Coronavirus Disease 2019 (COVID-19) Transmission in the United States Before Versus After Relaxation of Statewide Social Distancing Measures
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Abstract
Background
Weeks after issuing social distancing orders to suppress severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and reduce growth in cases of severe coronavirus disease 2019 (COVID-19), all US states and the District of Columbia partially or fully relaxed these measures.
Methods
We identified all statewide social distancing measures that were implemented and/or relaxed in the United States between 10 March and 15 July 2020, triangulating data from state government and third-party sources. Using segmented linear regression, we estimated the extent to which relaxation of social distancing affected epidemic control, as indicated by the time-varying, state-specific effective reproduction number (Rt).
Results
In the 8 weeks prior to relaxation, mean Rt declined by 0.012 units per day (95% confidence interval [CI], −.013 to −.012), and 46/51 jurisdictions achieved Rt < 1.0 by the date of relaxation. After relaxation of social distancing, Rt reversed course and began increasing by 0.007 units per day (95% CI, .006–.007), reaching a mean Rt of 1.16. Eight weeks later, the mean Rt was 1.16 and only 9/51 jurisdictions were maintaining an Rt < 1.0. Parallel models showed similar reversals in the growth of COVID-19 cases and deaths. Indicators often used to motivate relaxation at the time of relaxation (eg, test positivity rate <5%) predicted greater postrelaxation epidemic growth.
Conclusions
We detected an immediate and significant reversal in SARS-CoV-2 epidemic suppression after relaxation of social distancing measures across the United States. Premature relaxation of social distancing measures undermined the country’s ability to control the disease burden associated with COVID-19.
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SciScore for 10.1101/2020.07.15.20154534: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The primary limitation of our analysis is the potential for confounding by phenomena that occur simultaneously with relaxation of social distancing measures and also influence the trajectories of Rt. For example, if a social movement supportive of a reopening agenda [37] advocates for relaxation of state measures and independently influences social distancing behaviors [12, 14], we could misclassify the effect seen to be due to the …
SciScore for 10.1101/2020.07.15.20154534: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The primary limitation of our analysis is the potential for confounding by phenomena that occur simultaneously with relaxation of social distancing measures and also influence the trajectories of Rt. For example, if a social movement supportive of a reopening agenda [37] advocates for relaxation of state measures and independently influences social distancing behaviors [12, 14], we could misclassify the effect seen to be due to the measure relaxation (in place of the social movement). However, we found similar effect sizes and time-specific reversal in Rt trends across most states, and irrespective of political and demographic characteristics. Moreover, because relaxation took place on across a wide range of dates, confounders who would have to occur independently across multiple states and similarly vary with relaxation of state measures. Notwithstanding this potential limitation, our findings suggest that suppression of SARS-CoV-2 after removal of statewide social distancing regulations has failed. Robust surveillance programs are needed so that, should the observed trends continue, state and local public health policy makers can continuously evaluate the stringency of social distancing measures required to prevent subsequent epidemic surges [15-20, 33, 34]. Considering the current projected timelines for vaccine development [38], and low levels of cumulative population infection even in countries that have experienced severe epidemics [39, 40], thoughtful public health lea...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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