Societal disruptions and child mental health: evidence from ADHD diagnosis during the COVID-19 pandemic

We study how the societal disruptions of the COVID-19 pandemic impacted diagnosis of a prevalent childhood mental health condition, Attention Deficit Hyperactivity Disorder (ADHD). Using both nationwide private health insurance claims and a single state's comprehensive electronic health records, we compare children exposed to the pandemic to same aged children prior to the pandemic. We find the pandemic reduced new ADHD diagnoses by 8.6% among boys and 11.0% among girls nationwide through February 2021. We further show that higher levels of in-person schooling in Fall 2020 dampened the decline for girls but had no moderating effect for boys.

If you build it, will they vaccinate? The impact of COVID-19 vaccine sites on vaccination rates and outcomes

Safe and effective vaccines have vastly reduced the lethality of the COVID-19 pandemic worldwide, but disparities exist in vaccine take-up. Although the out-of-pocket price is set to zero in the U.S., time (information gathering, signing up, transportation and waiting) and misinformation costs still apply. To understand the extent to which geographic access impacts COVID-19 vaccination take-up rates and COVID-19 health outcomes, we leverage exogenous, pre-existing variation in locations of retail pharmacies participating the U.S. federal government's vaccine distribution program through which over 40% of US vaccine doses were administered. We use unique data on nearly all COVID-19 vaccine administrations in 2021. We find that the presence of a participating retail pharmacy vaccination site in a county leads to an approximately 26% increase in the per-capita number of doses administered, possibly indicating that proximity and familiarity play a substantial role in vaccine take-up decisions. Increases in county-level per capita participating retail pharmacies lead to an increase in COVID-19 vaccination rates and a decline in the number of new COVID-19 cases, hospitalizations, and deaths, with substantial heterogeneity based on county rurality, political leanings, income, and race composition. The relationship we estimate suggests that averting one COVID-19 case, hospitalization, and death requires approximately 25, 200, and 1,500 county-level vaccine total doses, respectively. These results imply a 9,500% to 22,500% economic return on the full costs of COVID-19 vaccination. Overall, our findings add to understanding vaccine take-up decisions for the design of COVID era and other public health interventions.

The great unequalizer: initial health effects of COVID-19 in the United States

We measure inequities from the COVID-19 pandemic on mortality and hospitalizations in the United States during the early months of the outbreak. We discuss challenges in measuring health outcomes and health inequality, some of which are specific to COVID-19 and others that complicate attribution during most large health shocks. As in past epidemics, pre-existing biological and social vulnerabilities profoundly influenced the distribution of disease. In addition to the elderly, Hispanic, Black and Native American communities were disproportionately affected by the virus, particularly when assessed using the years of potential life lost metric. For example, Hispanic and Black Americans in 2020 saw 39.5 and 25 percent increases in excess mortality relative to trend, compared to a less than 15 percent increase for Whites;we find losses in potential years of life three to four times larger among Hispanic and Black compared to White Americans. Individual-level data from a commercially insured population show that otherwise similar Black and Hispanic enrollees were hospitalized due to COVID-19 at a higher rate than White enrollees. We provide a conceptual framework and initial empirical analysis which seek to shed light on contributors to pandemic-related health inequality, and suggest areas for future research.

Mandated and voluntary social distancing during the COVID-19 epidemic: a review

For much of 2020, the COVID-19 epidemic upended social and economic life globally. In an effort to reduce COVID-19 risks in the U.S., state and local governments issued many recommendations and regulations to induce social distancing, adding to voluntary reductions in interpersonal contact. The responses to the epidemic helped contain spread, but also lead to high unintended societal costs. In the summer months, states took steps to revive the economy and lift social distancing regulations. However, as many epidemiologists expected, the scale of the epidemic has expanded very rapidly in the fall. In the week of October 14, the US generated around 57,000 new COVID-19 cases and 700 deaths each day. By November 15, the country was generating about 151,000 new cases and 1,200 deaths per day. These rapid increases in cases and deaths raise concerns about the capacity of local healthcare systems around the country. State governments are once again facing difficult choices about whether and how to use policies to address the spread of the virus. The incoming Biden-Harris administration faces an important challenge in trying to manage the epidemic as well as a large scale vaccination campaign. Although the epidemic is less than a year old, it has generated a huge volume of research by economists, epidemiologists, and others. This body of work may help inform policy decisions facing society in the coming months.

Paid sick-leave and physical mobility: evidence from the United States during a pandemic

We study the effects of a massive temporary U.S. paid sick leave (PSL) mandate that became effective April 1st, 2020 on self-quarantining, proxied by physical mobility behaviors gleaned from cellular devices. Such behaviors are critical for containment of infectious diseases. The national PSL policy was implemented in response to the COVID-19 global pandemic and mandated two weeks of fully compensated paid leave. We study the impact of this policy using difference-in-differences methods, leveraging pre-policy county-level differences in the share of 'nonessential' workers likely eligible for paid sick leave benefits. We find robust evidence that the policy increased the average number of hours at home and reduced the share of the individuals likely at work. Comparing the county with the lowest to highest policy exposure, we find that the average hours per day not at home, and at work decreased by 8.9% and 6.9% post- policy.

Tracking public and private responses to the COVID-19 epidemic: evidence from state and local government actions

This paper examines the determinants of social distancing during the COVID-19 epidemic. We classify state and local government actions, and we study multiple proxies for social distancing based on data from smart devices. Mobility fell substantially in all states, even ones that have not adopted major distancing mandates. There is little evidence, for example, that stay-at-home mandates induced distancing. In contrast, early and information-focused actions have had bigger effects. Event studies show that first case announcements, emergency declarations, and school closures reduced mobility by 1-5% after 5 days and 7-45% after 20 days. Between March 1 and April 11, average time spent at home grew from 9.1 hours to 13.9 hours. We find, for example, that without state emergency declarations, event study estimates imply that hours at home would have been 11.3 hours in April, suggesting that 55% of the growth comes from emergency declarations and 45% comes from secular (non-policy) trends. State and local government actions induced changes in mobility on top of a large response across all states to the prevailing knowledge of public health risks. Early state policies conveyed information about the epidemic, suggesting that even the policy response mainly operates through a voluntary channel.