Statewide Interventions and Coronavirus Disease 2019 Mortality in the United States: An Observational Study. (8th July 2020)

• Record Type: Journal Article
• Authors: Yehya, Nadir; Venkataramani, Atheendar; Harhay, Michael O
• Is Part Of: Clinical infectious diseases. Volume 73:Number 7(2021)
• Page Start: e1863
• Page End: e1869
• Publication Date: 2020-07-08
• Subjects: pandemic -- SARS-CoV-2 -- coronavirus -- social distancing -- nonpharmaceutical interventions; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa923
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Social distancing is encouraged to mitigate viral spreading during outbreaks. However, the association between distancing and patient-centered outcomes in coronavirus disease 2019 (COVID-19) has not been demonstrated. In the United States, social distancing orders are implemented at the state level with variable timing of onset. Emergency declarations and school closures were 2 early statewide interventions. Methods: To determine whether later distancing interventions were associated with higher mortality, we performed a state-level analysis in 55 146 COVID-19 nonsurvivors. We tested the association between timing of emergency declarations and school closures with 28-day mortality using multivariable negative binomial regression. Day 1 for each state was set to when they recorded ≥ 10 deaths. We performed sensitivity analyses to test model assumptions. Results: At time of analysis, 37 of 50 states had ≥ 10 deaths and 28 follow-up days. Both later emergency declaration (adjusted mortality rate ratio [aMRR] 1.05 per day delay; 95% confidence interval [CI], 1.00–1.09; P = .040) and later school closure (aMRR 1.05; 95% CI, 1.01–1.09; P = .008) were associated with more deaths. When assessing all 50 states and setting day 1 to the day a state recorded its first death, delays in declaring an emergency (aMRR 1.05; 95% CI, 1.01–1.09; P = .020) or closing schools (aMRR 1.06; 95% CI, 1.03–1.09; P < .001) were associated with more deaths. Results were unchanged when excluding New York and New Jersey. Conclusions: Later statewide emergency declarations and school closure were associated with higher Covid-19 mortality. Each day of delay increased mortality risk 5 to 6%. Abstract : Later declarations of emergency and later school closure orders by a state were associated with higher state-level COVID-19 mortality in the United States, with each day of delay of either intervention increasing mortality risk by 5% to 6%.