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Association of Stay-at-Home Orders With COVID-19 Hospitalizations in 4 States

Educational Objective
To understand the utility of COVID-19 hospitalizations to assess impact of Stay-at-Home orders
1 Credit CME

In analyses of the effectiveness of response measures to the outbreak of coronavirus disease 2019 (COVID-19), most studies have used the number of confirmed cases or deaths. However, case count is a conservative estimate of the actual number of infected individuals in the absence of community-wide serologic testing. Death count is a lagging metric and insufficient for proactive hospital capacity planning. A more valuable metric for assessing the effects of public health interventions on the health care infrastructure is hospitalizations.1 As of April 18, 2020, governors in 42 states had issued statewide executive “stay-at-home” orders to help mitigate the risk that COVID-19 hospitalizations would overwhelm their state’s health care infrastructure. This study assessed the association between these orders and hospitalization trends.

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Article Information

Corresponding Author: Pinar Karaca-Mandic, PhD, University of Minnesota Carlson School of Management, 321 19th Ave S, Minneapolis, MN 55455 (pkmandic@umn.edu).

Accepted for Publication: May 13, 2020.

Published Online: May 27, 2020. doi:10.1001/jama.2020.9176

Author Contributions: Drs Sen and Karaca-Mandic had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Obtained funding: Sen, Karaca-Mandic.

Administrative, technical, or material support: Georgiou.

Conflict of Interest Disclosures: Dr Karaca-Mandic reported receiving personal fees from Tactile Medical, Precision Health Economics, and Sempre Health and grants from the Agency for Healthcare Research and Quality, the American Cancer Society, the National Institute for Health Care Management, the National Institute on Drug Abuse, and the National Institutes of Health. Dr Georgiou reported receiving personal fees from HealthGrades. Dr Sen reported no disclosures.

Funding/Support: This research uses publicly available data from the University of Minnesota COVID-19 Hospitalization Project, which is partially funded by the University of Minnesota Office of Academic Clinical Affairs and United Health Foundation.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Yi Zhu, MA, University of Minnesota Carlson School of Management, contributed to this project by launching the University of Minnesota COVID-19 Hospitalization Project website. Mr Zhu received no compensation for his contributions.

Additional Information: A preliminary plot of Minnesota’s current hospitalization numbers (not cumulative hospitalizations) with data prior to April 15 was shared by the authors on Twitter and LinkedIn.

References
1.
Karaca-Mandic  P , Georgiou  A , Sen  S . Calling all states to report standardized information on COVID-19 hospitalizations. Health Affairs blog. April 7, 2020. Accessed April 17, 2020. https://www.healthaffairs.org/do/10.1377/hblog20200406.532030/full/?cookieSet=1
2.
University of Minnesota COVID-19 Hospitalization Tracking Project website. Accessed April 30, 2020. https://carlsonschool.umn.edu/mili-misrc-covid19-tracking-project
3.
Lauer  SA , Grantz  KH , Bi  Q ,  et al.  The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application.   Ann Intern Med. 2020;172(9):577-582. doi:10.7326/M20-0504PubMedGoogle ScholarCrossref
4.
Guan  WJ , Ni  ZY , Hu  Y ,  et al; China Medical Treatment Expert Group for Covid-19.  Clinical characteristics of coronavirus disease 2019 in China.   N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032PubMedGoogle ScholarCrossref
5.
Wang  D , Hu  B , Hu  C ,  et al.  Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China.   JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585PubMedGoogle ScholarCrossref
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