Social distancing, population density and spread of COVID-19 in England: longitudinal study

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Background: The UK government introduced social distancing measures between March 16-22, 2020, aiming to slow down transmission of COVID-19. Aim: To explore the spreading of COVID-19 in relation to population density after the introduction of social distancing measures. Design & setting: Longitudinal design with 5 weekly COVID-19 incidence rates per 100,000 for 149 English Upper Tier Local Authorities (UTLAs), March 16-April 19. Method: Multivariable multilevel model to analyse weekly incidence rates per 100,000; time was level-1 unit and UTLA level-2 unit. Population density was divided into quartiles. The model included an interaction between week and population density. Potential confounders: percentage aged 65+, percentage non-white British, percentage in two highest classes of the National Statistics Socio-economic Classification. Co-variates: male life expectancy at birth, COVID-19 prevalence rate per 100,000 on March 15. Confounders and co-variates were standardized around the mean. Results: Incidence rates per 100,000 peaked in the week of March 30-April 5, showing higher adjusted incidence rate per 100,000 (46.2; 95% confidence interval (95%CI) 40.6-51.8) in most densely populated ULTAs (quartile 4) than in less densely populated ULTAs (quartile 1: 33.3, 95%CI 27.4-37.2; quartile 2: 35.9, 95%CI 31.6-40.1). Thereafter, incidence rate dropped in the most densely populated ULTAs resulting in rate of 22.4 (95%CI 16.9-28.0) in the week of April 13-19; this was lower than in quartiles 1, 2, and 3, respectively 31.4 (95%CI 26.5-36.3), 34.2 (95%CI 29.9-38.5), and 43.2 (39.0-47.4). Conclusion: After the introduction of social distancing measures, the incidence rates per 100,000 dropped strongest in most densely populated ULTAs.
Original languageEnglish
Number of pages5
JournalBritish Journal of General Practice Open
Publication statusAccepted/In press - 28 Jun 2020

Bibliographical note

Article in the top 10 BJGP Open most read research list for 2020

Structured keywords

  • Covid19


  • COVID-19
  • incidence rate
  • population density
  • primary healthcare
  • social distancing
  • England


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