Impact of Pharmaceutical and Non-pharmaceutical Interventions on COVID-19 in Tunisia

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2024 Oct 13

PMID 39396980

Authors

Hela Abroug

Cyrine Bennasrallah

Manel Ben Fredj

Meriem Kacem

Manel Ben Belgacem

Wafa Dhouib

Amel Gara

Amani Maatouk

Imen Zemni

Donia Ben Hassine

Syrine Gallas

Ines Bouanene

Asma Sriha Belguith

Affiliations

Soon will be listed here.

Abstract

Background: In COVID-19 management, a variety of pharmaceutical interventions (PI) and non- pharmaceutical interventions (NPI) were adopted to limit the spread of the disease and its associated deaths. We aimed to evaluate the impact of PI and NPI on risks of COVID-19 transmission and deaths.

Method: We collected aggregate data from March 2nd, 2020, to December 1, 2022 from the Tunisian Ministry of Health's website and OurWorldInData.org site. NPI Periods (NPIP: March 2020 to March 2021) and PI Periods (PIP) were distributed to NPIP1, 2, 3 and 4 and to PIP1, 2, 3 and 4, respectively. We calculated the Relative Risks (RR) and 95% Confidence Intervals (CI) by comparing the subsequent period with previous one.

Results: The risk of SARS-CoV-2 transmission increased progressively from the zero cases period (NPIP2) to the mitigate strategy period (NPIP3) (RR = 14.0; 95% CI: 12.4-15.8) and to the stop-and-go epidemic control period (NPIP4) (RR = 23.1 (95% CI: 22.4-23.9). It was stabilized in the targeted vaccination period (PIP1) (RR = 1.08, 95% CI: 1.07-1.08) and reduced during the mass vaccination period (PIP2) (RR: 0.50, 95% CI: 0.50-0.51). SARS-CoV-2 transmission, increased during PIP3 concomitant with the Omicron wave (RR = 2.65, 95% CI: 2.64-2.67). It remained at a low level in PIP4 (RR = 0.18; 95% CI: 0.18-0.18). Compared to NPIP2, NPIP3 and NPIP4 were associated with a higher risk of COVID-19 mortality (RR = 3.337; 95% CI: 1.797-6.195) and (RR = 72.63 (95% CI: 54.01-97.68), respectively. Since the start of the immunization program, the risk of COVID-19 death has consistently decreased. In comparison to each previous period, the risk transitioned in PIP1 to RR = 0.91; 95% CI: 0.88-0.93, then to RR = 0.85; 95% CI: 0.83-0.88 in PIP2, to RR = 0.47; 95% CI: 0.45-0.50 in PIP3, and to RR = 0.19; 95% CI: 0.18-0.24 during PIP4.

Conclusion: In terms of lowering the risk of transmission and mortality, the NP strategy at the beginning of the epidemic outperformed the IP strategy during the outbreak.

References

Cascini F, Failla G, Gobbi C, Pallini E, Hui J, Luxi W . A cross-country comparison of Covid-19 containment measures and their effects on the epidemic curves. BMC Public Health. 2022; 22(1):1765. PMC: 9482299. DOI: 10.1186/s12889-022-14088-7. View

Cai J, Hu S, Lin Q, Ren T, Chen L . China's 'dynamic zero COVID-19 strategy' will face greater challenges in the future. J Infect. 2022; 85(1):e13-e14. PMC: 9015719. DOI: 10.1016/j.jinf.2022.04.025. View

Patino-Lugo D, Velez M, Velasquez Salazar P, Vera-Giraldo C, Velez V, Marin I . Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection. Colomb Med (Cali). 2020; 51(2):e4266. PMC: 7518730. DOI: 10.25100/cm.v51i2.4266. View

Chemaitelly H, Yassine H, Benslimane F, Al Khatib H, Tang P, Hasan M . mRNA-1273 COVID-19 vaccine effectiveness against the B.1.1.7 and B.1.351 variants and severe COVID-19 disease in Qatar. Nat Med. 2021; 27(9):1614-1621. DOI: 10.1038/s41591-021-01446-y. View

Saidi O, Malouche D, Saksena P, Arfaoui L, Talmoudi K, Hchaichi A . Impact of contact tracing, respect of isolation, and lockdown in reducing the number of cases infected with COVID-19. Case study: Tunisia's response from March 22 to May 4, 2020. Int J Infect Dis. 2021; 113:26-33. PMC: 7872851. DOI: 10.1016/j.ijid.2021.02.010. View

