The Effect of Strict State Measures on the Epidemiologic Curve of Covid-19 Infection in the Context of a Developing Country: A Simulation From Jordan

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> COVID-19 has posed an unprecedented global public health threat and caused a significant number of severe cases that necessitated long hospitalization and overwhelmed the health services in most affected countries. In response, the governments initiated a series of non-pharmaceutical interventions (NPIs) that led to severe economic and social impacts. The effect of these intervention measures on the spread of the COVID-19 pandemic are not well investigated within developing countries settings. This study simulated the trajectories of COVID-19 epidemic curve Jordan and assessed the effect of Jordan’s strict NPI measures on the spread of COVID-19. <jats:bold>Methods: </jats:bold>A modified Susceptible, Exposed, Infected, and Recovered (SEIR) epidemic model was utilized. The compartments in the proposed model categorized Jordan population into six deterministic compartments; Suspected, Exposed, Infectious Pre-symptomatic, Infectious with Mild Symptoms, Infectious with Moderate to Severe Symptoms, and Recovered. GLEAMviz client simulator was used to run the simulation model. Epidemic curves were plotted for estimated COVID-19 cases in the simulation model, and compared against the reported cases. <jats:bold>Results: </jats:bold>The simulation model estimated the highest number of total daily new COVID-19 cases, in the pre-symptomatic compartmental state, to be 65 cases, with an epidemic curve growing to its peak in 49 days and terminating in a duration of 83 days, and a total number of simulated cumulative case count of 1,048 cases. The curve representing the number of actual reported cases in Jordan showed a good pattern compatibility to that in the mild and moderate to severe compartmental states. Reproduction number under the NPIs was reduced from 5.6 to less than one. <jats:bold>Conclusion: </jats:bold>NPIs in Jordan were effective in controlling the COVID-19 epidemic and reducing the reproduction rate. Early strict intervention measures showed evidence of containing and suppressing the disease.</jats:p>

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“…Several countries, including Jordan, adopted strict Non-Pharmaceutical Intervention (NPI) measures in attempts to achieve containment of the disease and to flatten the COVID-19 epidemiologic curve [ 3 ]. Globally, higher educational institutions have, fully or partially, closed their campuses to limit the rapid spread of SARS-CoV-2 infection.…”

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“…Accordingly, a countrywide strict lockdown and nationwide curfew were imposed. This curfew prohibited the movement of people, implemented a stay-at-home policy, stopped public, social, and religious events, closed all shops, and suspended both governmental and non-governmental institutions except for vital sectors [ 1 , 3 ]. During the early couple of days of the curfew, the residents were prevented from leaving their homes except for the health emergencies only [ 3 ].…”

“…This curfew prohibited the movement of people, implemented a stay-at-home policy, stopped public, social, and religious events, closed all shops, and suspended both governmental and non-governmental institutions except for vital sectors [ 1 , 3 ]. During the early couple of days of the curfew, the residents were prevented from leaving their homes except for the health emergencies only [ 3 ]. Then, they were allowed five specific days per week to move around and walk in their geographic boundaries between 10 a.m. and 6 p.m. [ 3 ].…”

“…During the early couple of days of the curfew, the residents were prevented from leaving their homes except for the health emergencies only [ 3 ]. Then, they were allowed five specific days per week to move around and walk in their geographic boundaries between 10 a.m. and 6 p.m. [ 3 ]. People who were found in violation of the curfew order would be immediately imprisoned for up to a year.…”

“…Although these strict state NPI measures including lockdown and curfew were successful in combating the spread of the infection [ 1 , 3 ] ( Fig. 1 ), they had major impacts on the population including difficulty in reaching their daily needs, the inability of individuals with chronic medical illnesses to reach their medications’ supplies, and obstacle dealing with health emergencies as well as the psychological impact of the COVID-19 outbreak and its related lockdown measures and the home quarantine of unknown duration on the general population.…”