 April to 18 May 2020), and restrictions were lifted (Unlockdown 1.0) on 1 June 2020. This study evaluated the effect of lockdown policy on the COVID-19 incidence rate at the national level to inform policy response for this and future pandemics. We conducted an interrupted time series analysis with a segmented regression model using publicly available data on daily reported new COVID-19 cases between 2 March 2020 and 1 September 2020. National-level data from Google Community Mobility Reports during this timeframe were also used in model development and robustness checks. Results showed an 8% [95% confidence interval (CI) = 6–9%] reduction in the change in incidence rate per day after Lockdown 1.0 compared to prior to the Lockdown order, with an additional reduction of 3% (95% CI = 2–3%) after Lockdown 4.0, suggesting an 11% (95% CI = 9–12%) reduction in the change in COVID-19 incidence after Lockdown 4.0 compared to the period before Lockdown 1.0. Uptake of the lockdown policy is indicated by decreased mobility and attenuation of the increasing incidence of COVID-19. The increasing rate of incident case reports in India was attenuated after the lockdown policy was implemented compared to before, and this reduction was maintained after the restrictions were eased, suggesting that the policy helped to ‘flatten the curve’ and buy additional time for pandemic preparedness, response and recovery.

Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis

“…The effectiveness of measures such as universal lockdowns and closures of businesses and schools for the containment of covid-19 have largely been effective, but depended on early implementation when incidence rates of covid-19 were still low 425258. Only Japan reported no decrease in covid-19 incidence after school closures,44 and other studies found that different public health measures were sometimes implemented simultaneously or soon after one another, thus the results should be interpreted with caution 324656…”

“…Speculation remains as how best to implement physical distancing measures 122. Studies that assess physical distancing measures might interchangeably study physical distancing with lockdown35525664 and other measures and thus direct associations are difficult to assess.…”

Adherence to COVID-19 protective behaviours in India from May to December 2020: evidence from a nationally representative longitudinal survey

“…Although decisions to reopen economically varied across geographies, protective behaviours—like maintaining social distance, avoiding unnecessary travel and wearing masks—remained widely encouraged; for a more in-depth look at India’s initial lockdown timeline, refer to previous work. 21 During the unlock phases, caseloads remained low; however, the country subsequently experienced a spike in cases late in the summer and early fall of 2020. Following a lull in cases during the winter, infections again began to grow at an alarming rate starting in March 2021; by 15 April 2021, India had clearly entered a second COVID-19 surge unparalleled in the rest of the world, with nearly every state reporting a rapid growth in infections.…”

“…After the national lockdown ended on 31 May 2020, the central government initiated reopening through various ‘unlock’ phases while ceding future control over lockdowns and closures to individual states. Although decisions to reopen economically varied across geographies, protective behaviours—like maintaining social distance, avoiding unnecessary travel and wearing masks—remained widely encouraged; for a more in-depth look at India’s initial lockdown timeline, refer to previous work 21. During the unlock phases, caseloads remained low; however, the country subsequently experienced a spike in cases late in the summer and early fall of 2020.…”

Integrated health service delivery during COVID-19: a scoping review of published evidence from low-income and lower-middle-income countries

“…Improving or expanding case surveillance, contact tracing, communications campaigns, combating misinformation and maintaining access to essential health services were established as the risk mitigation strategies. [5][6][7] However, the fragmented nature of health service delivery in L-LMICs poses extraordinary challenges to meet the dual goal of pandemic response and routine service continuity. 8 Integrated health service delivery during CoVId-19 pandemic Integrated, people-centred health systems are increasingly considered a central component of Universal Health Coverage and are globally recognised with an adopted resolution of the 69th World Health Assembly in 2016.…”