The Impact of Legislation on Covid-19 Mortality in a Brazilian Federative Unit was Mediated by Social Isolation

  1. Fredi A. Diaz-Quijano
  2. Tatiane Bomfim Ribeiro
  3. Aléxia Viana da Rosa
  4. Rossana Reis
  5. Fernando Aith
  6. Deisy F. L. Ventura

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Abstract

Background

This study aimed to estimate the effect of restrictive laws on actual social isolation and COVID-19 mortality. Moreover, we evaluated how community adherence, measured with an index of social isolation, would mediate the lockdown effect on COVID-19 mortality.

Methods

This ecological study assessed the legislations published until June 30, 2020, in the Brazilian state of Ceará. We performed a systematic review and classification of restrictive norms and estimated their immediate effect on social isolation, measured by an index based on mobile data, and the subsequent impact on COVID-19 mortality (three weeks later). A mediation analysis was performed to estimate the effect of rigid lockdown on mortality that was explained for effective social isolation.

Results

The social isolation index showed an increase of 11.9% (95% CI: 2.9% - 21%) during the days in which a rigid isolation norm (lockdown) was implemented. Moreover, this rigid lockdown was associated with a reduction of 26% (95% CI: 21% - 31%) in the three-week-delayed mortality. We also calculated that the rigid lockdown had the indirect effect, i.e., mediated by adherence to social isolation, of reducing COVID-19 mortality by 38.24% (95% CI: 21.64% to 56.07%). Therefore, the preventive effect of this norm was fully explained by the actual population adherence, reflected in the social isolation index. On the other hand, mandatory mask use was associated with 11% reduction in COVID-19 mortality (95% CI: 8% −13%).

Conclusions

We estimated the effect of quarantine regulations on social isolation and evidenced that a rigid lockdown law led to a reduction of COVID-19 mortality in one state of Brazil. In addition, the mandatory masks norm was an additional determinant of the reduction of this outcome.

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  1. ScreenIT

    SciScore for 10.1101/2021.06.16.21259057: (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

    Software and Algorithms
    SentencesResources
    STATA v.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    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:
    In spite of these limitations, this work makes a contribution to support preventive policies with epidemiological evidence. Furthermore, we highlight the usefulness of the social isolation index to monitor adherence to quarantine measures.

    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.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.06.16.21259057v1 on medRxiv