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. 2021 Apr;51(4):e13484.
doi: 10.1111/eci.13484. Epub 2021 Feb 1.

Assessing mandatory stay-at-home and business closure effects on the spread of COVID-19

Eran Bendavid  1   2 , Christopher Oh  1 , Jay Bhattacharya  2 , John P A Ioannidis  1   3   4   5   6
Affiliations

Assessing mandatory stay-at-home and business closure effects on the spread of COVID-19

Eran Bendavid et al. Eur J Clin Invest. 2021 Apr.

Abstract

Background and aims: The most restrictive nonpharmaceutical interventions (NPIs) for controlling the spread of COVID-19 are mandatory stay-at-home and business closures. Given the consequences of these policies, it is important to assess their effects. We evaluate the effects on epidemic case growth of more restrictive NPIs (mrNPIs), above and beyond those of less-restrictive NPIs (lrNPIs).

Methods: We first estimate COVID-19 case growth in relation to any NPI implementation in subnational regions of 10 countries: England, France, Germany, Iran, Italy, Netherlands, Spain, South Korea, Sweden and the United States. Using first-difference models with fixed effects, we isolate the effects of mrNPIs by subtracting the combined effects of lrNPIs and epidemic dynamics from all NPIs. We use case growth in Sweden and South Korea, 2 countries that did not implement mandatory stay-at-home and business closures, as comparison countries for the other 8 countries (16 total comparisons).

Results: Implementing any NPIs was associated with significant reductions in case growth in 9 out of 10 study countries, including South Korea and Sweden that implemented only lrNPIs (Spain had a nonsignificant effect). After subtracting the epidemic and lrNPI effects, we find no clear, significant beneficial effect of mrNPIs on case growth in any country. In France, for example, the effect of mrNPIs was +7% (95% CI: -5%-19%) when compared with Sweden and + 13% (-12%-38%) when compared with South Korea (positive means pro-contagion). The 95% confidence intervals excluded 30% declines in all 16 comparisons and 15% declines in 11/16 comparisons.

Conclusions: While small benefits cannot be excluded, we do not find significant benefits on case growth of more restrictive NPIs. Similar reductions in case growth may be achievable with less-restrictive interventions.

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Figures

FIGURE 1
FIGURE 1
Growth rate in cases for study countries. The black bars demonstrate the average growth rate in cases in each subnational unit (95% CI) prior to any policies implemented. The figures to the right show the daily growth rate in cases for each of the countries and demonstrate the shared decline in case growth across all countries, including the countries that did not implement mrNPIs (South Korea and Sweden)
FIGURE 2
FIGURE 2
Effects of individual NPIs in all study countries. The variation in the timing and location of NPI implementation allows us to identify the effects of individual NPIs on the daily growth rate of cases. Where multiple NPIs were implemented simultaneously (in the same day) across all subnational units (eg school closure, work from home and no private gatherings in Spain), their overall effect cannot be identified individually and is shown combined
FIGURE 3
FIGURE 3
Combined effects of all NPIs in study countries. The point estimate and 95% CI of the combined effect of NPIs on growth rate in cases, estimated from a combination of individual NPIs. The estimates show significant effects in all countries except Spain and range from a 33% (9%‐57%) decline in South Korea to 10% (6%‐13%) in England. The point estimate of the effect in Spain is also negative but small (2%) and not significant
FIGURE 4
FIGURE 4
Effect of mrNPIs on daily growth rates after accounting for the effects of lrNPIs in South Korea and Sweden. Under no comparison is there evidence of reduction in case growth rates from mrNPIs, in any country. The point estimates are positive (point in the direction of mrNPIs resulting in increased daily growth in cases) in 12 out of 16 comparisons
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References

    1. Bassett BA. Strict lower bound on the COVID‐19 fatality rate in overwhelmed healthcare systems. medRxiv. Published online April 27, 2020:2020.04.22.20076026. doi:10.1101/2020.04.22.20076026.
    1. Virus‐linked hunger tied to 10 000 child deaths each month. AP NEWS. Published July 27, 2020. https://apnews.com/5cbee9693c52728a3808f4e7b4965cbd. Accessed August 26, 2020.
    1. Issue brief: Reports of increases in opioid related overdose and other concerns during the COVID pandemic. https://www.ama‐assn.org/system/files/2020‐08/issue‐brief‐increases‐in‐opioid‐related‐ov.... Accessed August 26, 2020.
    1. Guha‐Sapir D, Moitinho de Almeida M, Keita M, Greenough G, Bendavid E. COVID‐19 policies: remember measles. Science. 2020;369(6501):261. 10.1126/science.abc8637 - DOI - PubMed
    1. O’Leary ST, Trefren L, Roth H, Moss A, Severson R, Kempe A. Number of childhood and adolescent vaccinations administered before and after the COVID‐19 outbreak in Colorado. JAMA Pediatr. Published online December 7, 2020. doi:10.1001/jamapediatrics.2020.4733. - PMC - PubMed