Delayed Interventions, Low Compliance, and Health Disparities Amplified the Early Spread of COVID-19

  1. Aliea M. Jalali
  2. Sumaia G. Khoury
  3. JongWon See
  4. Alexis M. Gulsvig
  5. Brent M. Peterson
  6. Richard S. Gunasekera
  7. Gentian Buzi
  8. Jason Wilson
  9. Thushara Galbadage

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Abstract

The United States (US) public health interventions were rigorous and rapid, yet failed to arrest the spread of the Coronavirus Disease 2019 (COVID-19) pandemic as infections spread throughout the US. Many factors have contributed to the spread of COVID-19, and the success of public health interventions depends on the level of community adherence to preventative measures. Public health professionals must also understand regional demographic variation in health disparities and determinants to target interventions more effectively. In this study, a systematic evaluation of three significant interventions employed in the US, and their effectiveness in slowing the early spread of COVID-19 was conducted. Next, community-level compliance with a state-level stay at home orders was assessed to determine COVID-19 spread behavior. Finally, health disparities that may have contributed to the disproportionate acceleration of early COVID-19 spread between certain counties were characterized. The contribution of these factors for the disproportionate spread of the disease was analyzed using both univariate and multivariate statistical analyses. Results of this investigation show that delayed implementation of public health interventions, a low level of compliance with the stay at home orders, in conjunction with health disparities, significantly contributed to the early spread of the COVID-19 pandemic.

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  1. ScreenIT

    SciScore for 10.1101/2020.07.31.20165654: (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: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We have identified a few limitations with this study. For example, data from the 30 most populous counties were included in this investigation. These data, unfortunately, represent a small segment of the overall population in the US, and thus it would be inappropriate to extrapolate generalizations for all regions in the US. The regions and data utilized also served as a snapshot of the early spreading of COVID-19. The investigators of this study purposefully aimed to reduce the potential introduction of a time-based bias so that public health interventions could be compared uniformly across all counties. Our results have illustrated how early COVID-19 began to spread through populous counties. Second, the mobility data we used to determine compliance to stay at home orders were derived from time-series data. We averaged the daily percent changes to give categorical data for comparison purposes. In doing so, we may likely have overlooked daily changes that may have provided a greater level of insight. However, this is beyond the scope of this study and is a potential future direction of research. Two other factors may have impacted the case rates of some of these study counties. COVID-19 testing and screening were not uniformly administered across these counties that could lead to some bias in the number of reported cases. Besides travel within a county, there is travel across counties that can likely influence the spread of COVID-19. We did not take into account this variabl...

    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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  2. Version published to 10.1101/2020.07.31.20165654v1 on medRxiv