JAMA study on US State COVID Restrictions and Excess Deaths:

Jul 28, 2024, 9:09 AM

Very interesting study about the difference in excess deaths during the pandemic and restrictions that were implemented by the states, from the most stringent to the least stringent. It appears that vaccine and mask mandates were very helpful in limiting excess deaths. Things like school closures were not. This will be useful in planning for future pandemics, I think. And we know there will be pandemics again.

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2821581?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072624

Findings This cross-sectional analysis including all 50 US states plus the District of Columbia found that if all states had imposed COVID-19 restrictions similar to those used in the 10 most (least) restrictive states, excess deaths would have been an estimated 10% to 21% lower (13%-17% higher) than the 1.18 million that actually occurred during the 2-year period analyzed. Behavior changes were associated with 49% to 79% of this overall difference.

Meaning These findings indicate that collectively, stringent COVID-19 restrictions were associated with substantial decreases in excess deaths during the pandemic.

Exposures Age and cause of death.

Main Outcomes Excess deaths, age-standardized excess death rates per 100 000, and excess death ratios.

Results Mask requirements and vaccine mandates were negatively associated with excess deaths, prohibitions on vaccine or mask mandates were positively associated with death rates, and activity limitations were mostly not associated with death rates. If all states had imposed restrictions similar to those used in the 10 most restrictive states, excess deaths would have been an estimated 10% to 21% lower than the 1.18 million that actually occurred during the 2-year analysis period; conversely, the estimates suggest counterfactual increases of 13% to 17% if all states had restrictions similar to those in the 10 least-restrictive states. The estimated strong vs weak state restriction difference was 271 000 to 447 000 deaths, with behavior changes associated with 49% to 79% of the overall disparity.

Conclusions and Relevance This cross-sectional study indicates that stringent COVID-19 restrictions, as a group, were associated with substantial decreases in pandemic mortality, with behavior changes plausibly serving as an important explanatory mechanism. These findings do not support the views that COVID-19 restrictions were ineffective. However, not all restrictions were equally effective; some, such as school closings, likely provided minimal benefit while imposing substantial cost.

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