Global Assessment of the Relationship between Government Response Measures and COVID-19 Deaths

Abstract Objective To provide an early global assessment of the impact of government stringency measures on the rate of growth in deaths from COVID-19. We hypothesized that the overall stringency of a government’s interventions and the speed of implementation would affect the growth and level of deaths related to COVID-19 in that country. Design Observational study based on an original database of global governmental responses to the COVID-19 pandemic. Daily data was collected on a range of containment and closure policies for 170 countries from January 1, 2020 until May 27, 2020 by a team of researchers at Oxford University, UK. These data were combined into an aggregate stringency index (SI) score for each country on each day (range: 0-100). Regression was used to show correlations between the speed and strength of government stringency and deaths related to COVID-19 with a number of controls for time and country-specific demographic, health system, and economic characteristics. Interventions Nine non-pharmaceutical interventions such as school and work closures, restrictions on international and domestic travel, public gathering bans, public information campaigns, as well as testing and contact tracing policies. Main outcomes measures The primary outcome was deaths related to COVID-19, measured both in terms of maximum daily deaths and growth rate of daily deaths. Results For each day of delay to reach an SI 40, the average daily growth rate in deaths was 0.087 percentage points higher (0.056 to 0.118, P<0.001). In turn, each additional point on the SI was associated with a 0.080 percentage point lower average daily growth rate (−0.121 to −0.039, P<.001). These daily differences in growth rates lead to large cumulative differences in total deaths. For example, a week delay in enacting policy measures to SI 40 would lead to 1.7 times as many deaths overall. Conclusions A lower degree of government stringency and slower response times were associated with more deaths from COVID-19. These findings highlight the importance of non-pharmaceutical responses to COVID-19 as more robust testing, treatment, and vaccination measures are developed.