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. 2020 Dec 18;17(24):9520.
doi: 10.3390/ijerph17249520.

COVID-19 Policy Differences across US States: Shutdowns, Reopening, and Mask Mandates

Xue Zhang  1   2 , Mildred E Warner  1   2
Affiliations

COVID-19 Policy Differences across US States: Shutdowns, Reopening, and Mask Mandates

Xue Zhang et al. Int J Environ Res Public Health. .

Abstract

This work used event study to examine the impact of three policies (shutdowns, reopening, and mask mandates) on changes in the daily COVID-19 infection growth rate at the state level in the US (February through August 2020). The results show the importance of early intervention: shutdowns and mask mandates reduced the COVID-19 infection growth rate immediately after being imposed statewide. Over the longer term, mask mandates had a larger effect on flattening the curve than shutdowns. The increase in the daily infection growth rate pushed state governments to shut down, but reopening led to significant increases in new cases 21 days afterward. The results suggest a dynamic social distancing approach: a shutdown for a short period followed by reopening, combined with universal mask wearing. We also found that the COVID-19 growth rate increased in states with higher percentages of essential workers (during reopening) and higher percentages of minorities (during the mask mandate period). Health insurance access for low-income workers (via Medicaid expansion) helped to reduce COVID-19 cases in the reopening model. The implications for public health show the importance of access to health insurance and mask mandates to protect low-income essential workers, but minority groups still face a higher risk of infection during the pandemic.

Keywords: COVID-19; Medicaid expansion; essential worker; mask mandate; minority; reopen; shut down; state policy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
COVID-19 daily confirmed cases (7-day rolling average); US states. Source: author’s analysis of state policy using NY Times [1,26] and CNN data [31].
Figure A1
Figure A1
COVID-19 daily confirmed cases (7-day rolling average); US states. Source: author’s analysis of state policy using NY Times [1,26] and CNN data [31].
Figure A1
Figure A1
COVID-19 daily confirmed cases (7-day rolling average); US states. Source: author’s analysis of state policy using NY Times [1,26] and CNN data [31].
Figure 1
Figure 1
Policy implementation period and COVID-19 daily new infections, US. Note: earliest policy start date to latest policy start date across 50 US states. Source: author’s analysis of state policy using NY Times [1,26] and CNN data [31].
Figure 2
Figure 2
Relation between state policies and COVID-19 daily infection growth rate before/after implementation. Source: significant coefficient results from Table 3; 50 US states; February through August 2020.
See this image and copyright information in PMC

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