comparing the impact on covid19 mortality of selfimposed behavior change and of government CORD-Papers-2022-06-02 (Version 1)

Title: Comparing the impact on COVID19 mortality of selfimposed behavior change and of government regulations across 13 countries
Abstract: OBJECTIVE: Countries have adopted different approaches at different times to reduce the transmission of coronavirus disease 2019 (COVID19). Crosscountry comparison could indicate the relative efficacy of these approaches. We assess various nonpharmaceutical interventions (NPIs) comparing the effects of voluntary behavior change and of changes enforced via official regulations by examining their impacts on subsequent death rates. DATA SOURCES: Secondary data on COVID19 deaths from 13 European countries over MarchMay 2020. STUDY DESIGN: We examine two types of NPI: the introduction of governmentenforced closure policies and selfimposed alteration of individual behaviors in the period prior to regulations. Our proxy for the latter is Google mobility data which captures voluntary behavior change when disease salience is sufficiently high. The primary outcome variable is the rate of change in COVID19 fatalities per day 1620 days after interventions take place. Linear multivariate regression analysis is used to evaluate impacts. Data collection/extraction methods: publicly available. PRINCIPAL FINDINGS: Voluntarily reduced mobility occurring prior to government policies decreases the percent change in deaths per day by 9.2 percentage points (pp) (95% confidence interval [CI] 4.514.0 pp). Government closure policies decrease the percent change in deaths per day by 14.0 pp (95% CI 10.817.2 pp). Disaggregating government policies the most beneficial for reducing fatality are intercity travel restrictions canceling public events requiring face masks in some situations and closing nonessential workplaces. Other subcomponents such as closing schools and imposing stayathome rules show smaller and statistically insignificant impacts. CONCLUSIONS: NPIs have substantially reduced fatalities arising from COVID19. Importantly the effect of voluntary behavior change is of the same order of magnitude as governmentmandated regulations. These findings including the substantial variation across dimensions of closure have implications for the optimal targeted mix of government policies as the pandemic waxes and wanes especially given the economic and human welfare consequences of strict regulations.
Published: 2021-06-28
Journal: Health Serv Res
DOI: 10.1111/1475-6773.13688
DOI_URL: http://doi.org/10.1111/1475-6773.13688
Author Name: Jamison Julian C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jamison_julian_c
Author Name: Bundy Donald
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bundy_donald
Author Name: Jamison Dean T
Author link: https://covid19-data.nist.gov/pid/rest/local/author/jamison_dean_t
Author Name: Spitz Jacob
Author link: https://covid19-data.nist.gov/pid/rest/local/author/spitz_jacob
Author Name: Verguet Stphane
Author link: https://covid19-data.nist.gov/pid/rest/local/author/verguet_stphane
sha: c5e6b1791c4e99121254e1c194abeced8fcc0f04
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 34182593
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/34182593
pmcid: PMC8441808
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441808
url: https://www.ncbi.nlm.nih.gov/pubmed/34182593/ https://doi.org/10.1111/1475-6773.13688
has_full_text: TRUE
Keywords Extracted from Text Content: COVID-19 NPIs coronavirus disease 2019 stay-at-home COVID-19 11 Tracker tÀ18 grocery globe mobility-independent [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] Brazil, shelter-in-place waxes people coronavirus easy-to-interpret COVID-19 level-may t. facial human NPIs Figure 1 stay-at-home
Extracted Text Content in Record: First 5000 Characters:Objective: Countries have adopted different approaches, at different times, to reduce the transmission of coronavirus disease 2019 . Cross-country comparison could indicate the relative efficacy of these approaches. We assess various nonpharmaceutical interventions (NPIs), comparing the effects of voluntary behavior change and of changes enforced via official regulations, by examining their impacts on subsequent death rates. Study Design: We examine two types of NPI: the introduction of government-enforced closure policies and self-imposed alteration of individual behaviors in the period prior to regulations. Our proxy for the latter is Google mobility data, which captures voluntary behavior change when disease salience is sufficiently high. The primary outcome variable is the rate of change in COVID-19 fatalities per day, 16-20 days after interventions take place. Linear multivariate regression analysis is used to evaluate impacts. Data collection/extraction methods: publicly available. Principal Findings: Voluntarily