LAUSR

To evaluate the effectiveness of nonpharmaceutical interventions in the metro and coastal regions of Georgia, the authors examined trends in coronavirus disease 2019 cases and deaths and their association with the implementation of various government restrictions. The joinpoint analyses showed greater reductions in case and death rates in more populated areas; county-level restrictions had greater associations with reducing both outcomes than statewide restrictions alone; and there were measurable effects in the trends of cases and deaths after the implementation of some of the less restrictive mandates. Ultimately, protecting vulnerable populations, implementing social distancing requirements, and mandating masks can be effective countermeasures for containment while mitigating the economic and psychosocial effects of stricter shelters-in-place and business closures. Abstract Objectives As coronavirus disease 2019 (COVID-19) spread, many states implemented nonpharmaceutical interventions in the absence of effective therapies with varying degrees of success. Our aim was to evaluate restrictions comparing two regions of Georgia and their impact on outcomes as measured by confirmed illness and deaths. Methods Using The New York Times COVID-19 incidence data and mandate information from various web sites, we examined trends in cases and deaths using joinpoint analysis at the region and county level before and after the implementation of a mandate. Results We found that rates of cases and deaths showed the greatest decrease in acceleration after the simultaneous implementation of a statewide shelter-in-place for vulnerable populations combined with social distancing for businesses and limiting gatherings to <10 people. County-level shelters-in-place, business closures, limits on gatherings to <10, and mask mandates showed significant case rate decreases after a county implemented them. School closures had no consistent effect on either outcome. Conclusions Our findings indicate that protecting vulnerable populations, implementing social distancing, and mandating masks may be effective countermeasures to containment while mitigating the economic and psychosocial effects of strict shelters-in-place and business closures. In addition, states should consider allowing local municipalities the flexibility to enact nonpharmaceutical interventions that are more or less restrictive than the state-level mandates under some conditions in which the data indicate it is necessary to protect communities from disease or undue economic burden.