Influence of Seasonality and Public-Health Interventions on the COVID-19 Pandemic in Northern Europe
Abstract
:1. Introduction
2. Methodology
2.1. Data
2.2. Statistical Analysis
2.3. Study Area
2.4. Describing the Progression of the COVID-19 Pandemic for Each Country
3. Results and Discussion
3.1. Influence of Non-Pharmaceutical Interventions on Pandemic Progression in Northern Europe
3.2. Influence of Vaccinations on Pandemic Progression in Northern Europe
3.3. Influence of Seasonality on Pandemic Progression in Northern Europe
3.4. Influence of Multiple Factors on Pandemic Progression in Northern Europe
4. Study Limitations and Future Research Directions
5. Conclusions and Recommendations
- The stringency of NPIs, e.g., travel restrictions, “stay-at-home” measures, mask mandates and social distancing;
- The percentage of the population fully vaccinated with COVID-19 vaccines (defined in terms of the original recommended numbers of doses for each vaccine);
- The expected seasonality of human beta-coronaviruses (since SARS-CoV-2 is a human beta-coronavirus)—using as a proxy the decadal average of human beta-coronavirus incidences in Sweden based on Swedish clinical data (2010–2020) recorded before the COVID-19 pandemic began.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
- Glossary
- Confirmed Case: most Northern European countries (Ireland, Norway, Finland and Sweden) used a positive RT-PCR test as confirmation of a case of COVID-19 regardless of whether symptoms were apparent or not, for most of the pandemic—except for the first few months while testing capacity was still being built up. The UK used a combination of RT-PCR and antigen (lateral flow device) tests to confirm positive cases. According to Our World in Data, the case definition for Denmark remained unclear but was defined by the Danish State Serum Institute (SSI) as a person testing positive for COVID-19 antigen who was registered by the sampling date [89,122]. The reported case figures on a given date do not necessarily show the number of new cases on that day—this is due to delays in reporting, additionally, the actual number of cases is likely to be much higher than the number of confirmed cases—due to limited testing [89].
- Death: the definition of COVID-19 death varied between Northern European countries, e.g., in the UK, deaths were published for people who died up to 28 days after having a positive COVID test or if COVID-19 was recorded on their death certificate [90]. In Ireland “COVID-19 deaths include deaths in all possible, probable and confirmed COVID-19 cases (as per the COVID-19 case definition)—unless there is a clear alternative cause of death that cannot be related to COVID-19 infection (e.g., trauma). There should be no period of complete recovery from COVID-19 between the illness and death” [123]. In Denmark, Sweden and Norway, a death with COVID-19 was defined as a death occurring ≤30 days after a positive SARS-CoV-2 test, regardless of reported cause of death [122,124]. Nonetheless, broadly speaking, these definitions refer to “deaths with COVID-19” [89,90]. Establishing what subset of these deaths were “deaths from COVID-19” or even deaths where COVID-19 was a major factor is still a matter of debate [75,91].
- Positivity rate: the proportion of reported RT-PCR tests returning a positive result [89].
- Stringency index: the stringency index is a composite measure of nine metrics: school closures; workplace closures; cancellation of public events; restrictions on public gatherings; closures of public transport; stay-at-home requirements; public information campaigns; restrictions on internal movements; and international travel controls. The index is on a scale from 0 to 100 (100 = strictest). For further details on its construction, see Hale et al., 2021 [4].
- Fully vaccinated individuals: defined as the fraction of population who received all doses prescribed by the initial vaccination protocol. This equates to one dose for the Johnson & Johnson DNA vaccine [8]; two doses for the Oxford/AstraZeneca DNA vaccine [7] and two doses for the Pfizer/BioNTech [5] or Moderna mRNA [6] vaccines. This definition does not consider “boosters”. Typically, people are not considered vaccinated until 14 days after the final dose.
- Time-lagged death: a time-lagged measurement of death due to COVID-19 (per 100,000 of the population) was used to estimate the probable time period between infection and death. This is an especially useful metric because it is because it is a proxy for a subset of infections. Although there are a wide variety of estimates of the average time from infection to death (in cases that end in death), we chose a period of 3 weeks, which is commonly used in other analyses [2,37,86].
- Hospitalised patients: median number of patients in hospital due to COVID-19 on a given week per 100,000 of the population [89]. In Denmark, hospitalisation with COVID-19 was defined as a patient hospitalised for at least 12 h or any length of time in intensive care during the 14 days following sampling date of a positive SARS-CoV-2 test or as a patient testing positive during hospitalisation [122].
- Intensive care unit (ICU) occupancy: median number of patients in ICU due to COVID-19 in a given week [89].
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Northern European Countries | NPIs | Vaccination | Seasonality |
---|---|---|---|
Ireland | x | x | ✓ |
UK | x | x | ✓ |
Sweden | x | x | ✓ |
Denmark | x | x | ✓ |
Finland | x | x | ✓ |
Norway | x | x | ✓ |
Northern European Countries | NPIs | Vaccination | Seasonality |
---|---|---|---|
Ireland | x | x | ✓ |
UK | x | x | ✓ |
Sweden | x | x | ✓ |
Denmark | x | x | ✓ |
Finland | x | x | ✓ |
Norway | x | x | ✓ |
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Quinn, G.A.; Connolly, M.; Fenton, N.E.; Hatfill, S.J.; Hynds, P.; ÓhAiseadha, C.; Sikora, K.; Soon, W.; Connolly, R. Influence of Seasonality and Public-Health Interventions on the COVID-19 Pandemic in Northern Europe. J. Clin. Med. 2024, 13, 334. https://doi.org/10.3390/jcm13020334
Quinn GA, Connolly M, Fenton NE, Hatfill SJ, Hynds P, ÓhAiseadha C, Sikora K, Soon W, Connolly R. Influence of Seasonality and Public-Health Interventions on the COVID-19 Pandemic in Northern Europe. Journal of Clinical Medicine. 2024; 13(2):334. https://doi.org/10.3390/jcm13020334
Chicago/Turabian StyleQuinn, Gerry A., Michael Connolly, Norman E. Fenton, Steven J. Hatfill, Paul Hynds, Coilín ÓhAiseadha, Karol Sikora, Willie Soon, and Ronan Connolly. 2024. "Influence of Seasonality and Public-Health Interventions on the COVID-19 Pandemic in Northern Europe" Journal of Clinical Medicine 13, no. 2: 334. https://doi.org/10.3390/jcm13020334