reduced mobility, occurring prior to government policies, decreases the percent change in deaths per day by 9.2 percentage points (pp) (95% confidence interval [CI] 4.5-14.0 pp). Government closure policies decrease the percent change in deaths per day by 14.0 pp (95% CI 10.8-17.2 pp). Disaggregating government policies, the most beneficial for reducing fatality, are intercity travel restrictions, canceling public events, requiring face masks in some situations, and closing nonessential workplaces. Other sub-components, such as closing schools and imposing stay-at-home rules, show smaller and statistically insignificant impacts. Conclusions: NPIs have substantially reduced fatalities arising from COVID-19. Importantly, the effect of voluntary behavior change is of the same order of magnitude as government-mandated regulations. These findings, including the substantial variation across dimensions of closure, have implications for the optimal targeted mix of government policies as the pandemic waxes and wanes, especially given the economic and human welfare consequences of strict regulations. What is known on this topic? • Along with epidemiological data, analysts have tracked and published accounts of the nature, timing, and magnitude of government-mandated nonpharmaceutical interventions (NPIs) for many countries. • A substantial literature provides initial evidence on which NPIs do and which do not constructively affect the course of the pandemic, for example, typically international travel restrictions appear to do so but stay-at-home orders do not as much. • Much less analysis has addressed the extent to which voluntary behavior change also has an important role to play in the response to the pandemic. What this study adds? • The pandemic in Europe led people to substantially reduce their own risky behavior, resulting in reduction of COVID-19 mortality by an amount close to that of mandated NPIs. • This suggests the value of government policies that enable or encourage voluntary NPIs (e.g., provision of free masks), as opposed to mandated NPIs (e.g., strict stay-at-home orders) which have a smaller benefit-cost ratio. being. This is much more than a global health crisis. 3 After the "first wave" of the epidemic receded in Western Europe, countries began to retrospectively examine their NPI policies, partly to assess when and how to reverse the school closure and movement restriction policies that have such substantial developmental and economic consequences, and partly to plan for subsequent epidemic waves. The challenge, however, is that the method used to originally select the NPIs may be less helpful for actual evaluation. In the absence of real data or prior experience, the evidence base supporting the rollout of such unprecedented NPIs relied on mathematical forecasting models 4-9 drawing on input parameters for epidemiologic quantities like severity and attack rate, risk factors, and timing of transmission, for which empirical validation remains nascent. 10 These assumptions may have been inadvertently misleading, hence needing careful reassessment before being used as the basis for future decisions. For instance, with respect to school closures, a review of evidence from before COVID-19 11 as well as preliminary findings from Australia, 12 France, 13, 14 and Ireland 15 suggest that school children-especially at primary level-may not be important drivers of coronavirus epidemics, in contrast to influenza, and school closure might play a substantially smaller role than the models had projected. The need now is to retrospectively assess the true impact of NPIs on COVID-related morbidity and mortality, in order to optimize their implementation (or lack thereof) going forward, using empirical evidence. In this respect, a number of studies have conducted retrospective analyses of the possible mitigating effects of NPIs on the COVID death toll at the country level or comparatively across c
Keywords Extracted from PMC Text: 5, 6, 7, 8, 9 Policyi,t−18 publication41 nascent.10 " t+k−4,where di,t COVID‐19 coronavirus Figure 1 reduced‐form shelter‐in‐place" mobility‐independent Flaxman lockdowns NPIs coronavirus disease 2019 t:(2)∆i easy‐to‐interpret imposed.30 ∆i A4 Model III t−18+β2Policyi t−18+γXi+θi+μ1t+μ2t2+ei Tracker t=100*∑k=15di days.31 Models I–III appendix shelter‐in‐place States,18 models4 ln2/ln1+∆ ̄^t=7 cross‐country globe globe.28 grocery States,25 colleagues21 period‐similar Ireland15 people children Xit long‐term self‐imposed Brazil,42 France,16 Sweden,17 53,528 al.21 face‐to‐face country‐average government‐imposed intensive‐care patients facial crisis.3 α+β1Behaviori t−18 lockdown t+k−4∑k=15di
