Peer Review History

Original SubmissionJune 10, 2020
Decision Letter - Chiara Lazzeri, Editor

PONE-D-20-17348

The basic reproduction number can be accurately estimated within 14 days after societal lockdown: The early stage of the COVID-19 epidemic in Denmark

PLOS ONE

Dear Dr. Valentin,

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Kind regards,

Chiara Lazzeri

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

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Reviewer #1: the authors' aim was to determine "the time from a political strategy have been enforced until the effect can be accurately estimated". Furthermore they aimed to estimate the fraction of infected individuals that are symptomatic and the average infection period. the primary analysis focuses on basic reproduction number before and after lockdown. The population in study is represented by the Danish National Health authority in-patient registry.

comments:

#1 in the methods section it should be stated if Danish National Health authority in-patient registry data are available on a public repository or not.

# 2 the authors should better address in the discussion a major limitation: the analysis was made on an in-patient population and not int the whole population: how could this bias the results?

# 3 there is a couple of papers that should be interesting to discuss:

- Alexandre Hyafil , David Moriña. Analysis of the impact of lockdown on the reproduction number of the SARS-Cov-2 in Spain. Gac Sanit . 2020 May 23;S0213-9111(20)30098-4. doi: 0.1016/j.gaceta.2020.05.003. Online ahead of print.

- Greg Dropkin. COVID-19 UK Lockdown Forecasts and R 0. Front Public Health. 2020 May 29;8:256. doi: 10.3389/fpubh.2020.00256. eCollection 2020.

Reviewer #2: Thank you for sharing your work. I find the overall theme of your work interesting. However, there are some points that should be addressed. The manuscript needs some language editing. I think with the help of a native speaker, you can signficantly improve the quality of your work. You have chosen to use the number of admitted patients, ICU admissions and deaths to calculate the basic reproduction number for COVID-19 spread; Were all of these patients confirmed as COVID-19 positive? In literature, we read about incubation times of up to 14 days. Yet you chose an icubation time of 4.7 days. Why?

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Reviewer #1: No

Reviewer #2: No

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Revision 1

Editor comments

In your revised cover letter, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

Response: We have added the following sentence to the Data sources section:

“Aggregated data is freely available for all in Statbank Denmark. Access to individual patient data can only be obtained by authorized researchers through the Danish National Health Authority, since Danish legislation prohibits unauthorized access.”

Reviewer comments

Reviewer #1:

The authors' aim was to determine "the time from a political strategy have been enforced until the effect can be accurately estimated". Furthermore they aimed to estimate the fraction of infected individuals that are symptomatic and the average infection period. the primary analysis focuses on basic reproduction number before and after lockdown. The population in study is represented by the Danish National Health authority in-patient registry.

Comment #1: in the methods section it should be stated if Danish National Health authority in-patient registry data are available on a public repository or not.

Response: Thank you for taking the time to review our manuscript. See response in editor comments.

Comment # 2: the authors should better address in the discussion a major limitation: the analysis was made on an in-patient population and not int the whole population: how could this bias the results?

Response: Thank you for addressing the lack of thoroughly discussing the limitations of our study. We have expanded the paragraph in the discussion section addressing the pros and cons of using in-patient data and deaths counts rather than the infection counts of the general public.

Comment # 3: there is a couple of papers that should be interesting to discuss:

- Alexandre Hyafil , David Moriña. Analysis of the impact of lockdown on the reproduction number of the SARS-Cov-2 in Spain. Gac Sanit . 2020 May 23;S0213-9111(20)30098-4. doi: 0.1016/j.gaceta.2020.05.003. Online ahead of print.

- Greg Dropkin. COVID-19 UK Lockdown Forecasts and R 0. Front Public Health. 2020 May 29;8:256. doi: 10.3389/fpubh.2020.00256. eCollection 2020.

Response: Thank you for expanding our reference list. We have added a paragraph to the discussion section, which addresses results of the suggested publications.

Reviewer #2:

Thank you for sharing your work. I find the overall theme of your work interesting. However, there are some points that should be addressed.

Comment #1: The manuscript needs some language editing. I think with the help of a native speaker, you can signficantly improve the quality of your work.

Response: Thank you for taking the time to comment on our manuscript. The manuscript has already been language edited by a native English speaker and have now been through a second round of language editing.

Comment #2: You have chosen to use the number of admitted patients, ICU admissions and deaths to calculate the basic reproduction number for COVID-19 spread; Were all of these patients confirmed as COVID-19 positive?

Response: Thank you for your concern. Patients were defined as COVID-19 positive according to the Danish national guidelines, which includes test for active virus (at the time all tests were administered using polymerase chain reaction (PCR) based tests) within 14 days prior to admission or several times during admission or both. Thus, patients may only have been tested positive once. We added a comment regarding this issue to the data sources section.

Comment #3: In literature, we read about incubation times of up to 14 days. Yet you chose an icubation time of 4.7 days. Why?

Response: Thank you for your concern. We agree that the reported incubation time is varying substantially between publications. However, it is not possible to infer the incubation time from our dataset, thus, we reviewed the publications, for which the authors claim to have estimated the incubation time. Based on this review we chose the incubation time from the study, which we believe is the most scientifically rigorous.

Decision Letter - Chiara Lazzeri, Editor

The basic reproduction number can be accurately estimated within 14 days after societal lockdown: The early stage of the COVID-19 epidemic in Denmark

PONE-D-20-17348R1

Dear Dr. Valentin,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Chiara Lazzeri

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Formally Accepted
Acceptance Letter - Chiara Lazzeri, Editor

PONE-D-20-17348R1

The basic reproduction number can be accurately estimated within 14 days after societal lockdown: The early stage of the COVID-19 epidemic in Denmark

Dear Dr. Valentin:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Chiara Lazzeri

Academic Editor

PLOS ONE

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