Effects of Varying Approaches to Lifting COVID-19 Pandemic Restrictions in the United States
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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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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
Ethics IRB: This study was approved by the Institutional Review Board as non-human subjects research. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources SPSS version 27 SPSSsuggested: (SPSS, RRID:SCR_002865)(IBM Corporation, Armonk, NY) was used for database construction activities and SAS version 9.4 (SAS Institute, Inc. SAS Institutesuggested: (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 LimitationRecogni…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
Ethics IRB: This study was approved by the Institutional Review Board as non-human subjects research. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources SPSS version 27 SPSSsuggested: (SPSS, RRID:SCR_002865)(IBM Corporation, Armonk, NY) was used for database construction activities and SAS version 9.4 (SAS Institute, Inc. SAS Institutesuggested: (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.
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