Effects of Varying Approaches to Lifting COVID-19 Pandemic Restrictions in the United States

  1. Jessica E. Galarraga
  2. Daniel Popovsky
  3. Kevin Delijani
  4. Hannah Hanson
  5. Mark Hanlon

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Abstract

Background

Policy approaches to lifting COVID-19 restrictions have varied significantly across the United States. An evaluation of the effects of state reopening policies on population health outcomes can inform ongoing and future pandemic responses. This study evaluates the approaches to lifting social distancing restrictions based on adherence to the Centers for Disease Control and Prevention (CDC) guidance established during the first wave of the COVID-19 pandemic.

Methods

We performed a retrospective study using difference-in-differences analyses to examine the effects of reopening policies on COVID-19 outcomes with risk-adjustment for population density, temporal changes, and concurrent mask policy implementation. We examined the effects of reopening policies on per capita case rates and rates of severe COVID-19 outcomes, including hospitalizations and deaths.

Results

Adherence to the CDC’s reopening gating metrics and phased social distancing guidelines resulted in fewer COVID-19 cases, hospitalizations, and deaths. Phase one adherent states exhibited a 50-fold reduction in daily new cases and a 3-fold reduction in daily new deaths after reopening. Phase two adherent states experienced improvements in COVID-19 outcomes after reopening, while non-adherent states had a resurgence of worsening outcomes after lifting restrictions.

Conclusions

Our study findings indicate that adherence to the CDC’s reopening guidance after implementing social distancing restrictions during the COVID-19 pandemic substantially prevents new cases, hospitalizations, and deaths. Following a stepwise reopening strategy and ensuring a sustained decline in case rates and test positivity rates before lifting restrictions can mitigate on a large scale the negative effects of a pandemic on population health outcomes.

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  1. ScreenIT

    SciScore for 10.1101/2022.01.04.22268766: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This study was approved by the Institutional Review Board as non-human subjects research.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    SPSS version 27
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    (IBM Corporation, Armonk, NY) was used for database construction activities and SAS version 9.4 (SAS Institute, Inc.
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    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:
    There are several limitations to this study. First, although we focused on a period of the pandemic with the least within state heterogeneity in policy responses, there was still county-level variation within some U.S. states in reopening policies during the study period which may lead to heterogeneity within the comparison groups. This limitation, however, would underestimate rather than overestimate the effects of adherence and lessen our ability to detect significant differences between the study groups. Despite this limitation, our study findings detected substantial disparities in outcomes by adherence category on the state level. Another study limitation is that the adherent group included some states that were stricter than the CDC guidance in the phased framework for social distancing and therefore the documented effects may be partly driven by restrictions stricter than the tested CDC guidelines. Further, the study period is limited to the first wave of the pandemic in the U.S. and the magnitude of the effects of reopening strategies on epidemiological trends with the presence of vaccination and differences in the transmissibility of COVID-19 may vary.

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.01.04.22268766v1 on medRxiv