Dagan N, Barda N, Kepten E, Miron O, Perchik S, Katz M . BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting. N Engl J Med. 2021; 384(15):1412-1423. PMC: 7944975. DOI: 10.1056/NEJMoa2101765. View

Hsiang S, Allen D, Annan-Phan S, Bell K, Bolliger I, Chong T . The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature. 2020; 584(7820):262-267. DOI: 10.1038/s41586-020-2404-8. View

Talic S, Shah S, Wild H, Gasevic D, Maharaj A, Ademi Z . 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. BMJ. 2021; 375:e068302. PMC: 9423125. DOI: 10.1136/bmj-2021-068302. View

Iezadi S, Gholipour K, Azami-Aghdash S, Ghiasi A, Rezapour A, Pourasghari H . Effectiveness of non-pharmaceutical public health interventions against COVID-19: A systematic review and meta-analysis. PLoS One. 2021; 16(11):e0260371. PMC: 8610259. DOI: 10.1371/journal.pone.0260371. View

10.

Batteux E, Mills F, Jones L, Symons C, Weston D . The Effectiveness of Interventions for Increasing COVID-19 Vaccine Uptake: A Systematic Review. Vaccines (Basel). 2022; 10(3). PMC: 8949230. DOI: 10.3390/vaccines10030386. View

11.

Radhakrishnan N, Liu M, Idowu B, Bansari A, Rathi K, Magar S . Comparison of the clinical characteristics of SARS-CoV-2 Delta (B.1.617.2) and Omicron (B.1.1.529) infected patients from a single hospitalist service. BMC Infect Dis. 2023; 23(1):747. PMC: 10617227. DOI: 10.1186/s12879-023-08714-x. View

12.

Arabi M, Al-Najjar Y, Mhaimeed N, Salameh M, Paul P, Alanni J . Severity of the Omicron SARS-CoV-2 variant compared with the previous lineages: A systematic review. J Cell Mol Med. 2023; 27(11):1443-1464. PMC: 10243162. DOI: 10.1111/jcmm.17747. View

13.

Machado A, Kislaya I, Rodrigues A, Sequeira D, Lima J, Cruz C . COVID-19 vaccine effectiveness against symptomatic SARS-CoV-2 infections, COVID-19 related hospitalizations and deaths, among individuals aged ≥65 years in Portugal: A cohort study based on data-linkage of national registries February-September.... PLoS One. 2022; 17(9):e0274008. PMC: 9469958. DOI: 10.1371/journal.pone.0274008. View

14.

Flacco M, Soldato G, Acuti Martellucci C, Carota R, Di Luzio R, Caponetti A . Interim Estimates of COVID-19 Vaccine Effectiveness in a Mass Vaccination Setting: Data from an Italian Province. Vaccines (Basel). 2021; 9(6). PMC: 8227269. DOI: 10.3390/vaccines9060628. View

15.

Chung H, He S, Nasreen S, Sundaram M, Buchan S, Wilson S . Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study. BMJ. 2021; 374:n1943. PMC: 8377789. DOI: 10.1136/bmj.n1943. View

16.

Hale T, Angrist N, Goldszmidt R, Kira B, Petherick A, Phillips T . A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker). Nat Hum Behav. 2021; 5(4):529-538. DOI: 10.1038/s41562-021-01079-8. View

17.

Harder T, Kulper-Schiek W, Reda S, Treskova-Schwarzbach M, Koch J, Vygen-Bonnet S . Effectiveness of COVID-19 vaccines against SARS-CoV-2 infection with the Delta (B.1.617.2) variant: second interim results of a living systematic review and meta-analysis, 1 January to 25 August 2021. Euro Surveill. 2021; 26(41). PMC: 8518304. DOI: 10.2807/1560-7917.ES.2021.26.41.2100920. View

18.

Salje H, Tran Kiem C, Lefrancq N, Courtejoie N, Bosetti P, Paireau J . Estimating the burden of SARS-CoV-2 in France. Science. 2020; 369(6500):208-211. PMC: 7223792. DOI: 10.1126/science.abc3517. View

19.

Paules C, Marston H, Fauci A . Coronavirus Infections-More Than Just the Common Cold. JAMA. 2020; 323(8):707-708. DOI: 10.1001/jama.2020.0757. View

20.

Diarra M, Kebir A, Talla C, Barry A, Faye J, Louati D . Non-pharmaceutical interventions and COVID-19 vaccination strategies in Senegal: a modelling study. BMJ Glob Health. 2022; 7(2). PMC: 8882665. DOI: 10.1136/bmjgh-2021-007236. View