The median of the national-level daily search index for Covid-19 related terms was 4, 533 (IQR (Interquartile Range)=1, 301) before theCOVID-19 outbreak (January 1 2017 to December 30 2019), and 314, 718 (IQR=445, 074) after the outbreak (December 31 2019 to March 15 2021). The median of the provincial-level search index, ranged from 63 (IQR=7) in Tibet to 1138 (IQR=302) in Guangdong before COVOD-19, and ranged from 1386 (IQR=983) in Tibet to 38, 061(IQR=45, 784) in Guangdong after the COVID-19 outbreak. The crude relative change in the median of the search index ranged from 2 099% in Tibet and 2 034% in Hainan to 3 872% in Beijing and 4 284% in Liaoning (Table 1). 89, 936 cases of SARS-COV-2 occurred nationwide (ranging from 1 case in Tibet to 68, 021 cases in Hubei) from December 31, 2020 to March 15, 2021. The number of confirmed cases outside Tibet and Hubei ranged from 18 (0.1%) in Qinghai to 2, 245 (10.6%) in Guangdong province. In conjunction with these search patterns, 13%, 76% and 11% of confirmed Covid-19 cases were reported in January 2020, February 2020 and from March 2020 to March 2021 respectively.
As shown in Table 2, there was a 10% (relative risk (RR)=1.10, 95% CI 1.071.13, p<0.0001), 11% (RR=1.11, 95% CI 1.081.14, p<0.0001) and 13% (RR=1.13, 95% CI 1.101.16, p<0.0001) annual increase in the search index before the pandemic among regions with low, middle and high HDI respectively. The difference in pre-Covid-19 trends of the search index among the three HDI groups was not statistically significant (middle vs. low, ratio of RR=1.01, p=0.6188; high vs. low, ratio of RR=1.03, p=0.2239) (Table 2, Fig.1).
Baidu search index by province and number of new confirmed cases over time. (A) Observed daily search index (log transformed) by province and HDI category over time. Aggregated search index by HDI category over time is shown in Fig. S1. (B) Daily new confirmed COVID-19 in China (cases in Hubei provinces are excluded).
During the initial wave, the search index increased by 41%, 62% and 58% on December 31, 2019 among regions with low (RR=1.41, 95% CI 1.341.49, p<0.0001), middle (RR=1.62, 95% CI 1.541.70, p<0.0001) and high (RR=1.58, 95% CI 1.481.68, p<0.0001) HDI, respectively. The immediate increase in middle and high HDI regions was statistically significantly higher than the increase in low HDI regions (middle vs. low, ratio of RR=1.15, p=0.0002; high vs. low, ratio of RR=1.12, p=0.0091).
Similarly, there was a 107-fold, 125-fold and 125-fold increase in search index between January 18 and January 25 2020, the period shortly after the official announcement of human-to-human transmission (HHT), among regions with low (RR=106.8, 95% CI 100.1114.0, p<0.0001), middle (RR=124.6, 95% CI 117.6131.9, p<0.0001) and high (RR=125.3, 95% CI 116.5134.8, p<0.0001) HDI, respectively. The immediate increase in this short period among middle and high HDI regions were statistically significantly higher than the increase in low HDI regions (middle vs. low, ratio of RR=1.16, p=0.0004; high vs. low, ratio of RR=1.17, p=0.0012). From the peak of the search index on January 25 to June 10 2020, a 10%, 11% and 11% decrease per week was observed in the search index among regions with low (RR=0.90, 95% CI 0.890.90, p<0.0001), middle (RR=0.89, 95% CI 0.880.89, p<0.0001) and high (RR=0.89, 95% CI 0.890.90, p<0.0001) HDI, respectively (Table 2).
The outbreak in Beijing was associated with a 91%, 34% and 112% increase in the search index among regions with low (RR=1.91, 95% CI 1.792.03, p<0.0001), middle (RR=1.34, 95% CI 1.261.42, p<0.0001) and high (RR=2.12, 95% CI 1.982.27, p<0.0001) HDI, respectively, in the first week (June 1117 2020) of the outbreak. Additionally, the Beijing outbreak was associated with an increase in the monthly change rate of the search index. From June 17 to October 11 2020, a 4% decrease, 2% increase and 6% decrease per month in the search index was observed among regions with low (RR=0.96, 95% CI 0.950.96, p<0.0001), middle (RR=1.02, 95% CI 1.011.02, p<0.0001) and high (RR=0.94, 95% CI 0.930.94, p<0.0001) HDI, respectively (Table 2).
The Qingdao outbreak was associated with a comparable 31%, 34% and 41% immediate increase in the search index among regions with low (RR=1.31, 95% CI 1.231.40, p<0.0001), middle (RR=1.34, 95% CI 1.261.42, p<0.0001) and high (RR=1.41, 95% CI 1.311.52, p<0.0001) HDI, respectively. In the winter wave after the Qingdao outbreak, search index increased by 1%, 2% and 2% per week among regions with low (RR=1.01, 95% CI 1.001.01, p=0.0647), middle (RR=1.02, 95% CI 1.011.02, p<0.0001) and high (RR=1.02, 95% CI 1.011.03, p=0.0002) HDI, respectively.
The Shijiazhuang outbreak in January 2021 was associated with a 100%, 167% and 145% immediate increase in search index among regions with low (RR=2.00, 95% CI 1.852.16, p<0.0001), middle (RR=2.67, 95% CI 2.502.86, p<0.0001) and high (RR=2.45, 95% CI 2.242.67, p<0.0001) HDI. In regions with low HDI (middle vs. low, ratio of RR=1.34, p<0.0001; high vs. low, the ratio of RR=1.22, p=0.0007). However, the 20% and 22% weekly decrease in search index after the Shijiazhuang outbreak among regions with middle (RR=0.80, 95% CI 0.790.80, p<0.0001) and high (RR=0.78, 95% CI 0.770.79, p<0.0001) HDI, respectively, was statistically significantly greater (p<0.0001) than the 17% monthly decrease in the region with low HDI (RR=0.83, 95% CI 0.820.84, p<0.0001). Figure2 illustrated the heterogeneity in the immediate relative change in the search index following each pre-specified exposure across the country.
Immediate relative change in search index at different exposure period (A) December 31 2019, the estimated start of the first Covid-19 wave. (B) 18 January 18 2020 (official announcement of human-to-human transmission) to Jan 25 January 2020 (shortly after the lockdown and the estimated peak of daily search index in the initial Covid-19 wave). (C) Outbreak in Beijing starting on June 11 2020. (D) Outbreak in Shijiazhuang starting on January 3 2021. Specific point estimate for relative change and the corresponding 95% CIs are provided in the supplemental materials.
The results from models where HDI or its component was coded as a continuous variable were consistent with findings from our main analysis. As shown in Table S1, the pre-pandemic trends in two provinces differing in HDI, GNPPP (Gross national product per person), education year or life expectancy by one standard deviation were similar (p>0.1). The immediate relative increase in the search index in a province with one standard higher HDI was statistically higher (initial wave: ratio of RR=1.09, p<0.0001; HHT announcement: ratio of RR=1.04 p=0.0395; Beijing outbreak: ratio of RR=1.06, p=0.0090; Qingdao outbreak: ratio of RR=1.04, p=0.0324; Shijiazhuang outbreak: ratio of RR=1.11, p<0.0001). In contrast, the gradual decrease in the search index in a province with one standarddeviation higher HDI after each exposure was either similar or greater. For each exposure, the difference associated with GNPPP, education year or life expectancy in the directions and magnitudes of both immediate and gradual effect across provinces was similar to the difference associated with HDI.
Excerpt from:
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