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

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..

In 4 states with stay-at-home orders, cumulative hospitalizations for COVID-19 deviated from projected best-fit exponential growth rates after these orders became effective. The deviation started 2 to 4 days sooner than the median effective date of each state’s order and may reflect the use of a median incubation period for symptom onset and time to hospitalization to establish this date.

Other factors that potentially decreased the rate of virus spread and subsequent hospitalizations include school closures, social distancing guidelines, and general pandemic awareness. In addition, economic insecurity and loss of health insurance during the pandemic may have also decreased hospital utilization. Limitations of the study include that these other factors could not be modeled in the analysis and that data on only 4 states were available.