Barbeito, InésPrecioso, DanielSierra, María JoséVegas-Azcárate, SusanaFernández-Balbuena, SoniaVitoriano, BegoñaGómez-Ullate, DavidCao, RicardoMonge, Susana2023-05-192023-05-192023Barbeito I, Precioso D, Sierra MJ, Vegas-Azcárate S, Fernández Balbuena S, Vitoriano B, Goméz-Ullate D, Cao R, Monge S and the Study Group for Non-Pharmaceutical Interventions in Spain (2023) Effectiveness of non-pharmaceutical interventions in nine fields of activity to decrease SARS-CoV-2 transmission (Spain, September 2020–May 2021). Front. Public Health 11:1061331. doi: 10.3389/fpubh.2023.10613312296-2565http://hdl.handle.net/2183/33102[Abstract]: Background: We estimated the association between the level of restriction in nine different fields of activity and SARS-CoV-2 transmissibility in Spain, from 15 September 2020 to 9 May 2021. Methods: A stringency index (0–1) was created for each Spanish province (n = 50) daily. A hierarchical multiplicative model was fitted. The median of coefficients across provinces (95% bootstrap confidence intervals) quantified the effect of increasing one standard deviation in the stringency index over the logarithmic return of the weekly percentage variation of the 7-days SARS-CoV-2 cumulative incidence, lagged 12 days. Results: Overall, increasing restrictions reduced SARS-CoV-2 transmission by 22% (RR = 0.78; one-sided 95%CI: 0, 0.82) in 1 week, with highest effects for culture and leisure 14% (0.86; 0, 0.98), social distancing 13% (0.87; 0, 0.95), indoor restaurants 10% (0.90; 0, 0.95) and indoor sports 6% (0.94; 0, 0.98). In a reduced model with seven fields, culture and leisure no longer had a significant effect while ceremonies decreased transmission by 5% (0.95; 0, 0.96). Models R2 was around 70%. Conclusion: Increased restrictions decreased COVID-19 transmission. Limitations include remaining collinearity between fields, and somewhat artificial quantification of qualitative restrictions, so the exact attribution of the effect to specific areas must be done with caution. Copyright © 2023 Barbeito, Precioso, Sierra, Vegas-Azcárate, Fernández Balbuena, Vitoriano, Goméz-Ullate, Cao, Monge and the Study Group for Non-Pharmaceutical Interventions in Spain.engAtribución 3.0 Españahttp://creativecommons.org/licenses/by/3.0/es/COVID-19EffectivenessHierarchical modelsLogarithmic returnNon-pharmaceutical interventions (NPI)PandemicSARS-CoV-2Stringency indexjournal articleopen access