Most US residents initially obeyed COVID-19 lockdowns, mobile data show

Residents ventured out about 98% less in most counties in the 42 US states and territories that issued stay-at-home orders to contain SARS-CoV-2, the virus that causes COVID-19. But after the first state relaxed those orders, more people were active outside of their homes in states that had not eased those orders, according to a study published today in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR).

The study, conducted from Mar 1 to May 31, involved analysis of data from government websites and mobile devices. During the study period, 22 jurisdictions shifted from mandatory orders to advisories, 11 ended or allowed orders to expire, and 1 state's orders were overturned by its supreme court. The first state to end stay-at-home orders was Alaska, on Apr 24. Eight jurisdictions' mandatory orders applied to at least part of the population beyond May 31.

County-level differences in population movement varied by stay-at-home order date and urban or rural status. Stay-at-home orders resulted in less resident movement in 2,295 (97.6%) of the 2,351 counties that had data. Regardless of rural or urban county status, movement rose significantly immediately after orders were lifted or expired—even in states that still had lockdowns.

The authors said the findings show that lockdowns may reduce population movement and face-to-face contact in the community and that the implementation of public health policies in one state may also influence behaviors in other states. They added that it's important to recognize the individual and societal costs of stay-at-home orders.

"Although stay-at-home orders might assist in limiting potential exposure to SARS-CoV-2 and have had public support, such orders substantially disrupt daily life and have resulted in adverse economic impact," they wrote. "Further studies are needed to assess the timing and conditions under which stay-at-home orders might be best used to protect health, minimize negative impacts, and ensure equitable enforcement of community mitigation policies."
Sep 3 MMWR study

Indiana data: Non-whites, older people much more likely to die of COVID-19

The COVID-19 case-fatality rate (CFR) in community-dwelling Indiana residents was three times higher in non-whites and 2.5 times higher than that of flu in people 65 years and older, a study published yesterday in the Annals of Internal Medicine found.

Indiana University researchers analyzed coronavirus prevalence estimates of people 12 years and older from a random sample taken across their state and COVID-19 tests from Apr 25 to 29. Nursing home residents, which made up 54.9% of the state's deaths at that time, weren't counted because they would have been unable to leave their facilities for testing.

The overall CFR was 0.26%, falling to 0.01% in residents younger than 40 years but rising to 1.71% in those 60 and older. Whites' CFR was 0.18%, compared with 0.59% in non-whites.

The authors noted that death rates typically inflate the actual CFR because they are calculated on the basis of confirmed cases, which do not reflect true case numbers because so many COVID-19 infections generate no symptoms and thus go undetected.

"We found that the risk for death among infected persons increased with age," the researchers wrote. "Of note, the [CFR] for non-Whites is more than 3 times that for Whites, despite COVID-19 decedents in that group being 5.6 years younger on average."
Sep 2 Ann Intern Med research letter