Original Article

Nonpharmaceutical Interventions in Georgia: Public Health Implications

Authors: Renee C. White, PhD, MPH, Ruiyan Luo, PhD, Richard Rothenberg, MD, MPH

Abstract

Objectives: As coronavirus disease 2019 (COVID-19) spread, many states implemented nonpharmaceutical interventions in the absence of effective therapies with varying degrees of success. Our aim was to evaluate restrictions comparing two regions of Georgia and their impact on outcomes as measured by confirmed illness and deaths.

Methods: Using The New York Times COVID-19 incidence data and mandate information from various web sites, we examined trends in cases and deaths using joinpoint analysis at the region and county level before and after the implementation of a mandate.

Results: We found that rates of cases and deaths showed the greatest decrease in acceleration after the simultaneous implementation of a statewide shelter-in-place for vulnerable populations combined with social distancing for businesses and limiting gatherings to <10 people. County-level shelters-in-place, business closures, limits on gatherings to <10, and mask mandates showed significant case rate decreases after a county implemented them. School closures had no consistent effect on either outcome.

Conclusions: Our findings indicate that protecting vulnerable populations, implementing social distancing, and mandating masks may be effective countermeasures to containment while mitigating the economic and psychosocial effects of strict shelters-in-place and business closures. In addition, states should consider allowing local municipalities the flexibility to enact nonpharmaceutical interventions that are more or less restrictive than the state-level mandates under some conditions in which the data indicate it is necessary to protect communities from disease or undue economic burden.
Posted in: Infectious Disease143

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References

1. Fuller J, Hakim A, Victory K, et al. Mitigation policies and COVID-19– associated mortality—37 European countries, January 23–June 30, 2020. MMWR Morb Mortal Wkly Rep 2021;70:58–62.
 
2. Arndt C, Davies R, Gabriel S, et al. Covid-19 lockdowns, income distribution, and food security: an analysis for South Africa. Global Food Security 2020;26:100410.
 
3. Jacobsen GD, Jacobsen KH. Statewide COVID-19 stay-at-home orders and population mobility in the United States. World Med Health Policy 2020; 12:347–356.
 
4. Haffajee RL, Mello MM. Thinking globally, acting locally—the U.S. response to Covid-19. N Engl J Med 2020;382:e75.
 
5. Governor Brian P. Kemp Office of the Governor. 2020 executive orders. https://gov.georgia.gov/executive-action/executive-orders/2020-executive-orders. Accessed October 12, 2020.
 
6. DIY Maps. Free color-coded maps of Georgia. http://diymaps.net/ga.htm. Published 2021. Accessed January 18, 2021.
 
7. The New York Times. Coronavirus (Covid-19) data in the United States. https://github.com/nytimes/covid-19-data. Accessed October 12, 2020.
 
8. US Census Bureau. QuickFacts. https://www.census.gov/quickfacts/fact/table/US/PST045222. Accessed October 12, 2020.
 
9. Opportunity Insights. Opportunity Insights economic tracker. https:// tracktherecovery.org. Accessed March 11, 2021.
 
10. Chetty R, Friedman JN, Hendren N, et al. The economic impacts of COVID19: evidence from a new public database built from private sector data. https://opportunityinsights.org/wp-content/uploads/2020/05/tracker_paper.pdf. Published October 2022. Accessed March 11, 2021.
 
11. Quesada J, López-Pineda A, Gil-Guillén V, et al. Período de incubación de la COVID-19: revisión sistemática y metaanálisis. Rev Clín Esp 2021;221: 109–117.
 
12. Bui LV, Nguyen HT, Levine H, et al. Estimation of the incubation period of COVID-19 in Vietnam. PLOS One 2020;15:e0243889.
 
13. Jiang X, Rayner S, Luo MH. Does SARS-CoV-2 have a longer incubation period than SARS and MERS? J Med Virol 2020;92:476–478.
 
14. Lauer SA, Grantz KH, Bi Q, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 2020;172:577–582.
 
15. Quest Diagnostics. Quest Diagnostics media statement about COVID-19 testing. https://newsroom.questdiagnostics.com/COVIDTestingUpdates. Published 2021. Accessed January 18, 2021.
 
16. LabCorp. COVID-19 news & media. https://www.labcorp.com/newsroom/covid/all. Published 2021. Accessed January 18, 2021.
 
17. Marschner IC. Estimating age-specific COVID-19 fatality risk and time to death by comparing population diagnosis and death patterns: Australian data. BMC Med Res Methodol 2021;21:126.
 
18. Dreher N, Spiera Z, McAuley FM, et al. Policy interventions, social distancing, and SARS-CoV-2 transmission in the United States: a retrospective state-level analysis. Am J Med Sci 2021;361:575–584. .
 
19. Liu X, Xu X, Li G, et al. Differential impact of non-pharmaceutical public health interventions on COVID-19 epidemics in the United States. BMC Public Health 2021;21:965.
 
20. Matzinger P, Skinner J. Strong impact of closing schools, closing bars and wearing masks during the Covid-19 pandemic: results from a simple and revealing analysis. MedRxiv, doi: 10.1101/2020.09.26.20202457.
 
21. Auger KA, Shah SS, Richardson T, et al. Association between statewide school closure and COVID-19 incidence and mortality in the U.S. JAMA 2020;324:859–870.
 