Extracted PMC Text Content in Record: First 5000 Characters:Over the course of 1 year, the transmission of the coronavirus disease 2019 (COVID‐19) has spread to essentially every country on the planet: as of June 2021, COVID‐19 has infected hundreds of millions of individuals and killed more than 3.5 million.1 During the first months of the pandemic, in the absence of available effective biomedical interventions like vaccines and treatments and in anticipation of an unprecedented surge of patients in need of intensive care in hospitals, a large number of national responses focused on the implementation of drastic nonpharmaceutical interventions (NPIs), including the closing of schools and universities, the prohibition of most commercial business, and the legal enforcement of local lockdowns and "shelter‐in‐place" orders. As a result, in May/June 2020, an estimated 1.2 billion children who should have been attending schools were not doing so,2 with long‐term consequences for learning potential and the creation of national capital, and hundreds of millions of adults have had to cease their economic activities, with profound and immediate consequences for national economies and personal livelihoods and well‐being. This is much more than a global health crisis.3 After the "first wave" of the epidemic receded in Western Europe, countries began to retrospectively examine their NPI policies, partly to assess when and how to reverse the school closure and movement restriction policies that have such substantial developmental and economic consequences, and partly to plan for subsequent epidemic waves. The challenge, however, is that the method used to originally select the NPIs may be less helpful for actual evaluation. In the absence of real data or prior experience, the evidence base supporting the rollout of such unprecedented NPIs relied on mathematical forecasting models4, 5, 6, 7, 8, 9 drawing on input parameters for epidemiologic quantities like severity and attack rate, risk factors, and timing of transmission, for which empirical validation remains nascent.10 These assumptions may have been inadvertently misleading, hence needing careful reassessment before being used as the basis for future decisions. For instance, with respect to school closures, a review of evidence from before COVID‐1911 as well as preliminary findings from Australia,12 France,13, 14 and Ireland15 suggest that school children—especially at primary level—may not be important drivers of coronavirus epidemics, in contrast to influenza, and school closure might play a substantially smaller role than the models had projected. The need now is to retrospectively assess the true impact of NPIs on COVID‐related morbidity and mortality, in order to optimize their implementation (or lack thereof) going forward, using empirical evidence. In this respect, a number of studies have conducted retrospective analyses of the possible mitigating effects of NPIs on the COVID death toll at the country level or comparatively across countries.8, 9, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 In particular, using a combination of modeling approaches, Haug and colleagues21 estimated the effectiveness of NPIs on the effective reproduction number across 56 countries and 79 territories and pointed out that less disruptive NPIs might be as effective as more drastic NPIs like national lockdowns. Likewise, Brauner et al.20 examined 34 European and seven non‐European countries and inferred that closing all educational institutions (in particular, including secondary and higher education), limiting gatherings to 10 people or less, and closing face‐to‐face businesses, each reduced transmission considerably. In this paper, we use a time series of COVID‐related mortality data, over March–May 2020 during the first epidemic wave, from 13 comparable Western European countries to undertake a statistical examination of the timing of introduction of NPIs and their impact on daily COVID deaths. Crucially, we include not only the full spectrum of government‐mandated regulations but also proxy measures of voluntary behavior change before the introduction of the government policies. Here, "voluntary" simply means in the absence of government regulations or enforcement; the impetus may still arise from government or other institutional sources, in addition to peer effects (including social media) and purely self‐motivated change. This allows us to directly compare the potential effects of naturally salient social distancing and enhanced hygiene practices versus externally imposed and enforced regulations, with a view to contributing to the ongoing debate regarding restrictions on gatherings and movement; school and workplace closures; and other dimensions of government intervention in Europe and beyond. Daily figures for new confirmed COVID‐19 deaths by country were accessed through the European Centre for Disease Prevention and Control.27 We used data for the 13 Western European countries with greater than 500 COVID deaths as of 16 May (Tabl
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