The financial health of "swing hospitals" during the first COVID-19 outbreak.

The hospitals in Japan have hitherto had complete autonomy in deciding whether to admit COVID-19 patients. In fact, they were "swinging" between admitting or not COVID-19 patients, especially during the initial COVID-19 outbreak. To address endogenous decision making, we estimated the effect of admitting COVID-19 patients on hospital profits using instrumental variable (IV) regression. We derived the IVs from the guidelines of the national government on which hospital types should admit COVID-19 patients. Our empirical results revealed that the monthly profits per bed decreased by approximately JPY 600,000 ( ≈ USD 4615), which is 15 times the average monthly profit in 2019. This overwhelming financial damage indicates it is costly for some hospitals to treat COVID-19 patients because of their low suitability in admitting such patients. Based on the implications of our main results, we propose an alternative strategy to handling patient surges in case of new infectious disease outbreaks.

SARS-CoV-2 suppression and early closure of bars and restaurants: a longitudinal natural experiment.

Despite severe economic damage, full-service restaurants and bars have been closed in hopes of suppressing the spread of SARS-CoV-2 worldwide. This paper explores whether the early closure of restaurants and bars in February 2021 reduced symptoms of SARS-CoV-2 in Japan. Using a large-scale nationally representative longitudinal survey, we found that the early closure of restaurants and bars decreased the utilization rate among young persons (OR 0.688; CI95 0.515-0.918) and those who visited these places before the pandemic (OR 0.754; CI95 0.594-0.957). However, symptoms of SARS-CoV-2 did not decrease in these active and high-risk subpopulations. Among the more inactive and low-risk subpopulations, such as elderly persons, no discernible impacts are observed in both the utilization of restaurants and bars and the symptoms of SARS-CoV-2. These results suggest that the early closure of restaurants and bars without any other concurrent measures does not contribute to the suppression of SARS-CoV-2.

What the COVID-19 school closure left in its wake: Evidence from a regression discontinuity analysis in Japan.

To control the spread of COVID-19, the national government of Japan abruptly started the closure of elementary schools on March 2, 2020, but preschools were exempted from this nationwide school closure. Taking advantage of this natural experiment, we examined how the proactive closure of elementary schools affected various outcomes related to children and family well-being. To identify the causal effects of the school closure, we exploited the discontinuity in the probability of going to school at a certain threshold of age in months and conducted fuzzy regression discontinuity analyses. The data are from a large-scale online survey of mothers whose firstborn children were aged 4 to 10 years. The results revealed a large increase in children's weight and in mothers' anxiety over how to raise their children. On the outcomes related to marital relationships, such as the incidence of domestic violence and the quality of marriage, we did not find statistically significant changes. These findings together suggest that school closures could have large unintended detrimental effects on non-academic outcomes among children.