Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA.
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Clin Infect Dis. 2021 Oct 5;73(7):e1863-e1869. doi: 10.1093/cid/ciaa923.
Social distancing is encouraged to mitigate viral spreading during outbreaks. However, the association between distancing and patient-centered outcomes in coronavirus disease 2019 (COVID-19) has not been demonstrated. In the United States, social distancing orders are implemented at the state level with variable timing of onset. Emergency declarations and school closures were 2 early statewide interventions.
To determine whether later distancing interventions were associated with higher mortality, we performed a state-level analysis in 55 146 COVID-19 nonsurvivors. We tested the association between timing of emergency declarations and school closures with 28-day mortality using multivariable negative binomial regression. Day 1 for each state was set to when they recorded ≥ 10 deaths. We performed sensitivity analyses to test model assumptions.
At time of analysis, 37 of 50 states had ≥ 10 deaths and 28 follow-up days. Both later emergency declaration (adjusted mortality rate ratio [aMRR] 1.05 per day delay; 95% confidence interval [CI], 1.00-1.09; P = .040) and later school closure (aMRR 1.05; 95% CI, 1.01-1.09; P = .008) were associated with more deaths. When assessing all 50 states and setting day 1 to the day a state recorded its first death, delays in declaring an emergency (aMRR 1.05; 95% CI, 1.01-1.09; P = .020) or closing schools (aMRR 1.06; 95% CI, 1.03-1.09; P < .001) were associated with more deaths. Results were unchanged when excluding New York and New Jersey.
Later statewide emergency declarations and school closure were associated with higher Covid-19 mortality. Each day of delay increased mortality risk 5 to 6%.
为了减轻病毒在爆发期间的传播，鼓励保持社交距离。然而，在 2019 年冠状病毒病（COVID-19）中，距离与以患者为中心的结果之间的关系尚未得到证实。在美国，各州实施社会隔离令，其开始时间也各不相同。紧急声明和学校关闭是最早的两项全州范围的干预措施。
为了确定较晚的隔离干预措施是否与更高的死亡率有关，我们在 55146 例 COVID-19 非幸存者中进行了州一级的分析。我们使用多变量负二项式回归检验了紧急声明和学校关闭的时间与 28 天死亡率之间的关联。每个州的第 1 天设定为记录≥10 例死亡的日期。我们进行了敏感性分析以检验模型假设。
在分析时，50 个州中有 37 个州的死亡人数≥10 人，且有 28 天的随访时间。紧急声明较晚（调整后的死亡率比 [aMRR] 每天延迟 1.05；95%置信区间 [CI]，1.00-1.09；P=0.040）和学校关闭较晚（aMRR 1.05；95%CI，1.01-1.09；P=0.008）均与更多死亡有关。当评估所有 50 个州，并将第 1 天设置为各州记录首例死亡的日期时，紧急情况宣布的延迟（aMRR 1.05；95%CI，1.01-1.09；P=0.020）或学校关闭（aMRR 1.06；95%CI，1.03-1.09；P<0.001）与更多死亡有关。排除纽约州和新泽西州后，结果仍然不变。
较晚的全州范围的紧急声明和学校关闭与 COVID-19 死亡率较高有关。每延迟一天，死亡风险就会增加 5%至 6%。
