Author ORCID Identifier

0000-0002-4806-3698

Date of Award

Fall 1-7-2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Richard Rothenberg

Second Advisor

Ruiyan Luo

Third Advisor

Heather Bradley

Abstract

Background:

In November 2019, an illness later known as Coronavirus Disease 2019 (COVID-19) surfaced in Wuhan, China. As COVID-19 began to spread rapidly, many countries implemented a strict shelter-in-place to "flatten the curve" and build capacity to treat in the absence of effective preventative therapies or treatments. Lockdowns typically consisted of restricting gatherings, closing schools and workplaces, cancelling public events, and issuing stay-at-home orders. Lockdowns are among the more controversial non-pharmaceutical interventions (NPIs) due to the risks of quarantining entire populations and shutting down commerce. Policymakers and public health officials must ultimately balance the positive health effects of lockdowns with economic, social, and psychological costs.

Methods:

This dissertation consisted of three interrelated studies concentrating on evaluating the NPIs employed during the 2020 COVID-19 pandemic response. The first study examined our understanding of the effectiveness of government mandated NPIs through a systematic review of analytical studies from the beginning of the pandemic to May 2021. Using Boolean search terms, we searched MedLine, Web of Science, and LitCOVID and found 82 full text articles meeting the inclusion criteria. We then reviewed each article for the NPIs evaluated, types of study designs and analytical methods, and findings.

The second study examined the public health impacts of the state and county level government restrictions in 2020 for two regions of Georgia, the Metro Atlanta area, and the Coastal District. Taking incidence data from the COVID-19 data repository assembled by the New York Times and mandate information from various state and county websites, we performed joinpoint analysis examining the trends in cases and deaths at the region and county level before and after a mandate’s implementation and relaxation.

The third study examined the economic implications of those same state and county restrictions in the Metro and Coastal regions during 2020. Taking unemployment rate data from the Bureau of Labor Statistics and initial unemployment claims rate data from the Opportunity Insights Economic Tracker with the same mandate information from study 2, we performed joinpoint analysis examining the trends in employment at the region and county level before and after a mandate’s implementation and relaxation.

Results:

Of the 82 studies included in the systematic review, conclusions were mixed. Findings from most studies indicated that shelters-in-place (SIPs) and workplace closures tended to have the more significant associations with decreased COVID incidence. A smaller proportion (13%) found inconclusive or nonsignificant results from these more restrictive measures. Restrictions of gatherings had mixed findings, but school closures and mask mandates were typically found to be effective in reducing COVID cases where they were implemented.

The second study evaluating the public health impacts of NPIs in Georgia found that the mandates with the largest individual negative impact on cases and deaths in both regions for all counties were the simultaneous implementation of a statewide SIP for the vulnerable combined with social distancing for businesses and limiting gatherings toSIPs, business closures, gathering restrictions to

The third study evaluating the economic impacts of NPIs in Georgia found that the mandates with the largest impact on accelerating unemployment claims rate in both regions for all counties were the full SIP mandates and closure of non-essential businesses at the state and county levels. These mandates had an effect at the level they were first implemented, i.e., if the county implemented an SIP and afterwards the state did as well, the state-wide SIP had no additional measurable effect on claims rates. School closures had a consistent impact on increasing the acceleration of unemployment claims rates, but to a lesser degree than the SIP orders or business closures. Restricting gatherings to eithereffect, implementing social distancing for businesses did not.

Conclusions:

Our findings indicate that less restrictive measures may be effective at reducing COVID incidence, even more effective than some of their more restrictive counterparts. Additionally, the most restrictive measures consistently had the largest negative economic impacts, while less restrictive measures like limiting gatherings and implementing social distancing in businesses had much lesser impacts. Protecting the vulnerable, implementing social distancing requirements, and mandating masks can be effective countermeasures to containment while mitigating the economic impacts of strict shelters-in-place and business closures.

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