22. Krishnamachari B, Morris A, Zastrow D, et al. The role of mask mandates, stay at home orders and school closure in curbing the COVID-19 pandemic prior to vaccination. Am J Infect Control 2021;49:1036–1042.
 
23. Singh S, Shaikh M, Hauck K, et al. Impacts of introducing and lifting non-pharmaceutical interventions on COVID-19 daily growth rate and compliance in the United States. Proc Natl Acad Sci USA 2021;118: e2021359118.
 
24. Courtemanche C, Garuccio J, Le A, et al. Strong social distancing measures in the United States reduced the COVID-19 growth rate. Health Affairs (Project Hope) 2020;39:1237–1246.
 
25. Castex G, Dechter E, Lorca M. COVID-19: the impact of social distancing policies, cross-country analysis. Econ Disasters Clim Chang 2021;5:135–159.
 
26. Yilmazkuday H. Nonlinear effects of mobility on COVID-19: implications for targeted lockdowns. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3756548. Updated March 21, 2022. Accessed February 6, 2021.
 
27. Vahabi N, Salehi M, Duarte JD, et al. County-level longitudinal clustering of COVID-19 mortality to incidence ratio in the United States. Sci Rep 2021;11:3088.
 
28. Adepoju OE, Ojinnaka CO. County-level determinants of COVID-19 testing and cases: are there racial/ethnic disparities in Texas? Popul Health Manag 2021;24:589–594.
 
29. Keskinocak P, Oruc BE, Baxter A, et al. The impact of social distancing on COVID19 spread: state of Georgia case study. PLOS One 2020;15: e0239798.
 
30. Lyu W, Wehby GL. Community use of face masks and COVID-19: evidence from a natural experiment of state mandates in the U.S. Health Affairs (Project Hope) 2020;39:1419–1425.
 
31. Rader B, White LF, Burns MR, et al. Mask wearing and control of SARSCoV-2 transmission in the United States. MedRxiv, doi: 10.1101/2020.08. 23.20078964.
 
32. Noland RB. Mobility and the effective reproduction rate of COVID-19. J Transp Health 2021;20:101016.
 
33. Karaca-Mandic P, Sen S, Georgiou A, et al. Association of COVID-19- related hospital use and overall COVID-19 mortality in the USA. J Gen Intern Med, doi: 10.1007/s11606-020-06084-7.
 
34. French G, Hulse M, Nguyen D, et al. Impact of hospital strain on excess deaths during the COVID-19 pandemic—United States, July 2020–July 2021. MMWR Morb Mortal Wkly Rep 2021;70:1613–1616.
 
35. Moore JX, Langston ME, George V, et al. Epidemiology of the 2020 pandemic of COVID-19 in the state of Georgia: inadequate critical care resources and impact after 7 weeks of community spread. J Am Coll Emerg Phys Open. 2020;1:527–532.
 
36. Tobías A. Evaluation of the lockdowns for the SARS-CoV-2 epidemic in Italy and Spain after one month follow up. Sci Total Environ 2020;725: 138539.
 
37. Siqueira CAD, Freitas YNL, Cancela MD, et al. The effect of lockdown on the outcomes of COVID-19 in Spain: an ecological study. PLoS One 2020; 15:e0236779.
 
38. Lyu W, Wehby GL. Shelter-in-place orders reduced COVID-19 mortality and reduced the rate of growth in hospitalizations. Health Affairs (Project Hope) 2020;39:1615–1623.
 
39. Ghosal S, Bhattacharyya R, Majumder M. Impact of complete lockdown on total infection and death rates: a hierarchical cluster analysis. Diabetes Metab Syndrome 2020;14:707–711.
 
40. Basellini U, Alburez-Gutierrez D, Del Fava E, et al. Linking excess mortality to mobility data during the first wave of COVID-19 in England and Wales. SSM Popul Health 2021;14:100799.
 
41. Aparicio Fenoll A, Grossbard S. Later onset, fewer deaths from COVID. Pathog Glob Health 2021;115:1–3.
 
42. Chaudhry R, Dranitsaris G, Mubashir T, et al. A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes. EClinicalMedicine 2020;25:100464.
 
43. Bendavid E, Oh C, Bhattacharya J, et al. Assessing mandatory stay-at-home and business closure effects on the spread of COVID-19. Eur J Clin Invest 2021;51:e13484.
 
44. Castaneda MA, Saygili M. The effect of shelter-in-place orders on social distancing and the spread of the COVID-19 pandemic: a study of Texas. Front Public Health 2020;8:596607.
 
45. Duhon J, Bragazzi N, Kong JD. The impact of non-pharmaceutical interventions, demographic, social, and climatic factors on the initial growth rate of COVID-19: a cross-country study. Sci Total Environ 2021; 760:144325.
 
46. Hwang DT. Coronavirus lockdown and virus suppression: an international analysis. Technol Forecast Soc Change 2021;170:120861.
 
47. Liu Y, Morgenstern C, Kelly J, et al. The impact of non-pharmaceutical interventions on SARS-CoV-2 transmission across 130 countries and territories. BMC Med 2021;19:40. .
 
48. Wong MC, Huang J, Teoh J, et al. Evaluation on different non-pharmaceutical interventions during COVID-19 pandemic: an analysis of 139 countries. J Infect 2020;81:e70–e71.
 
49. Wieland T. A phenomenological approach to assessing the effectiveness of COVID-19 related non-pharmaceutical interventions in Germany. Saf Sci 2020;131:104924.