The interplay of policy, behavior, and socioeconomic conditions in early COVID-19 epidemiology in Georgia
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Abstract
To investigate the impact of local public health orders, behavior, and population factors on early epidemic dynamics, we investigated variation among counties in the U.S. state of Georgia. We conducted regressions to identify predictors of (1) local public health orders, (2) mobility as a proxy for behavior, and (3) epidemiological outcomes (i.e., cases and deaths). We used an event study to determine whether social distancing and shelter-in-place orders caused a change in mobility.
Counties at greater risk for large early outbreaks (i.e., larger populations and earlier first cases) were more likely to introduce local public health orders. Social distancing orders gradually reduced mobility by 19% ten days after their introduction, and lower mobility was associated with fewer cases and deaths. Air pollution and population size were predictors of cases and deaths, while larger elderly or Black population were predictors of lower mobility and greater cases, suggesting self-protective behavior in vulnerable populations. Early epidemiological outcomes reflected responses to policy orders and existing health and socioeconomic disparities related to disease vulnerability and ability to socially distance. Teasing apart the impact of behavior changes and population factors is difficult because the epidemic is embedded in a complex social system with multiple potential feedbacks.
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SciScore for 10.1101/2021.03.24.21254256: (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:However, testing limitations and lack of early knowledge about the virus may have contributed to substantial underreporting of cases, especially in rural counties lacking public health infrastructure. As statewide orders were lifted, county governments in Georgia and across the country became increasingly responsible for containing local outbreaks.38–40 Local governments will therefore need to understand the impact of these orders and …
SciScore for 10.1101/2021.03.24.21254256: (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:However, testing limitations and lack of early knowledge about the virus may have contributed to substantial underreporting of cases, especially in rural counties lacking public health infrastructure. As statewide orders were lifted, county governments in Georgia and across the country became increasingly responsible for containing local outbreaks.38–40 Local governments will therefore need to understand the impact of these orders and identify county-level features that may affect outbreak risk and nonpharmaceutical intervention implementation to respond to this ongoing pandemic and other emerging infectious diseases. Infectious disease outbreaks are intimately dependent on the societal settings in which they occur, and COVID-19 is no exception. Demographics, health, economic resources, and social power—and disparities in these factors—within communities affect both their vulnerability to and responses to disease outbreaks. Here, we showed that while social distancing orders did reduce mobility (Supplement: Table S2, Fig. 4), and reduced mobility in turn reduced COVID-19 cases in most counties (Supplement: Table S6, Fig. 6), the efficacy of these nonpharmaceutical interventions was mediated by the will of municipal and state governments to impose, and ability of community members to observe, public health orders. Specifically, counties with earlier epidemics, larger populations, and greater shares of Democratic voters were more likely to introduce social distancing or shelter...
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.
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- No protocol registration statement was detected.
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