Abstract
ObjectiveCountries have adopted different approaches, at different times, to reduce the transmission of coronavirus disease 2019 (COVID‐19). 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.Data SourcesSecondary data on COVID‐19 deaths from 13 European countries, over March–May 2020.Study DesignWe 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 FindingsVoluntarily 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.ConclusionsNPIs 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.
Highlights
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 “shelterin-place” orders
We conduct a statistical analysis of the potential impact of NPIs, either government-imposed policies or voluntary behavior changes, on COVID-19 deaths over March–May 2020 among 13 Western European countries
Summary
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]. 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 colleagues[21] 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.
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