Abstract
BACKGROUND: During the second wave of COVID-19 in August 2020, the Tokyo Metropolitan Government implemented public health and social measures to reduce on-site dining. Assessing the associations between human behavior, infection, and social measures is essential to understand achievable reductions in cases and identify the factors driving changes in social dynamics. OBJECTIVE: The aim of this study was to investigate the association between nighttime population volumes, the COVID-19 epidemic, and the implementation of public health and social measures in Tokyo. METHODS: We used mobile phone location data to estimate populations between 10 PM and midnight in seven Tokyo metropolitan areas. Mobile phone trajectories were used to distinguish and extract on-site dining from stay-at-work and stay-at-home behaviors. Numbers of new cases and symptom onsets were obtained. Weekly mobility and infection data from March 1 to November 14, 2020, were analyzed using a vector autoregression model. RESULTS: An increase in the number of symptom onsets was observed 1 week after the nighttime population volume increased (coefficient=0.60, 95% CI 0.28 to 0.92). The effective reproduction number significantly increased 3 weeks after the nighttime population volume increased (coefficient=1.30, 95% CI 0.72 to 1.89). The nighttime population volume increased significantly following reports of decreasing numbers of confirmed cases (coefficient=-0.44, 95% CI -0.73 to -0.15). Implementation of social measures to restaurants and bars was not significantly associated with nighttime population volume (coefficient=0.004, 95% CI -0.07 to 0.08). CONCLUSIONS: The nighttime population started to increase after decreasing incidence of COVID-19 was announced. Considering time lags between infection and behavior changes, social measures should be planned in advance of the surge of an epidemic, sufficiently informed by mobility data.