Session: Mitigation Interventions in the United States: An Exploratory Investigation of Determinants (Society for Social Work and Research 26th Annual Conference - Social Work Science for Racial, Social, and Political Justice)

Backgrounds: To fight the COVID-19 pandemic, most states and municipalities in the United States implemented various types of non-pharmaceutical mitigation interventions. An exploratory investigation made by this team on the determinants and impacts of these interventions in the first five weeks (i.e., from March 13 to April 7, 2020) obtained three findings: (1) some states may have missed optimal timing to implement social distancing; (2) of nine mitigation strategies, only three showed impacts; and (3) some vulnerable subpopulations exposed to mitigation interventions the longest time and may have suffered from the pandemic most severely (XXX, et al., 2020, citation omitted for anonymous review). This symposium presents findings of a follow-up study that extends the observational window to January 5, 2021. The ending date was purposefully chosen to isolate the impact of vaccination on COVID-19 counts. During this period, the U.S. experienced the highest COVID-19 case counts and a heavy toll of lives; many states enacted, lifted, and reenacted non-pharmaceutical mitigations due to the painful considerations of balancing the unaffordable economic burdens and the need to prevent a wide spread of the disease. This symposium aims to present findings on the determinants of implementing, lifting, and re-implementing the mitigation strategies during this crucial period. It aims to address two research questions: what are the key determinants of the timing of enacting, lifting, and reenacting mitigation interventions? Which strategies should be undertaken at which time points in order to maximize utility functions?

Objectives: The proposed symposium is organized around three objectives: (1) present the methods and results of a content analysis of 3,703 state governmental documents that identified 6 types of non-pharmaceutical mitigation interventions and the timing at which states enacted, lifted, and reenacted each of these strategies; (2) present findings of the determinant study that explores factors associated with the implementation of social distancing interventions; and (3) discuss the implications of this study.

Methods: Content analysis, Cox proportional hazards model, and recurrence survival model correcting for clustering effect were employed in the analysis.

Findings: Six non-pharmaceutical mitigation interventions were identified from all 50 states and Washington DC. Exact times of enactment, rescindment, reenactment, and re-lifting were documented and linked to five blocks of variables collected from the census data and published statistics. We found that states with high prevalence rates of COVID-19 reacted more slowly to the outbreak. We found that states with high proportions of African Americans and Hispanics, and high unemployment rates enacted interventions earlier but lifted later, hence, these populations suffered from the pandemic the longest time. We also found that states with high proportions voting for President Joe Biden adopted interventions earlier but lifted later.

Conclusions: An early removal of social distancing interventions in the absence of effective pharmaceutical interventions was risky. The delayed adoption of mitigations in some states helps explain why the pandemic in the U.S. lasted for a long period at a very high level. The vulnerable populations suffered most severely from the COVID-19 pandemic.