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Title: Estimating the COVID-19 spread through real-time population mobility patterns : surveillance in low- and middle-income countries
Authors: Tyrovolas, S 
Giné-Vázquez, I
Fernández, D
Morena, M
Koyanagi, A
Janko, M
Haro, JM
Yang, L 
Lee, P 
Pan, W
Panagiotakos, D
Molassiotis, A 
Issue Date: Jun-2021
Source: Journal of medical Internet research, 14 June 2021, v. 23, no. 6, e22999
Abstract: Background: On January 21, 2020, the World Health Organization reported the first case of severe acute respiratory syndrome coronavirus 2, which rapidly evolved to the COVID-19 pandemic. Since then, the virus has also rapidly spread among Latin American, Caribbean, and African countries.
Objective: The first aim of this study is to identify new emerging COVID-19 clusters over time and space (from January 21 to mid-May 2020) in Latin American, Caribbean, and African regions, using a prospective space–time scan measurement approach. The second aim is to assess the impact of real-time population mobility patterns between January 21 and May 18, 2020, under the implemented government interventions, measurements, and policy restrictions on COVID-19 spread among those regions and worldwide.
Methods: We created a global COVID-19 database, of 218 countries and territories, merging the World Health Organization daily case reports with other measures such as population density and country income levels for January 21 to May 18, 2020. A score of government policy interventions was created for low, intermediate, high, and very high interventions. The population’s mobility patterns at the country level were obtained from Google community mobility reports. The prospective space–time scan statistic method was applied in five time periods between January and May 2020, and a regression mixed model analysis was used.
Results: We found that COVID-19 emerging clusters within these five periods of time increased from 7 emerging clusters to 28 by mid-May 2020. We also detected various increasing and decreasing relative risk estimates of COVID-19 spread among Latin American, Caribbean, and African countries within the period of analysis. Globally, population mobility to parks and similar leisure areas during at least a minimum of implemented intermediate-level control policies (when compared to low-level control policies) was related to accelerated COVID-19 spread. Results were almost consistent when regional stratified analysis was applied. In addition, worldwide population mobility due to working during high implemented control policies and very high implemented control policies, when compared to low-level control policies, was related to positive COVID-19 spread.
Conclusions: The prospective space–time scan is an approach that low-income and middle-income countries could use to detect emerging clusters in a timely manner and implement specific control policies and interventions to slow down COVID-19 transmission. In addition, real-time population mobility obtained from crowdsourced digital data could be useful for current and future targeted public health and mitigation policies at a global and regional level.
Keywords: COVID-19
Digital public health
Emerging countries
Low and middle-income countries
Mobile data
Social distancing
Publisher: JMIR Publications, Inc.
Journal: Journal of medical Internet research 
ISSN: 1439-4456
EISSN: 1438-8871
DOI: 10.2196/22999
Rights: © Stefanos Tyrovolas, Iago Giné-Vázquez, Daniel Fernández, Marianthi Morena, Ai Koyanagi, Mark Janko, Josep Maria Haro, Yang Lin, Paul Lee, William Pan, Demosthenes Panagiotakos, Alex Molassiotis. Originally published in the Journal of Medical Internet Research (, 14.06.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
The following publication Tyrovolas S, Giné-Vázquez I, Fernández D, Morena M, Koyanagi A, Janko M, Haro JM, Lin Y, Lee P, Pan W, Panagiotakos D, Molassiotis A Estimating the COVID-19 Spread Through Real-time Population Mobility Patterns: Surveillance in Low- and Middle-Income Countries J Med Internet Res 2021;23(6): e22999 is available at
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