A little-noticed study says government orders to “shelter in place” during the COVID-19 fight did not save lives and spurred an uptick in excess deaths in some places, especially overseas.
Researchers from the RAND Corporation and the University of Southern California studied excess mortality from all causes, the virus or otherwise, in 43 countries and the 50 U.S. states that imposed shelter-in-place, or “SIP,” policies.
In short, the orders didn’t work.
“We fail to find that SIP policies saved lives. To the contrary, we find a positive association between SIP policies and excess deaths. We find that following the implementation of SIP policies, excess mortality increases,” the researchers said in a working paper for the National Bureau of Economic Research (NBER).
The increase was statistically significant in other countries in the weeks following the imposition of shelter-in-place orders. In the U.S., excess deaths rose in the weeks following the order before subsiding 20 weeks later under the orders.
The findings undercut blue states that relied on stay-at-home methods as the treatment of choice throughout the pandemic, while providing a measure of vindication for GOP leaders who said they were harmful and that constituents could protect themselves.
Former President Trump told Americans to stay home to slow the spread in March 2020 but criticized ongoing shutdowns as counterproductive overreach throughout 2020.
Researchers counted all excess deaths to avoid a messy debate over what constituted a COVID-19 death. They pointed to reported upticks in deaths of despair — including drug overdoses, homicides, and unintentional injuries in 2020 — and delays in diagnosing other health conditions as part of the reason the orders fell flat.
“There’s little evidence these policies saved lives and there is some evidence they led to an increase in deaths of despair,” Neeraj Sood, a study author and USC professor, told The Washington Times.
He said government moves often lagged behind choices that individuals made to mitigate their risk of catching COVID-19, blunting the anticipated impact of shelter-in-place orders.
“People respond to the pandemic on their own. They’re invested in their own self-interest and self-preservation,” he said.
Mr. Sood said he might have received criticism over the paper six months ago, but most of the reaction has been positive or constructive as the team accepts comments ahead of submission to a peer-reviewed journal.
“I really haven’t gotten any negative comments saying, like, ‘You guys are ruining public health’ or ‘Why did you write this paper?’” he said. “I haven’t gotten any of those, surprisingly.”
Researchers found the shelter-in-place orders had only a modest impact in restricting movement, although people in American neighborhoods with higher incomes tended to stay put more than lower income ones, and mobility was more restricted in Europe than in U.S. states.
Shelter-in-place orders did slash excess mortality in the island nations of Australia, Malta and New Zealand, and the state of Hawaii, which is also an island chain, the researchers found.
It is possible that islands saw a benefit because “they were able to keep out kind of the inflow of people into the population,” Mr. Sood said.
The paper also looked at the trajectory of deaths compared with the timing of the orders, and found they remained counterproductive.
If the orders were implemented when excess deaths were on the rise, “then the results from the event study would be biased towards finding that SIP policies lead to excess deaths,” the researchers wrote. “However, we find the opposite: countries that implemented SIP policies experienced a decline in excess mortality prior to implementation compared to countries that did not implement SIP policies.”
Researchers said it is difficult to game out how the virus would have spread in the absence of the orders. But they thought it was important to take a long-term look at stay-at-home orders that were imposed in spring 2020 to keep hospitals afloat. The lockdowns became a preferred method in many places during the up-and-down fight with the coronavirus until vaccines arrived last December.
“The implication is this is not a great policy for saving lives, and vaccinations are a greater investment,” Mr. Sood said.
The researchers said they looked real-world impact of shelter-in-place policies that occurred instead of what might have been the “ideal” policy, or if there had been better compliance with them.
Amesh Adalja, a health expert who wasn’t involved in the study, said it will take some time for the world to tease apart which policies were effective in mitigating the fallout from the pandemic.
“That being said, in general, public health tends to favor voluntary recommendations rather than official government force, such as stay-at-home orders for the uninfected. It may be the case that in certain situations the stay-at-home orders created a paradoxical increase in risk as people gathered at homes where indoor transmission took place,” said Dr. Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
Shutdowns exacted a massive economic toll and knocked children out of in-person learning for a year or even longer, prompting soul-searching around the method and a push to improve the development and approval of therapies or diagnostics that can detect future threats.
“No discussion of shelter in place orders is complete without realizing that the only reason that the governors thought they needed them was because of massive missteps at the federal level in January, February [and] in most of March of 2020, in which evasion, lack of preparation, botched testing and a litany of other mistakes put the country in a situation in which undetected chains of transmission were bubbling up and putting hospitals into crisis,” Dr. Adalja said.
The RAND and USC researchers said in light of their study, “continued reliance on SIP policies to slow COVID-19 transmission may not be optimal.”
Instead, the best policy response may be pharmaceutical interventions in the form of vaccinations and therapeutics when they become available, the researchers said.
“Early evidence suggests that initial vaccination efforts have led to large reductions in COVID-19 incidence,” they said. “Policy efforts to promote vaccination are thus likely to have large positive impacts.”
The Biden administration is emphasizing vaccination over shutdowns as it frets over the delta variant that is becoming dominant in the country. Los Angeles and other places are reimposing mask rules to protect people from the fast-moving delta variant but haven’t ordered sweeping shutdowns.