Evaluating the impact of stay-at-home orders on the time to reach the peak burden of Covid-19 cases and deaths: does timing matter?

  1. Alexandra Medline
  2. Lamar Hayes
  3. Katia Valdez
  4. Ami Hayashi
  5. Farnoosh Vahedi
  6. Will Capell
  7. Jake Sonnenberg
  8. Zoe Glick
  9. Jeffrey D. Klausner

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Abstract

Background

The economic, psychological, and social impact of pandemics and social distancing measures prompt the urgent need to determine the efficacy of non-pharmaceutical interventions (NPIs), especially those considered most stringent such as stay-at-home and self-isolation mandates. This study focuses specifically on the impact of stay-at-home orders, both nationally and internationally, on the control of COVID-19.

Methods

We conducted an observational analysis from April to May 2020 and included both countries and US states with known stay-at-home orders. Our primary exposure was the time between the date of the first reported case of COVID-19 to an implemented stay-at-home mandate for each region. Our primary outcomes were the time from the first reported case to the highest number of daily cases and daily deaths. We conducted linear regression analyses, controlling for the case rate of the outbreak in each respective region.

Results

For countries and US states, a longer period of time between the first reported case and stay-at-home mandates was associated with a longer time to reach both the peak daily case and death counts. The largest effect was among regions classified as the latest 10% to implement a mandate, which in the US, predicted an extra 35.3 days (95% CI: 18.2, 52.5) to the peak number of cases, and 38.3 days (95% CI: 23.6, 53.0) to the peak number of deaths.

Conclusions

Our study supports the association between the timing of stay-at-home orders and the time to peak case and death counts for both countries and US states. Regions in which mandates were implemented late experienced a prolonged duration to reaching both peak daily case and death counts.

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  1. Version published to 10.1186/s12889-020-09817-9
  2. ScreenIT

    SciScore for 10.1101/2020.05.30.20117853: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Google was used as our primary search engine.
    Google
    suggested: (Google, RRID:SCR_017097)
    We used SPSS version 26 for our analysis with a significance level of .05.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    The main limitation of this study was its observational nature and the exclusion of other NPIs, possibly confounding, that were implemented in the various regions we analyzed. However, we assume that by virtue of including many different regions and by repeating our analysis in several different ways, we can assume that the overall preventative effect of these NPIs were evenly spread out across these regions.22 Furthermore, another limitation of our study is that we did not account for the fidelity of and adherence to the implemented mandates which may have therefore biased our results. However, the directionality of this bias is unknown. Finally, the differences between regions as well as changes in testing capacity within each respective region may have also largely impacted the results of this study, as alluded to in other epidemiological observational studies that have recently investigated this topic.6,18 Overall, our study supports the potential effect of earlier stay-at-home mandates in the control of the spread of COVID-19. While this effect was modest generally, regions that significantly delayed implementation of their stay-at-home mandates experienced a pronounced and prolonged delay in reaching both peak daily case and death counts of COVID-19.

    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.

    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.

  3. Version published to 10.1101/2020.05.30.20117853v2 on medRxiv
  4. Version published to 10.1101/2020.05.30.20117853v1 on medRxiv