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      A comparative analysis of COVID-19 physical distancing policies in South Africa and Uganda

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          Abstract

          COVID-19 responses internationally have depended on physical distancing policies to manage virus transmission, given the initial absence of treatments and limitations on vaccine availability. Different jurisdictions have different contexts affecting their responses such as past epidemic experience, ratings of epidemic preparedness, and income level. COVID-19 responses in African countries have not been well-studied. A qualitative multiple embedded case study design was used to examine the COVID-19 policies in South Africa and Uganda from January 2020 to November 2021. This study included a documentary review using government websites and reports, news articles, and peer-reviewed journal articles to obtain data on policy responses and contextual factors. Epidemiological data were collected from public sources. Key informant interviews with relevant stakeholders were used to confirm findings and cover missing information. A comparative analysis was conducted to explore differences in implementation of different types of physical distancing policies and potential consequences of lifting or prolonging public health measures. South African and Ugandan policy responses included physical distancing measures such as lockdown, international travel bans, school closures, public transportation measures, and curfew, in addition to socioeconomic relief programs and vaccinations. Differences between jurisdiction policy responses existed in terms of overarching strategy, timing, and stringency. This study provided in-depth comparisons of COVID-19 policy responses and relevant contextual factors in South Africa and Uganda. The study showed how contextual factors such as population age, geographic distribution, and recent epidemic response experience can influence COVID-19 transmission and response. The study also showed differences in overall strategy, timing, and strictness of epidemic management policies in these jurisdictions. These findings suggest it may be important to have sustained, strict measures to limit the spread of COVID-19 and manage the course of a pandemic, which need to be further explored alongside other important social and economic pandemic outcomes.

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          Most cited references14

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          Gender Differences in Patients With COVID-19: Focus on Severity and Mortality

          Objective: The recent outbreak of Novel Coronavirus Disease (COVID-19) is reminiscent of the SARS outbreak in 2003. We aim to compare the severity and mortality between male and female patients with COVID-19 or SARS. Study Design and Setting: We extracted the data from: (1) a case series of 43 hospitalized patients we treated, (2) a public data set of the first 37 cases of patients who died of COVID-19 and 1,019 patients who survived in China, and (3) data of 524 patients with SARS, including 139 deaths, from Beijing in early 2003. Results: Older age and a high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. Age was comparable between men and women in all data sets. In the case series, however, men's cases tended to be more serious than women's (P = 0.035). In the public data set, the number of men who died from COVID-19 is 2.4 times that of women (70.3 vs. 29.7%, P = 0.016). In SARS patients, the gender role in mortality was also observed. The percentage of males were higher in the deceased group than in the survived group (P = 0.015). Conclusion: While men and women have the same prevalence, men with COVID-19 are more at risk for worse outcomes and death, independent of age.
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            A global database of COVID-19 vaccinations

            An effective rollout of vaccinations against COVID-19 offers the most promising prospect of bringing the pandemic to an end. We present the Our World in Data COVID-19 vaccination dataset, a global public dataset that tracks the scale and rate of the vaccine rollout across the world. This dataset is updated regularly and includes data on the total number of vaccinations administered, first and second doses administered, daily vaccination rates and population-adjusted coverage for all countries for which data are available (169 countries as of 7 April 2021). It will be maintained as the global vaccination campaign continues to progress. This resource aids policymakers and researchers in understanding the rate of current and potential vaccine rollout; the interactions with non-vaccination policy responses; the potential impact of vaccinations on pandemic outcomes such as transmission, morbidity and mortality; and global inequalities in vaccine access.
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              Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries

              Abstract Objective To evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally. Design Natural experiment using interrupted time series analysis, with results synthesised using meta-analysis. Setting 149 countries or regions, with data on daily reported cases of covid-19 from the European Centre for Disease Prevention and Control and data on the physical distancing policies from the Oxford covid-19 Government Response Tracker. Participants Individual countries or regions that implemented one of the five physical distancing interventions (closures of schools, workplaces, and public transport, restrictions on mass gatherings and public events, and restrictions on movement (lockdowns)) between 1 January and 30 May 2020. Main outcome measure Incidence rate ratios (IRRs) of covid-19 before and after implementation of physical distancing interventions, estimated using data to 30 May 2020 or 30 days post-intervention, whichever occurred first. IRRs were synthesised across countries using random effects meta-analysis. Results On average, implementation of any physical distancing intervention was associated with an overall reduction in covid-19 incidence of 13% (IRR 0.87, 95% confidence interval 0.85 to 0.89; n=149 countries). Closure of public transport was not associated with any additional reduction in covid-19 incidence when the other four physical distancing interventions were in place (pooled IRR with and without public transport closure was 0.85, 0.82 to 0.88; n=72, and 0.87, 0.84 to 0.91; n=32, respectively). Data from 11 countries also suggested similar overall effectiveness (pooled IRR 0.85, 0.81 to 0.89) when school closures, workplace closures, and restrictions on mass gatherings were in place. In terms of sequence of interventions, earlier implementation of lockdown was associated with a larger reduction in covid-19 incidence (pooled IRR 0.86, 0.84 to 0.89; n=105) compared with a delayed implementation of lockdown after other physical distancing interventions were in place (pooled IRR 0.90, 0.87 to 0.94; n=41). Conclusions Physical distancing interventions were associated with reductions in the incidence of covid-19 globally. No evidence was found of an additional effect of public transport closure when the other four physical distancing measures were in place. Earlier implementation of lockdown was associated with a larger reduction in the incidence of covid-19. These findings might support policy decisions as countries prepare to impose or lift physical distancing measures in current or future epidemic waves.
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                Author and article information

                Contributors
                Role: Formal analysisRole: InvestigationRole: VisualizationRole: Writing – original draft
                Role: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                3 July 2024
                2024
                : 4
                : 7
                : e0003170
                Affiliations
                [1 ] Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
                [2 ] Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada
                The University of British Columbia, CANADA
                Author notes

                The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0009-0003-0107-2110
                https://orcid.org/0000-0002-1237-6369
                https://orcid.org/0000-0003-2333-0144
                Article
                PGPH-D-23-02580
                10.1371/journal.pgph.0003170
                11221695
                38959235
                419f28e9-2511-4a66-8cfd-04ee449681a6
                © 2024 Mohammad et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 January 2024
                : 26 May 2024
                Page count
                Figures: 3, Tables: 3, Pages: 27
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                People and Places
                Geographical Locations
                Africa
                Uganda
                People and places
                Geographical locations
                Africa
                South Africa
                Medicine and Health Sciences
                Public and Occupational Health
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Social Sciences
                Political Science
                Public Policy
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Infectious Disease Control
                Vaccines
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                Custom metadata
                Epidemiological data on COVID-19 cases, deaths, and vaccinations are available publicly and can be downloaded from: https://ourworldindata.org/coronavirus A policy-relevant database of contextual factors and policies and in-depth individual country case reports used to inform this comparative analysis are shared publicly on the COVID-19 Policies and Epidemiology Working Group website: https://covid19-policies.healthsci.mcmaster.ca/ As part of the consent process, participants were informed that their interviews would remain confidential; therefore, original qualitative data are not available in any public repositories. Relevant excerpts from key informant interviews are included in the main text of the paper.
                COVID-19

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