大流行第一年,社交距离和封锁协议对美国COVID-19死亡率的影响

Valerie Hardoon, Bryant A. Pierce, Solomon C. Mbanefo, Harin N. Shah, Kanav Markan, Marika L. Forsythe
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引用次数: 0

摘要

SARS-CoV-2是导致COVID-19大流行的冠状病毒毒株,可导致严重的呼吸道疾病和死亡。在世界范围内,政府官员试图通过强制实施各种封锁和社会距离政策来保护公民,以遏制疫情的传播。在美国,每个州最初都实施了过渡或“分阶段”政策,其中包括不同程度的安全协议。这使它们能够逐步重新开放,目标是降低传播率,同时允许更高程度的公共集会和活动。最初的封锁有助于抑制疫情,而各州在疾病预防控制中心的指导下,就如何最好地重新开放经济,可以按照自己的议程行事。在大流行的早期阶段,这一战略被视为最佳策略。我们的研究旨在确定各州的死亡率和相变之间是否存在相关性。方法本研究选择的状态允许在整个阶段对不同的管理风格进行评估。美国各地的COVID-19病例率各不相同;一些州的感染率高于其他州。因此,本研究选择了六个州,每个州都来自不同的病例量和安全协议遵守情况:佛罗里达州,加利福尼亚州,纽约州,华盛顿州,堪萨斯州和德克萨斯州。从各自的政府网站上获得了COVID-19感染的发病率和死亡率等指标,允许使用贝叶斯逻辑混合模型计算和比较死亡率。当单独分析数据和作为荟萃分析的一部分时,有显著的结果。当检查按各州分组的各个阶段的死亡率时,除德克萨斯州外,每个过渡阶段都有下降趋势。发现纽约的中位数死亡率最低(中位数[IQR];其次是华盛顿州(0.014[0.011,0.020])、堪萨斯州(0.014[0.009,0.021])、德克萨斯州(0.018[0.013,0.028])、加利福尼亚州(0.021[0.011,0.037])和佛罗里达州(0.022[0.011,0.034])。然而,当汇总各州的数据时,显示出总体下降趋势,第0阶段的中位死亡率为0.039[0.019,0.067],到第4阶段降至0.010[0.007,0.013]。当综合所有状态时,观察到每个阶段死亡率降低约33.4%。根据我们的研究结果,随着各州在大流行的第一年重新开放,实施的安全协议和过渡期被证明有助于控制COVID-19的传播。美国各地死亡率的差异可能可以用每个州对隔离要求和社会距离政策的严格程度来解释。这使得某些州比其他州更有效地控制了传染病的传播,从而使它们能够以不同的速度在恢复正常的过程中经历相变。未来的研究是必要的,并且可以纳入更多的状态,以获得更健壮的样本量。进一步考虑混杂变量,如患者合并症和2020年底引入的COVID-19疫苗,也将使我们能够深入了解美国各地的死亡率是如何受到影响的
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effects of Social Distancing and Lockdown Protocols on Fatality Rates of COVID-19 in the U.S. During the First Year of the Pandemic
Background SARS-CoV-2, the coronavirus strain responsible for the COVID-19 pandemic, can lead to severe respiratory disease and death. Worldwide, government officials tried to protect its citizens by mandating various lockdowns and social distancing policies to curb the spread. In the United States, each state initially implemented a transition or “phasing” policy that included varying degrees of safety protocols. This allowed them to re-open gradually, the goal being to reduce transmission rates while simultaneously allowing for higher degrees of public gatherings and events. The initial lockdown was observed to help suppress the pandemic, and the states–with guidance from the CDC–were left to their own agenda on how to best re-open their economy. This strategy was seen as optimal during the early stages of the pandemic. Our study aimed to determine if there was a correlation between fatality rates and phase transitions across the states. Methods The states selected for this study allowed for evaluation of different management styles throughout the phase transitions. COVID-19 case rates varied across the U.S.; some states observed higher infection rates than others. Thus, six states, each from regions with different caseloads and safety protocol compliance, were selected for this study: Florida, California, New York, Washington, Kansas, and Texas. Metrics such as incidence and mortality rate of COVID-19 infection were obtained from their respective government websites, allowing fatality rates to be calculated and compared using Bayesian logistic mixed models. Results There are significant outcomes when analyzing the data individually and as part of a meta-analysis. When examining the fatality rates across phases grouped by individual state, there was a downward trend with each transition except in Texas. New York was found to have the lowest median fatality rate (median [IQR]; 0.011 [0.007, 0.017]), followed by Washington (0.014 [0.011, 0.020]), Kansas (0.014 [0.009, 0.021], Texas (0.018 [0.013, 0.028]), California (0.021 [0.011, 0.037]), and Florida (0.022 [0.011, 0.034]). However, when the states’ data was pooled an overall downward trend was demonstrated, with a median fatality rate of 0.039 [0.019, 0.067] in phase 0, dropping to 0.010 [0.007, 0.013] by phase 4. A decrease in fatality rate odds by about 33.4% through each phase transition was observed when combining all the states. Conclusion Based on our results, implemented safety protocols and phase transitions were shown to assist in controlling the spread of COVID-19 as the states re-opened during the first year of the pandemic. Differences in fatality rates throughout the U.S. can likely be explained by how disciplined each state was with quarantine requirements and social distancing policies. This allowed certain states to control the infectious spread more efficiently than others, thus allowing them to progress through the phase transitions at different rates as they returned to normal. Future studies are warranted and can incorporate additional states for a more robust sample size. Further accounting for confounding variables, such as patient comorbidities and the introduction of COVID-19 vaccines at the end of 2020, would also allow insight into how fatality rates have been affected across the U.S.
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