Mandatory public health measures to combat COVID-19 are more effective, says study

The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe, affecting over 112.53 million people worldwide. To mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, countries all over the world have implemented an array of public health measures.

These measures have included stay-at-home orders, isolation, quarantine, and travel restrictions and have taken different configurations from one country to another. In some countries, these measures are mandatory, while in others, people are given the freedom to voluntarily comply.

In a new study, researchers at Lundberg Health Advocates and the Johns Hopkins Bloomberg School of Public Health in the U.S. compared mandatory and voluntary implementations of shelter-in-place policies. They assessed their respective bearings on COVID-19 mortality, equity, and economic outcomes.

Overall, the researchers found that mandatory public health measures were more effective in reducing the number of cases and mortality tied to COVID-19.

Public health measures

When the coronavirus pandemic first emerged in Wuhan City, China, in December 2019, many countries imposed travel restrictions to prevent the spread of the virus. Despite these measures, many countries reported skyrocketing cases.

More than a year into the pandemic, the virus has reached 192 countries and regions across the world. Of these, many countries have millions of confirmed cases, including the United States, with over 28.33 million cases; India, with more than 11 million cases; Brazil, with about 10.32 million cases; and the United Kingdom, with about 4.15 million cases, among others.

In December, the U.K. reported a new variant that has been spreading in the country since late September 2020. Due to this, lockdown orders were imposed in January in an attempt to contain the virus.

Other countries implemented infection control measures like physical distancing, mask-wearing, and stay-at-home orders for high-risk populations.

The U.K. plans to gradually lift lockdown orders starting in March. Schools will open, and after-school sports and activities will be permitted. Recreational activities in public spaces will be allowed between two people. Further, from March 29 onwards, outdoor gatherings of either six people or two households will be slowed.

The study

In the study, published on the pre-print medRxiv* sever, the team aimed to see if mandatory public health orders are more effective in curtailing the spread of SARS-CoV-2.

To arrive at the study findings, the researchers analyzed mortality or fatality date from regions with similar demographics and comprehensive health data but with contrasting public health policies.

For instance, the team compared Colorado and Washington states, which implemented early mandatory shelter-in-place orders, and Massachusetts, which issued the order as a voluntary health advisory, in the United States.

In Europe, the team compared Norway’s and Sweden’s shelter-in-place orders, wherein the former was enforced as mandatory and the latter voluntary.

A comparative tabular format was used to study differences in mortality, equity, and economic impact between areas with mandatory versus voluntary policies.

The study results showed differences in the number of cases and death rates in the two groups. They revealed that higher population density in the U.S. is tied with decreased mortality. But, in Massachusetts, which is a population-dense state, there is a higher case burden and mortality than in Colorado or Washington. Massachusetts has a 4.7-fold higher population mortality rate than Washington and 3.7-fold higher than Colorado.

Economic impact varied between regions that practiced mandatory measures compared to those that had voluntary policies. For one, Sweden’s GDP dropped 8.6 percent in the second quarter, compared to Norway’s 7.4 percent. There were also higher losses in GDP in Massachusetts than in Colorado or Washington.

The researchers found that mandatory implementation of public health measures was tied to 3-to-4-fold lower population mortality in the United States model, and 11-fold lower in the European model. This suggests that compulsory orders amid the pandemic are more effective in stemming the viral spread.

We conclude that voluntary policies are less effective, based on historical precedent and the current analysis,” the researchers concluded in the study.

They added that the effects on health equity echoed the increased mortality outcomes of voluntary policies. Hence, they concluded that there was no economic benefit linked to voluntary measures.

Further, the team revealed that the mandatory enforcement of public health measures amid the coronavirus pandemic is a critical factor for the decreased mortality and weakened economic impact of the global health crisis.

When case numbers rise, mandatory measures should be reinstated in an equitable, thoughtful manner that promotes public engagement and supports livelihoods to limit the viral spread, prevent death, decrease inequities and preserve economic health,” the researchers explained.

Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Angela Betsaida B. Laguipo

Written by

Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.


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