Social distancing to slow the US COVID-19 epidemic: Longitudinal pretest–posttest comparison group study


Autoři: Mark J. Siedner aff001;  Guy Harling aff003;  Zahra Reynolds aff001;  Rebecca F. Gilbert aff001;  Sebastien Haneuse aff008;  Atheendar S. Venkataramani aff009;  Alexander C. Tsai aff001
Působiště autorů: Massachusetts General Hospital, Boston, Massachusetts, United States of America aff001;  Harvard Medical School, Boston, Massachusetts, United States of America aff002;  Africa Health Research Institute, KwaZulu-Natal, South Africa aff003;  University College London, London, United Kingdom aff004;  MRC/Wits Agincourt Unit, Rural Public Health and Health Transitions Research Unit, University of the Witwatersrand, Johannesburg, South Africa aff005;  Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America aff006;  Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America aff007;  Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America aff008;  Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America aff009;  Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America aff010
Vyšlo v časopise: Social distancing to slow the US COVID-19 epidemic: Longitudinal pretest–posttest comparison group study. PLoS Med 17(8): e1003244. doi:10.1371/journal.pmed.1003244
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003244

Souhrn

Background

Social distancing measures to address the US coronavirus disease 2019 (COVID-19) epidemic may have notable health and social impacts.

Methods and findings

We conducted a longitudinal pretest–posttest comparison group study to estimate the change in COVID-19 case growth before versus after implementation of statewide social distancing measures in the US. The primary exposure was time before (14 days prior to, and through 3 days after) versus after (beginning 4 days after, to up to 21 days after) implementation of the first statewide social distancing measures. Statewide restrictions on internal movement were examined as a secondary exposure. The primary outcome was the COVID-19 case growth rate. The secondary outcome was the COVID-19-attributed mortality growth rate. All states initiated social distancing measures between March 10 and March 25, 2020. The mean daily COVID-19 case growth rate decreased beginning 4 days after implementation of the first statewide social distancing measures, by 0.9% per day (95% CI −1.4% to −0.4%; P < 0.001). We did not observe a statistically significant difference in the mean daily case growth rate before versus after implementation of statewide restrictions on internal movement (0.1% per day; 95% CI −0.04% to 0.3%; P = 0.14), but there is substantial difficulty in disentangling the unique associations with statewide restrictions on internal movement from the unique associations with the first social distancing measures. Beginning 7 days after social distancing, the COVID-19-attributed mortality growth rate decreased by 2.0% per day (95% CI −3.0% to −0.9%; P < 0.001). Our analysis is susceptible to potential bias resulting from the aggregate nature of the ecological data, potential confounding by contemporaneous changes (e.g., increases in testing), and potential underestimation of social distancing due to spillover effects from neighboring states.

Conclusions

Statewide social distancing measures were associated with a decrease in the COVID-19 case growth rate that was statistically significant. Statewide social distancing measures were also associated with a decrease in the COVID-19-attributed mortality growth rate beginning 7 days after implementation, although this decrease was no longer statistically significant by 10 days.

Klíčová slova:

COVID 19 – Death rates – SARS – Social epidemiology – Socioeconomic aspects of health – United States – Virus testing – Social distancing


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2020 Číslo 8

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