Non-pharmaceutical interventions and covid-19 burden in the United States: retrospective, observational cohort study
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Abstract
To evaluate the adoption and discontinuation of four broadly used non-pharmaceutical interventions on shifts in the covid-19 burden among US states.
Design
Retrospective, observational cohort study.
Setting
US state data on covid-19 between 19 January 2020 and 7 March 2021.
Participants
US population with a diagnosis of covid-19.
Main outcome measures
Empirically derived breakpoints in case and mortality velocities (ie, rate of change) were used to identify periods of stable, decreasing, or increasing covid-19 burden. Associations between adoption of non-pharmaceutical interventions and subsequent decreases in case or death rates were estimated by use of generalised linear models accounting for weekly variability across US states. State level case and mortality counts per day were obtained from the Covid-19 Tracking Project. State level policies on non-pharmaceutical interventions included stay-at-home orders, indoor public gathering bans (mild >10 or severe ≤10 people), indoor restaurant dining bans, and public mask mandates. National policies were not included in statistical models.
Results
28 602 830 cases and 511 899 deaths were recorded during the study. Odds of a reduction in covid-19 case velocity increased for stay-at-home orders (odds ratio 2.02, 95% confidence interval 1.63 to 2.52), indoor dining bans (1.62, 1.25 to 2.10), public mask mandates (2.18, 1.47 to 3.23), and severe indoor public gathering bans (1.68, 1.31 to 2.16) in univariate analysis. In mutually adjusted models, odds remained elevated for orders to stay at home (adjusted odds ratio 1.47, 95% confidence interval 1.04 to 2.07) and public mask mandates (2.27, 1.51 to 3.41). Stay-at-home orders (odds ratio 2.00, 95% confidence interval 1.53 to 2.62; adjusted odds ratio 1.89, 95% confidence interval 1.25 to 2.87) was also associated with a greater likelihood of decrease in death velocity in unadjusted and adjusted models.
Conclusions
State level non-pharmaceutical interventions used in the US during the covid-19 pandemic, in particular stay-at-home orders, were associated with a decreased covid-19 burden.
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SciScore for 10.1101/2021.09.26.21264142: (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:Given sample size limitations, limited variation in some policy adoption, and temporal variation in the progression of COVID-19 to death, we are limited in our ability to attribute deviations in daily death counts to specific policy actions. An additional consideration is that NPIs associated with decreasing case velocities but not …
SciScore for 10.1101/2021.09.26.21264142: (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:Given sample size limitations, limited variation in some policy adoption, and temporal variation in the progression of COVID-19 to death, we are limited in our ability to attribute deviations in daily death counts to specific policy actions. An additional consideration is that NPIs associated with decreasing case velocities but not associated with decreasing subsequent deaths may signal that case decreases occurred disproportionally among younger individuals with less risk for COVID-19 mortality. This may be particularly true for public mask mandates, which were significantly associated with decreased case but not mortality burden in adjusted models. Our modeling approach allowed us to evaluate the merits of various NPIs concomitantly in a time-dependent fashion. Prior NPI studies have generally focused on pandemic influenza and relied on expert opinion or modeling rather than real-world data.7,9,15,30,31 In fact, the most recent Pandemic Influenza Plan by the U.S. Department of Health and Human Services described study of NPIs in the status of a data collection phase.15 Some retrospective data regarding NPIs and viral pandemics has been published. An analysis of U.S. cities found an association between increased duration of NPIs and total mortality reduction.30 Auger et al13 found school closures were associated with decreased COVID-19 incidence and mortality but adjustment for other NPIs was not included. Bendavid et al32 reported, in an international comparison of 10 count...
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.
Results from scite Reference Check: We found no unreliable references.
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