Policy Responses Against the COVID-19 Pandemic in Latin America: Interrupted Series Analyses of Local Governments

The COVID-19 pandemic is spreading rapidly worldwide. Latin America, the region with the highest income inequality, remains as one of the worst-hit areas worldwide. Despite accounting for 8.4% of the global population, Latin America has witnessed 20.3% of the total SARS-COV-2 cases and 30.2% of the COVID-19 deaths to date. Several countries in the region are among the worst-hit worldwide. Brazil has had more than 11 million SARS-COV-2 cases and Mexico, Argentina and Colombia have exceeded the 2 million cases each. Similarly, the five most populated countries in the region (Brazil, Argentina, Mexico, Colombia and Peru) exceed 600,000 SARS-COV-2-related deaths. The pandemic reached Latin America later than other continents, and the first case of COVID-19 in the region was reported in Brazil on February 26, followed by a case in Mexico on February 28, 2020 and subsequently spreading throughout the region during March 2020.

Policy responses to COVID-19 in Latin America have sought to reduce viral spread, increase the capacity of the health system response, mitigate negative consequences, and strengthen governance. Effectiveness studies of social distancing policies in China, India, European countries, the United States and worldwide have shown that these appear to be effective to reduce viral transmission.

Despite the heavy burden of the COVID-19 in Latin American countries, there have been few studies examining the effectiveness of COVID-19 policies. Likewise, few studies have explored variation at the local level in the effectiveness of COVID-19 policies. Inequalities in policy effectiveness can arise due to within-country differences at the local level due to their geographical, sociodemographic, mobility patterns, and governance differences. In Latin America, high levels of poverty, urban density, household crowding, lack of safety nets, unemployment and precarious work cluster geographically and coexist with structural inequities in governance and built environments, thus creating barriers for effective compliance with preventive recommendations and for the implementation of well-functioning contact tracing and isolation mechanisms. Understanding the effectiveness of policies at the local level and exploring potential explanations for effect heterogeneity is essential to reduce the burden of the ongoing COVID-19 pandemic and inform the preparedness for future pandemics.

In this study, the investigators aim, first, to estimate the effectiveness of nonpharmaceutical interventions on SARS-COV2 transmission and COVID-19 mortality in Latin America; second, to examine the effect heterogeneity of transmission and mortality at the local level. Third, assuming there is evidence of moderate to substantial heterogeneity at the local level, the investigators aim to explore potential explanations for this heterogeneity. The study will use an interrupted time series method to estimate their effects in each local government, and random effects meta-analysis and meta-regression to obtain pooled effects, heterogeneity estimates and potential explanations.

Methods Design and setting: Natural experiment exploiting the variation in the temporal and spatial implementation of policy interventions, aimed to reduce the spread and mortality of COVID-19 in Latin America. The unit of analysis are local governments, i.e. third-tier administrative levels such as municipalities, districts or cantons.