Statewide Interventions and Coronavirus Disease 2019 Mortality in the United States: An Observational Study.
Clin Infect Dis
; 73(7): e1863-e1869, 2021 10 05.
Article
in English
| MEDLINE | ID: covidwho-1455250
ABSTRACT
BACKGROUND:
Social distancing is encouraged to mitigate viral spreading during outbreaks. However, the association between distancing and patient-centered outcomes in coronavirus disease 2019 (COVID-19) has not been demonstrated. In the United States, social distancing orders are implemented at the state level with variable timing of onset. Emergency declarations and school closures were 2 early statewide interventions.METHODS:
To determine whether later distancing interventions were associated with higher mortality, we performed a state-level analysis in 55 146 COVID-19 nonsurvivors. We tested the association between timing of emergency declarations and school closures with 28-day mortality using multivariable negative binomial regression. Day 1 for each state was set to when they recordedâ ≥â 10 deaths. We performed sensitivity analyses to test model assumptions.RESULTS:
At time of analysis, 37 of 50 states hadâ ≥â 10 deaths and 28 follow-up days. Both later emergency declaration (adjusted mortality rate ratio [aMRR] 1.05 per day delay; 95% confidence interval [CI], 1.00-1.09; Pâ =â .040) and later school closure (aMRR 1.05; 95% CI, 1.01-1.09; Pâ =â .008) were associated with more deaths. When assessing all 50 states and setting day 1 to the day a state recorded its first death, delays in declaring an emergency (aMRR 1.05; 95% CI, 1.01-1.09; Pâ =â .020) or closing schools (aMRR 1.06; 95% CI, 1.03-1.09; Pâ <â .001) were associated with more deaths. Results were unchanged when excluding New York and New Jersey.CONCLUSIONS:
Later statewide emergency declarations and school closure were associated with higher Covid-19 mortality. Each day of delay increased mortality risk 5 to 6%.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Humans
Country/Region as subject:
North America
Language:
English
Journal:
Clin Infect Dis
Journal subject:
Communicable Diseases
Year:
2021
Document Type:
Article
Affiliation country:
Cid
Similar
MEDLINE
...
LILACS
LIS