Impact of adherence and stringency on the effectivenessof lockdown measures: a modelling study

During the COVID-19 pandemic, lockdowns were a widely used strategy to reduce disease transmission. However, there was much debate about the optimal level of strictness and duration of lockdowns. This study considers how lockdowns impact public health opinions, which in turn influence adherence to and effectiveness of these measures. We developed an agent-based simulation model to make a theoretical exploration of the impact of health-related opinions on the effectiveness of lockdowns in controlling disease spread. We simulated these dynamics within a hypothetical population connected via a simplified contact network (Watts-Strogatz), incorporating feedback loops between disease prevalence, opinions, and behaviour, including lockdown fatigue. We explored different scenarios of lockdown implementation in our hypothetical population network by varying a threshold value of prevalence when a lockdown is initiated and the stringency of the lockdown. Our qualitative findings imply that quickly imposing a lockdown with high stringency is the most effective at reducing infection spread, provided that there is a certain degree of adherence to the lockdown among the population. Furthermore, stricter lockdowns minimize fatigue with respect to the imposed measures, since the duration of a lockdown is shorter on average in this scenario. These theoretical results imply that such lockdown policies might therefore be a beneficial, high-impact tool in containing epidemic spread, especially when supplemented by information interventions maintaining the adherence to lockdown measures. Author summaryLockdowns were a widely used strategy to curb disease transmission during the COVID-19 pandemic. However, the effectiveness of such measures depends on the populations adherence to the regulations. Long and strict lockdowns may lower this adherence as the population experiences fatigue with the regulations. In our study, we model the interplay between lockdowns, disease transmission, and health-related opinions in a population network. We tested various lockdown scenarios by altering strictness of measures on the one hand, and lockdown initiation times based on disease prevalence rates on the other hand. Our findings show that swift, stringent lockdowns are the most effective in reducing infections, particularly with strong public compliance. Additionally, stricter lockdowns tend to reduce fatigue as they are generally shorter. These results highlight that prompt, rigorous lockdown policies, supported by strategies to maintain public adherence, are most efficient in controlling epidemics. Furthermore, effective communication to ensure community cooperation may enhance the success of these measures.