Abstract
Iowa is 1 of 5 states in the US that have not issued a stay-at-home order during the coronavirus disease 2019 (COVID-19) pandemic. There is no empirical evidence on whether issuing a stay-at-home order in Iowa could have been associated with a reduced rate of COVID-19 infections in the state. To compare COVID-19 cases in border counties in Iowa, which did not issue a stay-at-home order, with cases in border counties in Illinois, which did issue a stay-at-home order. This cross-sectional study with a difference-in-differences design compared daily changes in COVID-19 cases per 10 000 residents in 8 Iowa counties bordering Illinois with those in the 7 Illinois counties bordering Iowa before and after Illinois issued a stay-at-home order on March 21, 2020. Additional sensitivity analyses were conducted to account for differences in timing of closing schools and nonessential businesses between the 2 states and differential trends in COVID-19 cases by county population density and poverty rates. Issuing a stay-at-home order. Comparison of cumulative cases of COVID-19 per 10 000 residents in border counties in Iowa and Illinois. The total populations were 462 445 in the Iowa border counties and 272 385 in the Illinois border counties. Population density was higher in the Iowa counties (114.2 people per square mile) than in the Illinois counties (78.2 people per square mile). Trends of cumulative COVID-19 cases per 10 000 residents for the Iowa and Illinois border counties were comparable before the Illinois stay-at-home order, which went into effect at 5:00 pm on March 21 (March 15 to March 21: 0.024 per 10 000 residents vs 0.026 per 10 000 residents). After that, cases increased more quickly in Iowa and more slowly in Illinois. Within 10, 20, and 30 days after the enactment of the stay-at-home order in Illinois, the difference in cases was -0.51 per 10 000 residents (SE, 0.09; 95% CI, -0.69 to -0.32; P < .001), -1.15 per 10 000 residents (SE, 0.49; 95% CI, -2.12 to -0.18; P = .02), and -4.71 per 10 000 residents (SE, 1.99; 95% CI, -8.64 to -0.78; P = .02), respectively. The estimates indicate excess cases in the border Iowa counties by as many as 217 cases after 1 month without a stay-at-home order. This estimate of excess cases represents 30.4% of the 716 total cases in those Iowa counties by that date. Sensitivity analyses addressing differences in timing of closing schools and nonessential businesses and differences in county population density and poverty rates between the 2 states supported these findings. This cross-sectional study with a difference-in-differences design found an increase in estimated rates of COVID-19 cases per 10 000 residents in the border counties in Iowa compared with the border counties in Illinois following a stay-at-home order that was implemented in Illinois but not in Iowa.
Highlights
Iowa is 1 of 5 states that have not issued stay-at-home orders for the coronavirus disease 2019 (COVID-19) pandemic
Trends of cumulative COVID-19 cases per 10 000 residents for the Iowa and Illinois border counties were comparable before the Illinois stayat-home order, which went into effect at 5:00 PM on March 21 (March 15 to March 21: 0.024 per 10 000 residents vs 0.026 per 10 000 residents)
From March 15 to March 21, the average daily cases per 10 000 residents was 0.024 in the Iowa counties and 0.026 in the Illinois counties
Summary
Iowa is 1 of 5 states that have not issued stay-at-home orders for the coronavirus disease 2019 (COVID-19) pandemic. The state has issued a series of orders, including banning large gatherings and closing bars and restaurant dining on March 17, 2020; closing some nonessential businesses (eg, dental offices, clothing stores, barbershops, massage therapy, medical spas) on March 26, 2020; closing all primary and secondary schools (recommended on March 15, 2020) on April 2, 2020; and closing additional businesses (eg, malls, nongrocery stores, museums, libraries, social clubs) on April 6, 2020.1. Illinois, which borders Iowa, issued a stay-at-home order effective on the evening of March 21, 2020.4 The order closed all nonessential businesses in that state. Using a cross-sectional study with difference-in-differences design, we compared the cases of COVID-19 in border counties in Iowa and Illinois
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