Mobility and Mortality During the COVID-19 Pandemic
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J Gen Intern Med DOI: 10.1007/s11606-020-05943-7 © Society of General Internal Medicine 2020
INTRODUCTION
Social distancing and other behavioral interventions help limit the spread of infectious diseases.1 These measures include school closures, cancellations of large gatherings, and travel restrictions.1 We assessed the effectiveness of social distancing during the coronavirus (COVID-19) pandemic by examining the association between reductions in driving distances and mortality rates on an international basis.
METHODS
We identified the 45 countries with the highest numbers of COVID-19 cases globally, and excluded 9 countries because driving distance data were unavailable (e.g., China). We used an index date of the 100th COVID-19 case for each country to assess reductions in driving because this benchmark has been commonly used for pandemic growth. We calculated the mean change in driving from baseline for each country in the week following the index date using Apple Mobility Trends.2 For each nation, we also obtained the COVID-19 mortality rate as of April 30, 2020, using the Johns Hopkins University Coronavirus Resource Center.3 We used the Spearman rank correlation coefficient to test the association between the reduction in driving distance and the COVID-19 mortality rate in each country.
RESULTS
We observed significant variation in driving across the different countries. For example, Chile had a 64% decrease whereas
Received May 11, 2020 Accepted May 21, 2020
Spain had a 21% increase in driving distance. We also observed substantial variation in the COVID-19 mortality rate across different countries. Belgium had the highest mortality rate (656.7 per million) and India had the lowest (0.8 per million) at the follow-up time. As predicted (Fig. 1), we observed a significant association between decreased driving and lower COVID-19 mortality (r = 0.41, p < 0.001). In an analysis restricted to countries with a population over 30 million, we observed a similar association (r = 0.42, p = 0.01). In a further sensitivity analysis restricted to 19 of the nations in our primary analysis deemed by the World Health Organization to be in the top 30 with the best public health systems, we observed consistent findings (r = 0.38, p = 0.02).4 In addition, we also observed a similar association between decreased walking and lower COVID-19 mortality (r = 0.43, p < 0.001).
DISCUSSION
We found that countries exhibiting early and substantial decreases in driving during the pandemic experienced less COVID-19 mortality. This connection between mobility and mortality is unlikely to be causal and, instead, may be a marker for greater overall public health diligence and individual conscientiousness. One limitation to our analysis is that countries may offer fallible reporting on COVID mortality rates. In addition, many unmeasured interventions can reduce mortality during the pandemic including case surveillance, contact tracing, adequate personal protective equipment, and the regularity of hand hygiene.5, 6 Regardless of mechani
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