State-level COVID-19 restrictions helped save lives

Stringent state-level COVID-19 restrictions were associated with substantial decreases in pandemic mortality, according to a study published online July 26 in JAMA Health Forum.

Christopher J. Ruhm, Ph.D., from the Frank Batten School of Leadership and Public Policy at the University of Virginia in Charlottesville, examined how state restrictions affected the number of excess COVID-19 pandemic deaths. The analysis included U.S. Centers for Disease Control and Prevention data for 2020 to 2022 compared to baseline data for 2017 to 2019.

Ruhm found that mask requirements and vaccine mandates were negatively associated with excess deaths, while prohibitions on vaccine or mask mandates were positively associated with death rates. Activity limitations were mostly not associated with death rates. If all states implemented restrictions like those used in the 10 most restrictive states, excess deaths would have been reduced by 10 to 21 percent from the 1.18 million that actually occurred during the two-year analysis period. Conversely, if all states had restrictions similar to those in the 10 least-restrictive states, increases of 13 to 17 percent would have occurred. For strong versus weak state restrictions, the difference was 271,000 to 447,000 deaths, with behavior changes associated with 49 to 79 percent of the overall disparity.

"These findings do not support the views that COVID-19 restrictions were ineffective. However, not all restrictions were equally effective," Ruhm writes.

The author reported consulting fees from opioid litigation outside the submitted work.

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