Content Analysis of Governmental Documents to Extract Types and Timing of Mitigation Strategies

Backgrounds and Purpose: Social distancing interventions play an essential role as a public health response to infectious-disease outbreak. After President Trump declared a National Emergency on March 13, 42 States and Washington DC enacted Stay-at-Home orders, which covered approximately 94.7% of the U.S. population. Closely related to the Stay-at-Home order are various nonpharmaceutical containment interventions aiming to promote social distancing. The key research question in this study is to understand all social distancing interventions, including but not limited to the Stay-at-Home orders that Governors in each state issued to reduce the spread of Covid-19.

Methods: Qualitative content analysis was used to analyze large quantities of text data from governmental documents. Classifying large amounts of text data by content categories is the key coding process for content analysis. Major categories coded were directly derived from the governmental text data. After systematically reviewing 1,470 executive orders issued by State Governors, two independent researchers coded 9 mitigation strategies. Categories were strictly defined. When the coders disagreed, they achieved consensus through discussion.

Findings: Nine social distancing interventions were categorized as follows.

1) Stay-at-home orders: We coded the time (date and hour) of orders issued by governors to urge or require residents to stay at home except for essential activities.

2) Strengthened stay-at-home measures: We coded the time (date and hour) that more restricted social distancing strategies, including adding enforcement of stay-at-home order and grocery shopping limits, were issued.

3) Public school closure: We coded the time (date and hour) that governors formally closed all public K-12 schools

4) All school closure: We coded the time (date and hour) that governors formally announced the closure of all public and private K-12 schools

5) Restaurant/bar limits: We coded the time (date and hour) of the first formal order that required the closure of on-premises food and drink consumption and only allowed delivery, drive-through and carry-out options.

6) Large gathering ban of more than 10 people: This coding captured the date and hour that states first announced a prohibition of public gatherings with greater than 10 participants.

7) Large gathering ban of any size: This coding captured the date and hour that states officially prohibited public gatherings of any size. 19 states were included in this coding.

8) Non-essential business closure: We coded the date and hour that governors formally ordered closed all non-essential business. We excluded those states that only issued non-essential retail business closure orders

9) Mandatory self-quarantine: We coded the date and hour on which the governors announced mandatory self-quarantine of 14 days for all travelers from any other states. We excluded those states which limited travelers from certain areas only.

Conclusion and Implications: Considering variation across states in the frequency of use of alternative social distancing strategies and prior literature on social distancing, through content analysis we extracted information on 9 types of the mitigation interventions. Further research is needed to explore the determinants and impacts of interventions that this study identified.