Comparing the impact onCOVID‐19 mortality of self‐imposed 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 (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 Sources Secondary data on COVID‐19 deaths from 13 European countries, over March–May 2020. 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.

Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity

“…The finding of a 50% decline in surgical care during April of 2020 is likely owing to a combination of state-mandated cancellations of elective inpatient surgical procedures, more widespread stay-at-home social distancing orders, and self-imposed behavioral population-level mobility changes. 20 Additionally, we found signs of a shift from inpatient to outpatient procedures during the pandemic, which warrants further research.…”

Effects of strict containment policies on COVID-19 pandemic crisis: lessons to cope with next pandemic impacts

“…For instance, a high level of international trade in countries can explain the accelerated transmission dynamics and negative impact of the COVID-19 pandemic because trade generates a high socioeconomic interaction between people and, as a consequence, circulation of viral agents (Bontempi, 2022 ; Bontempi and Coccia 2021 ; Bontempi et al 2021 ). In this context, Jamison et al ( 2021 ) maintain that in Europe, non-pharmaceutical interventions based on incentives produce positive effects to cope with pandemic impact compared to compulsory rules and/or orders that have a smaller benefit–cost ratio (cf., Coccia 2019a ).…”

“…Barro ( 2020 ) also analyzes non-pharmaceutical interventions and mortality in US cities during the pandemic of 1918–1919 period and shows that the estimated effect on total deaths is small. Many studies show that hard restriction policies, such as full lockdowns of longer period, do not significantly reduce the number of confirmed cases and deaths related to COVID-19 (Allen 2022 ; Homburg 2020 ; Jamison et al 2021 ; Wieland 2020 ). Zhu and Tan ( 2022 ) assess the effectiveness of Hong Kong’s strict border restrictions with mainland China in curbing the transmission of COVID-19 pandemic.…”

Outbreak control management: Lessons from SARS‐CoV‐2 infections in 2020–2022 in Hong Kong, an international municipality with high‐frequency travelers

“…It might be hard to achieve the goal of “Zero‐COVID” ( https://en.wikipedia.org/wiki/Zero‐COVID Accessed: May 7, 2022), but the reemergence of COVID‐19 or emerging of novel infectious diseases are of top concerns to prevent trauma happening again in Hong Kong. 29 …”